Naomi A. Fineberg, Dan J. Stein, Katharina Domschke, Eric Hollander, Susanne Walitza, Michael Van Ameringen, Bernardo Dell'Osso, Joseph Zohar
<p>The WPA Section on Anxiety and Obsessive-Compulsive Disorders focuses its activities on a broad range of common and burdensome psychiatric conditions encompassing anxiety and fear-related disorders, obsessive-compulsive and related disorders, and behavioural addiction disorders, including problematic Internet use. This is an exciting area of developing clinical practice, as anxiety and obsessive-compulsive symptoms are increasingly played out in the digital environment.</p> <p>The Section provides a forum for clinician scientists and academics to exchange experiences and research advances. It organizes activities at WPA meetings, produces scientific publications and develops guidance on relevant topics, in collaboration with key stakeholder groups such as the World Health Organization (WHO), the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) (www.icocs.org), the Anxiety Disorders and Obsessive-Compulsive Research Networks of the European College of Neuropsychopharmacology (ECNP) (www.ecnp.eu), and the European Network for Problematic Usage of the Internet (www.internetandme.eu). Here we review some of the Section's recent initiatives and its ambitions for the next five years.</p> <p>The ICD-11 has refined and expanded the classification of anxiety disorders, and created two new groupings, one for Obsessive-Compulsive and Related Disorders and another for Disorders due to Addictive Behaviours, including several new diagnoses.</p> <p>The ICD-11 grouping of Anxiety or Fear-Related Disorders differentiates fear-related disorders (i.e., phobias related to discrete aversive situations) from anxiety disorders related to a sustained expectation that diffuse aversive events will occur. Separation anxiety disorder and selective mutism have been moved into this grouping.</p> <p>Obsessive-compulsive and related disorders often present late for treatment, resulting in poor clinical outcomes. To improve recognition and diagnosis, some members of our Section worked with the WHO to reclassify disparate diagnoses into a single Obsessive-Compulsive and Related Disorders grouping. A seminal field study demonstrated that health care practitioners make more accurate diagnoses of these disorders using the ICD-11 vs. ICD-10<span><sup>1</sup></span>. Moreover, this new classification has advanced research heuristics establishing compulsivity as a transdiagnostic neuropsychological domain.</p> <p>Another new ICD-11 grouping was created for Disorders due to Addictive Behaviours. This includes two new disorders – gaming disorder and gambling disorder (on- or off-line) – and a residual category for possible diagnosis of other forms of problematic behaviour with addictive, impulsive and/or compulsive features, including buying or shopping, pornography use, social media use, cyberchondria, digital hoarding, and online streaming.</p> <p>Evidence of overlap between compulsive and addictive mechanisms and disorders has led to the establishment of the
{"title":"An update from the WPA Section on Anxiety and Obsessive-Compulsive Disorders","authors":"Naomi A. Fineberg, Dan J. Stein, Katharina Domschke, Eric Hollander, Susanne Walitza, Michael Van Ameringen, Bernardo Dell'Osso, Joseph Zohar","doi":"10.1002/wps.21255","DOIUrl":"https://doi.org/10.1002/wps.21255","url":null,"abstract":"<p>The WPA Section on Anxiety and Obsessive-Compulsive Disorders focuses its activities on a broad range of common and burdensome psychiatric conditions encompassing anxiety and fear-related disorders, obsessive-compulsive and related disorders, and behavioural addiction disorders, including problematic Internet use. This is an exciting area of developing clinical practice, as anxiety and obsessive-compulsive symptoms are increasingly played out in the digital environment.</p>\u0000<p>The Section provides a forum for clinician scientists and academics to exchange experiences and research advances. It organizes activities at WPA meetings, produces scientific publications and develops guidance on relevant topics, in collaboration with key stakeholder groups such as the World Health Organization (WHO), the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) (www.icocs.org), the Anxiety Disorders and Obsessive-Compulsive Research Networks of the European College of Neuropsychopharmacology (ECNP) (www.ecnp.eu), and the European Network for Problematic Usage of the Internet (www.internetandme.eu). Here we review some of the Section's recent initiatives and its ambitions for the next five years.</p>\u0000<p>The ICD-11 has refined and expanded the classification of anxiety disorders, and created two new groupings, one for Obsessive-Compulsive and Related Disorders and another for Disorders due to Addictive Behaviours, including several new diagnoses.</p>\u0000<p>The ICD-11 grouping of Anxiety or Fear-Related Disorders differentiates fear-related disorders (i.e., phobias related to discrete aversive situations) from anxiety disorders related to a sustained expectation that diffuse aversive events will occur. Separation anxiety disorder and selective mutism have been moved into this grouping.</p>\u0000<p>Obsessive-compulsive and related disorders often present late for treatment, resulting in poor clinical outcomes. To improve recognition and diagnosis, some members of our Section worked with the WHO to reclassify disparate diagnoses into a single Obsessive-Compulsive and Related Disorders grouping. A seminal field study demonstrated that health care practitioners make more accurate diagnoses of these disorders using the ICD-11 vs. ICD-10<span><sup>1</sup></span>. Moreover, this new classification has advanced research heuristics establishing compulsivity as a transdiagnostic neuropsychological domain.</p>\u0000<p>Another new ICD-11 grouping was created for Disorders due to Addictive Behaviours. This includes two new disorders – gaming disorder and gambling disorder (on- or off-line) – and a residual category for possible diagnosis of other forms of problematic behaviour with addictive, impulsive and/or compulsive features, including buying or shopping, pornography use, social media use, cyberchondria, digital hoarding, and online streaming.</p>\u0000<p>Evidence of overlap between compulsive and addictive mechanisms and disorders has led to the establishment of the","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiang Long, Na Zhong, Jingjing Huang, Geoffrey M. Reed, Zhen Wang, Yifeng Xu, Min Zhao
<p>Since 2007, China has been actively collaborating with the World Health Organization (WHO) and international colleagues in the revision, field testing, training, and implementation of the ICD-11 chapter on mental, behavioural and neurodevelopmental disorders, and the related Clinical Descriptions and Diagnostic Requirements (CDDR)<span><sup>1</sup></span>. In 2018, the National Health Commission clearly highlighted the importance of the ICD-11 and requested all health care providers in China to use the ICD-11 in their clinical practice<span><sup>2</sup></span>. The ICD-11 CDDR are particularly instrumental to achieving this goal in mental health systems in China, as a vast country with over 30 provincial-level administrative regions and a population of more than 1.4 billion.</p> <p>The Shanghai Mental Health Center (SMHC), as a WHO Collaborating Centre for Research and Training in Mental Health and a National Center for Mental Disorders, has led the field testing and implementation of the ICD-11 CDDR in China<span><sup>3</sup></span>. Together with other WHO Collaborating Centers in China, National Centers for Mental Disorders, and prestigious institutions across the country, the SMHC has built a core team for ICD-11 CDDR implementation with over 60 national mental health leaders, including heads of leading mental health institutions and presidents of scientific and professional mental health associations. The implementation of the CDDR in China involves an interrelated and growing set of activities including translation, field testing, research, advocacy and training.</p> <p>Translation is the cornerstone of implementing the ICD-11 CDDR in China. The translation process started in 2016, and was a collective effort by experts from Shanghai, Beijing and Changsha, coordinated by the SMHC. It was an iterative process involving eight rounds of review and revision over eight years, with 24 translators and 12 reviewers contributing to the work. The final Chinese version of the ICD-11 CDDR is now available for all mental health professionals in China.</p> <p>In conjunction with the translation process, China conducted field testing of the ICD-11 CDDR from 2016 to 2021, following the protocols provided by the WHO. The SMHC was designated as an International Field Study Centre by the WHO, and the president of the SMHC, Min Zhao, was selected as chair of the ICD-11 International Advisory Group on Training and Implementation.</p> <p>The Chinese field-testing work involved 2,224 patients, 59 clinical raters, 59 referring clinicians, and 23 research assistants from 10 field testing sites nationwide. The field testing was conducted through a rigorous, multidisciplinary and participatory approach, and the results were submitted to the WHO in 2021 to support the ICD-11 CDDR validation and finalization.</p> <p>In June 2018, after most of the content in the CDDR had been finalized, the SMHC coordinated efforts with various government and professional agencies t
{"title":"Implementation of the ICD-11 CDDR in China","authors":"Jiang Long, Na Zhong, Jingjing Huang, Geoffrey M. Reed, Zhen Wang, Yifeng Xu, Min Zhao","doi":"10.1002/wps.21251","DOIUrl":"https://doi.org/10.1002/wps.21251","url":null,"abstract":"<p>Since 2007, China has been actively collaborating with the World Health Organization (WHO) and international colleagues in the revision, field testing, training, and implementation of the ICD-11 chapter on mental, behavioural and neurodevelopmental disorders, and the related Clinical Descriptions and Diagnostic Requirements (CDDR)<span><sup>1</sup></span>. In 2018, the National Health Commission clearly highlighted the importance of the ICD-11 and requested all health care providers in China to use the ICD-11 in their clinical practice<span><sup>2</sup></span>. The ICD-11 CDDR are particularly instrumental to achieving this goal in mental health systems in China, as a vast country with over 30 provincial-level administrative regions and a population of more than 1.4 billion.</p>\u0000<p>The Shanghai Mental Health Center (SMHC), as a WHO Collaborating Centre for Research and Training in Mental Health and a National Center for Mental Disorders, has led the field testing and implementation of the ICD-11 CDDR in China<span><sup>3</sup></span>. Together with other WHO Collaborating Centers in China, National Centers for Mental Disorders, and prestigious institutions across the country, the SMHC has built a core team for ICD-11 CDDR implementation with over 60 national mental health leaders, including heads of leading mental health institutions and presidents of scientific and professional mental health associations. The implementation of the CDDR in China involves an interrelated and growing set of activities including translation, field testing, research, advocacy and training.</p>\u0000<p>Translation is the cornerstone of implementing the ICD-11 CDDR in China. The translation process started in 2016, and was a collective effort by experts from Shanghai, Beijing and Changsha, coordinated by the SMHC. It was an iterative process involving eight rounds of review and revision over eight years, with 24 translators and 12 reviewers contributing to the work. The final Chinese version of the ICD-11 CDDR is now available for all mental health professionals in China.</p>\u0000<p>In conjunction with the translation process, China conducted field testing of the ICD-11 CDDR from 2016 to 2021, following the protocols provided by the WHO. The SMHC was designated as an International Field Study Centre by the WHO, and the president of the SMHC, Min Zhao, was selected as chair of the ICD-11 International Advisory Group on Training and Implementation.</p>\u0000<p>The Chinese field-testing work involved 2,224 patients, 59 clinical raters, 59 referring clinicians, and 23 research assistants from 10 field testing sites nationwide. The field testing was conducted through a rigorous, multidisciplinary and participatory approach, and the results were submitted to the WHO in 2021 to support the ICD-11 CDDR validation and finalization.</p>\u0000<p>In June 2018, after most of the content in the CDDR had been finalized, the SMHC coordinated efforts with various government and professional agencies t","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nora D. Volkow, Michael P. Schaub, Anja Busse, Vladimir Poznyak, Dzmitry Krupchanka, Giovanna Campello
<p>Since 2014, the United Nations Office on Drugs and Crime (UNODC) - World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions at the Commission on Narcotic Drugs, the drug-control policy-making body of the United Nations (UN). The public health dimensions of substance use, including prevention and treatment of substance use disorders, have become prominent in policy debates within the UN system.</p> <p>Adolescence, which is the focus of this ISN statement, has been defined as individuals aged between 10 and 19 years<span><sup>1</sup></span>. While no global data on substance use within this full age range could be located, global data among more limited subsets are available. Alcohol is the most commonly used substance among all people 15+ years of age<span><sup>2</sup></span>: 155 million, i.e. more than a quarter (26.5%) of all those aged 15-19, are current drinkers. In addition, the 15-19 age group exhibits higher rates of heavy episodic drinking when compared to the total population of drinkers<span><sup>3</sup></span>. Cannabis is the internationally controlled substance most widely used by adolescents, and its use among 15-16-year-olds varies by region, from less than 3% annual prevalence in Asia to over 17% in Oceania. In most geographical areas, the proportion of adolescents using cannabis is higher than in the general population aged 15-64<span><sup>3</sup></span>.</p> <p>Consistent with Sustainable Development Goals<span><sup>4</sup></span> and other international commitments<span><sup>5</sup></span>, UN Member States called for comprehensive, evidence-based prevention of substance use, including early prevention<span><sup>6</sup></span> and available, accessible, diverse, evidence-based treatment and care for children and young people with substance use disorders<span><sup>7</sup></span>. There is a joint responsibility for policy makers, scientists, service providers, and communities to implement effective demand-reduction strategies and to adequately address prevention, treatment and recovery support, as well as measures to reduce the negative health and social consequences of substance use disorders among adolescents.</p> <div>The UNODC-WHO ISN makes the following recommendations: <ul> <li>Expand the availability and use of evidence-based prevention, treatment and care strategies and interventions for adolescents, and ensure sustainable funding for their implementation.</li> <li>Facilitate the availability of evidence-based prevention programs in the public domain with reimbursement schemes, thus allowing for preventive interventions to be inclusive and to address the needs of socio-economically disadvantaged groups, ensuring that minoritized populations, Indigenous groups; and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people are included.</li> <li>Promote population-based and environmental prevention measures, such as enfor
{"title":"Prevention, treatment and care of substance use disorders among adolescents. Statement by the UNODC-WHO Informal Scientific Network, 2024","authors":"Nora D. Volkow, Michael P. Schaub, Anja Busse, Vladimir Poznyak, Dzmitry Krupchanka, Giovanna Campello","doi":"10.1002/wps.21260","DOIUrl":"https://doi.org/10.1002/wps.21260","url":null,"abstract":"<p>Since 2014, the United Nations Office on Drugs and Crime (UNODC) - World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions at the Commission on Narcotic Drugs, the drug-control policy-making body of the United Nations (UN). The public health dimensions of substance use, including prevention and treatment of substance use disorders, have become prominent in policy debates within the UN system.</p>\u0000<p>Adolescence, which is the focus of this ISN statement, has been defined as individuals aged between 10 and 19 years<span><sup>1</sup></span>. While no global data on substance use within this full age range could be located, global data among more limited subsets are available. Alcohol is the most commonly used substance among all people 15+ years of age<span><sup>2</sup></span>: 155 million, i.e. more than a quarter (26.5%) of all those aged 15-19, are current drinkers. In addition, the 15-19 age group exhibits higher rates of heavy episodic drinking when compared to the total population of drinkers<span><sup>3</sup></span>. Cannabis is the internationally controlled substance most widely used by adolescents, and its use among 15-16-year-olds varies by region, from less than 3% annual prevalence in Asia to over 17% in Oceania. In most geographical areas, the proportion of adolescents using cannabis is higher than in the general population aged 15-64<span><sup>3</sup></span>.</p>\u0000<p>Consistent with Sustainable Development Goals<span><sup>4</sup></span> and other international commitments<span><sup>5</sup></span>, UN Member States called for comprehensive, evidence-based prevention of substance use, including early prevention<span><sup>6</sup></span> and available, accessible, diverse, evidence-based treatment and care for children and young people with substance use disorders<span><sup>7</sup></span>. There is a joint responsibility for policy makers, scientists, service providers, and communities to implement effective demand-reduction strategies and to adequately address prevention, treatment and recovery support, as well as measures to reduce the negative health and social consequences of substance use disorders among adolescents.</p>\u0000<div>The UNODC-WHO ISN makes the following recommendations: <ul>\u0000<li>Expand the availability and use of evidence-based prevention, treatment and care strategies and interventions for adolescents, and ensure sustainable funding for their implementation.</li>\u0000<li>Facilitate the availability of evidence-based prevention programs in the public domain with reimbursement schemes, thus allowing for preventive interventions to be inclusive and to address the needs of socio-economically disadvantaged groups, ensuring that minoritized populations, Indigenous groups; and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people are included.</li>\u0000<li>Promote population-based and environmental prevention measures, such as enfor","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The concept of emotion regulation (ER) is receiving considerable attention in research on psychiatric disorders and their treatment. The popularity of the concept is largely rooted in its premise that deficits in adaptive responses toward undesired affective states contribute to the development and maintenance of most forms of psychopathology.</p> <p>This appears obvious when considering psychiatric disorders that are primarily defined by an excess of undesired affective states (e.g., anxiety and mood disorders). For these conditions, it follows almost by definition that the perpetuation or escalation of undesired affective states results from the individual's inability to regulate them.</p> <p>However, given that many behavioral and cognitive symptoms of other psychiatric disorders can also be conceptualized as dysfunctional ER strategies, the scope of this paradigm extends much further. Consider, for example, when avoidance is used to reduce anxiety, when alcohol is consumed to numb loneliness, when binge eating serves to distract from emotional anguish, or when appraising a situation as uncontrollable and hopeless is used to reduce the pressure to solve one's problems or to shield oneself from further disappointment. In all these scenarios, behavioral or cognitive strategies yield short-lived relief from undesired affective states. Since the immediate ameliorating effects of these maladaptive strategies reinforce their usage, individuals tend to progressively increase their adoption until criteria for an anxiety, alcohol use, eating or mood disorder, etc. are met.</p> <p>Importantly, this trajectory is preventable if the individual realizes the negative mid- and long-term consequences of maladaptive strategies, and pivots to more adaptive ways of coping with undesired affective states. However, any such shift will fail to the extent that the individual lacks effective ER skills. Since all psychiatric disorders are arguably maintained by behaviors and cognitions that initially reduce negative affect, and since a distressed individual is more likely to utilize those strategies in the absence of more adaptive alternatives, it can be hypothesized that all psychiatric disorders are, to a significant degree, perpetuated by insufficient ER skills.</p> <p>Drawing on this framework, it can be deduced that patients with psychiatric disorders should benefit from treatments that systematically enhance effective ER skills. Evidence-based ER frameworks, such as the Adaptive Coping with Emotions Model<span><sup>1</sup></span>, posit that such treatments should foster the ability to modify the intensity and duration of undesired affective states, as well as the ability to accept and tolerate such states when modification is not possible.</p> <p>Additionally, these treatments should foster so-called preparatory ER skills that facilitate the successful utilization of modification- and acceptance-focused ER skills. Examples of such preparatory skills include
情绪调节（ER）的概念在精神疾病及其治疗的研究中备受关注。这一概念的流行在很大程度上源于它的前提，即对不良情绪状态的适应性反应的缺陷是大多数精神病理学发展和维持的原因。对于这些病症，从定义上就可以看出，不良情绪状态的持续或升级是由于个体无法调节这些情绪状态。然而，鉴于其他精神疾病的许多行为和认知症状也可以被概念化为功能失调的应急反应策略，因此这一范式的范围可以延伸得更远。举例来说，当回避被用来减轻焦虑时，当饮酒被用来麻痹孤独感时，当暴饮暴食被用来转移情绪上的痛苦时，或者当把某种情况评价为无法控制和毫无希望时，被用来减轻解决问题的压力或避免进一步的失望。在所有这些情况下，行为或认知策略都能在短期内缓解不想要的情绪状态。重要的是，如果个体意识到适应不良策略所带来的中长期负面影响，并转而采用适应性更强的方式来应对不良情绪状态，那么这一轨迹是可以避免的。然而，如果个体缺乏有效的应急技能，任何这种转变都会失败。由于所有的精神障碍都可以说是通过最初减少负面情绪的行为和认知来维持的，而且在没有更多适应性替代方法的情况下，痛苦的个体更有可能使用这些策略，因此可以假设，所有的精神障碍在很大程度上都是由于缺乏有效的应急反应技能而长期存在的。以证据为基础的ER框架，如 "适应性情绪应对模式"（Adaptive Coping with Emotions Model1），认为此类治疗应培养患者改变不良情绪状态的强度和持续时间的能力，以及在无法改变不良情绪状态时接受和容忍这种状态的能力。这些准备技能的例子包括意识到自己的感受、充分识别和标记自己的感受、建立一个解释自己目前的感受是如何维持的心理模型，最好是以验证和消除自己的经历的方式，同时也提出具体的工具来促进成功的改变/接受。因此，以ER为重点的治疗还应加强患者的自我支持技能，使其能够坚持不懈地采取适应性策略，尽管这些策略最初可能会加重患者的负面情绪。此外，大量的纵向研究和实验研究表明，这种关联是由急诊室技能缺陷影响心理健康造成的，而不是（完全）相反3。关于特定应急反应技能的重要性，大量证据支持重新评估、接纳和自我同情的有效性4、5。更多的研究表明，明确侧重于提高应急反应技能的治疗方法（如辩证行为疗法）可有效治疗多种精神障碍。文献中更具体的证据表明，专门针对提高ER技能的干预措施（如情感调节训练、情绪调节疗法）可有效治疗多种失调症2、6。最后，在这些研究中观察到的明显中介效应表明，ER技能的提高是症状严重程度减轻的主要驱动力7、8。虽然这些发现令人鼓舞，但精神病理学背景下的ER研究仍然充满了挑战。首先，关键术语的概念定义不够清晰，从情感一词开始，尽管已经有人提出了更具体的定义（如："情绪"、"情感 "和 "情绪"），但该词仍被广泛用于各种情感状态。
{"title":"Emotion regulation and mental health: current evidence and beyond","authors":"Matthias Berking","doi":"10.1002/wps.21244","DOIUrl":"https://doi.org/10.1002/wps.21244","url":null,"abstract":"<p>The concept of emotion regulation (ER) is receiving considerable attention in research on psychiatric disorders and their treatment. The popularity of the concept is largely rooted in its premise that deficits in adaptive responses toward undesired affective states contribute to the development and maintenance of most forms of psychopathology.</p>\u0000<p>This appears obvious when considering psychiatric disorders that are primarily defined by an excess of undesired affective states (e.g., anxiety and mood disorders). For these conditions, it follows almost by definition that the perpetuation or escalation of undesired affective states results from the individual's inability to regulate them.</p>\u0000<p>However, given that many behavioral and cognitive symptoms of other psychiatric disorders can also be conceptualized as dysfunctional ER strategies, the scope of this paradigm extends much further. Consider, for example, when avoidance is used to reduce anxiety, when alcohol is consumed to numb loneliness, when binge eating serves to distract from emotional anguish, or when appraising a situation as uncontrollable and hopeless is used to reduce the pressure to solve one's problems or to shield oneself from further disappointment. In all these scenarios, behavioral or cognitive strategies yield short-lived relief from undesired affective states. Since the immediate ameliorating effects of these maladaptive strategies reinforce their usage, individuals tend to progressively increase their adoption until criteria for an anxiety, alcohol use, eating or mood disorder, etc. are met.</p>\u0000<p>Importantly, this trajectory is preventable if the individual realizes the negative mid- and long-term consequences of maladaptive strategies, and pivots to more adaptive ways of coping with undesired affective states. However, any such shift will fail to the extent that the individual lacks effective ER skills. Since all psychiatric disorders are arguably maintained by behaviors and cognitions that initially reduce negative affect, and since a distressed individual is more likely to utilize those strategies in the absence of more adaptive alternatives, it can be hypothesized that all psychiatric disorders are, to a significant degree, perpetuated by insufficient ER skills.</p>\u0000<p>Drawing on this framework, it can be deduced that patients with psychiatric disorders should benefit from treatments that systematically enhance effective ER skills. Evidence-based ER frameworks, such as the Adaptive Coping with Emotions Model<span><sup>1</sup></span>, posit that such treatments should foster the ability to modify the intensity and duration of undesired affective states, as well as the ability to accept and tolerate such states when modification is not possible.</p>\u0000<p>Additionally, these treatments should foster so-called preparatory ER skills that facilitate the successful utilization of modification- and acceptance-focused ER skills. Examples of such preparatory skills include ","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gaia Sampogna, Hasanen Al-Taiar, Franziska Baessler, Bulent Coskun, Hussien Elkholy, Mariana Pinto da Costa, Rodrigo Ramalho, Andrea Fiorillo
<p>Education of mental health professionals should reflect the changes occurring at scientific, clinical and sociocultural levels, and thus it should be continuously updated. However, in many parts of the world, psychiatric education is still based on a knowledge formed in the last century, and the most recent knowledge on the structure and functioning of the brain, human behaviors and social relationships is missing.</p> <p>Moreover, the mission of psychiatrists has evolved over time, from the diagnosis and management of full-blown mental disorders to the identification of a series of mental health problems which are associated with high levels of personal and societal burden. The involvement of experts by experience in policy, clinical and research activities is now acknowledged as a priority<span><sup>1, 2</sup></span>, and the need for a clinical characterization of individual patients beyond diagnosis in order to personalize treatment is widely recognized<span><sup>3, 4</sup></span>. These changes should be taken into account by current educational curricula, but this is not always the case.</p> <p>The WPA Section on Education in Psychiatry is committed to improve training and education worldwide, with a special attention to low- and middle-income countries (LMICs), since the future of psychiatry as a discipline strongly depends on the education of the new generations of professionals.</p> <p>The Section is updating the type of educational materials available for mental health professionals, and is keen to disseminate them worldwide<span><sup>5</sup></span>. In the last triennium, it has contributed to several educational activities, including the development of informational packages for the general public to decrease misconceptions on people with mental disorders, the update of training curricula for undergraduate medical students, and the organization of educational workshops and meetings for psychiatrists and other mental health professionals.</p> <p>In the triennium 2020-2023, following the COVID-19 pandemic – which has represented an unprecedent traumatic event with a detrimental impact on education, training and practice worldwide – the Section has been particularly active in developing and producing new tools to improve education in mental health worldwide<span><sup>6-8</sup></span>.</p> <p>The Chair of the Section, in collaboration with the WPA Past-President, has promoted a survey targeting the WPA Zonal Representatives, to identify the educational needs and interests of professionals associated with the WPA<span><sup>9</sup></span>. The main finding has been that these professionals are mostly concerned with public mental health activities and with primary prevention of mental disorders. The main unmet need is the development, implementation and dissemination of educational activities in languages other than English, in order to broaden their accessibility.</p> <p>Moreover, the Section has collected experiences on education and tr
{"title":"Improving education in psychiatry in an evolving scenario: the activities of the WPA Section on Education in Psychiatry","authors":"Gaia Sampogna, Hasanen Al-Taiar, Franziska Baessler, Bulent Coskun, Hussien Elkholy, Mariana Pinto da Costa, Rodrigo Ramalho, Andrea Fiorillo","doi":"10.1002/wps.21258","DOIUrl":"https://doi.org/10.1002/wps.21258","url":null,"abstract":"<p>Education of mental health professionals should reflect the changes occurring at scientific, clinical and sociocultural levels, and thus it should be continuously updated. However, in many parts of the world, psychiatric education is still based on a knowledge formed in the last century, and the most recent knowledge on the structure and functioning of the brain, human behaviors and social relationships is missing.</p>\u0000<p>Moreover, the mission of psychiatrists has evolved over time, from the diagnosis and management of full-blown mental disorders to the identification of a series of mental health problems which are associated with high levels of personal and societal burden. The involvement of experts by experience in policy, clinical and research activities is now acknowledged as a priority<span><sup>1, 2</sup></span>, and the need for a clinical characterization of individual patients beyond diagnosis in order to personalize treatment is widely recognized<span><sup>3, 4</sup></span>. These changes should be taken into account by current educational curricula, but this is not always the case.</p>\u0000<p>The WPA Section on Education in Psychiatry is committed to improve training and education worldwide, with a special attention to low- and middle-income countries (LMICs), since the future of psychiatry as a discipline strongly depends on the education of the new generations of professionals.</p>\u0000<p>The Section is updating the type of educational materials available for mental health professionals, and is keen to disseminate them worldwide<span><sup>5</sup></span>. In the last triennium, it has contributed to several educational activities, including the development of informational packages for the general public to decrease misconceptions on people with mental disorders, the update of training curricula for undergraduate medical students, and the organization of educational workshops and meetings for psychiatrists and other mental health professionals.</p>\u0000<p>In the triennium 2020-2023, following the COVID-19 pandemic – which has represented an unprecedent traumatic event with a detrimental impact on education, training and practice worldwide – the Section has been particularly active in developing and producing new tools to improve education in mental health worldwide<span><sup>6-8</sup></span>.</p>\u0000<p>The Chair of the Section, in collaboration with the WPA Past-President, has promoted a survey targeting the WPA Zonal Representatives, to identify the educational needs and interests of professionals associated with the WPA<span><sup>9</sup></span>. The main finding has been that these professionals are mostly concerned with public mental health activities and with primary prevention of mental disorders. The main unmet need is the development, implementation and dissemination of educational activities in languages other than English, in order to broaden their accessibility.</p>\u0000<p>Moreover, the Section has collected experiences on education and tr","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Geoffrey M. Reed, Karen T. Maré, Michael B. First, T.S. Jaisoorya, Girish N. Rao, John-Joe Dawson-Squibb, Christine Lochner, Mark van Ommeren, Dan J. Stein
<p>The movement to a descriptive, symptom-based diagnostic system that started with the DSM-III was in part a response to widespread concerns and criticisms regarding the reliability of psychiatric diagnoses. This fueled an emphasis on increasingly precise operationalization of diagnostic constructs and criteria, based on the assumption that this would produce successive improvements in reliability.</p> <p>Clinician-administered structured diagnostic interviews were subsequently developed. For example, the Research Diagnostic Criteria were used to develop a Schedule for Affective Disorders and Schizophrenia<span><sup>1</sup></span>, while the DSM-III criteria were incorporated into the Structured Clinical Interview for DSM (SCID)<span><sup>2</sup></span>. In addition, the Diagnostic Interview Schedule<span><sup>3</sup></span> was developed for use by non-clinician interviewers in epidemiological surveys of mental disorders. These instruments have been widely used in research on mental disorders.</p> <p>Structured diagnostic interviews have subsequently been developed or adapted for successive revisions of the DSM and the ICD. The SCID, a semi-structured interview – meaning that the interviewer probes unclear responses and makes certain clinical judgments – has been updated with each edition of the DSM<span><sup>4</sup></span>. The briefer and fully structured Mini International Neuropsychiatric Interview (MINI)<span><sup>5</sup></span> has also been widely employed. The Composite International Diagnostic Interview (CIDI)<span><sup>6</sup></span> incorporated both DSM and ICD diagnostic requirements and was used in the National Comorbidity Survey and the World Mental Health Surveys. Similarly, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), based on the Present State Examination, assessed for both DSM and ICD requirements<span><sup>7</sup></span>. Structured diagnostic interviews for children have also been developed, as have a range of more focused interviews that cover specific conditions or diagnostic groupings.</p> <p>Based on an extensive program of field testing, the reliability of the diagnostic guidance provided in the Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders (CDDR)<span><sup>8</sup></span> was found to be higher than that of other mental disorder classification systems, ranging from moderate to almost perfect according to the specific category. This finding was perhaps counterintuitive, insofar as the CDDR avoid highly prescriptive symptom counts and duration requirements, unless these are specifically supported scientifically, in order to facilitate clinical use.</p> <p>These results, therefore, challenge the assumed relationship between operational precision and diagnostic reliability. They also suggest that the diagnoses based on the CDDR would be sufficiently reliable for certain types of research projects (e.g., studies focusing on diagnostic gr
{"title":"The WHO Flexible Interview for ICD-11 (FLII-11)","authors":"Geoffrey M. Reed, Karen T. Maré, Michael B. First, T.S. Jaisoorya, Girish N. Rao, John-Joe Dawson-Squibb, Christine Lochner, Mark van Ommeren, Dan J. Stein","doi":"10.1002/wps.21227","DOIUrl":"https://doi.org/10.1002/wps.21227","url":null,"abstract":"<p>The movement to a descriptive, symptom-based diagnostic system that started with the DSM-III was in part a response to widespread concerns and criticisms regarding the reliability of psychiatric diagnoses. This fueled an emphasis on increasingly precise operationalization of diagnostic constructs and criteria, based on the assumption that this would produce successive improvements in reliability.</p>\u0000<p>Clinician-administered structured diagnostic interviews were subsequently developed. For example, the Research Diagnostic Criteria were used to develop a Schedule for Affective Disorders and Schizophrenia<span><sup>1</sup></span>, while the DSM-III criteria were incorporated into the Structured Clinical Interview for DSM (SCID)<span><sup>2</sup></span>. In addition, the Diagnostic Interview Schedule<span><sup>3</sup></span> was developed for use by non-clinician interviewers in epidemiological surveys of mental disorders. These instruments have been widely used in research on mental disorders.</p>\u0000<p>Structured diagnostic interviews have subsequently been developed or adapted for successive revisions of the DSM and the ICD. The SCID, a semi-structured interview – meaning that the interviewer probes unclear responses and makes certain clinical judgments – has been updated with each edition of the DSM<span><sup>4</sup></span>. The briefer and fully structured Mini International Neuropsychiatric Interview (MINI)<span><sup>5</sup></span> has also been widely employed. The Composite International Diagnostic Interview (CIDI)<span><sup>6</sup></span> incorporated both DSM and ICD diagnostic requirements and was used in the National Comorbidity Survey and the World Mental Health Surveys. Similarly, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), based on the Present State Examination, assessed for both DSM and ICD requirements<span><sup>7</sup></span>. Structured diagnostic interviews for children have also been developed, as have a range of more focused interviews that cover specific conditions or diagnostic groupings.</p>\u0000<p>Based on an extensive program of field testing, the reliability of the diagnostic guidance provided in the Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders (CDDR)<span><sup>8</sup></span> was found to be higher than that of other mental disorder classification systems, ranging from moderate to almost perfect according to the specific category. This finding was perhaps counterintuitive, insofar as the CDDR avoid highly prescriptive symptom counts and duration requirements, unless these are specifically supported scientifically, in order to facilitate clinical use.</p>\u0000<p>These results, therefore, challenge the assumed relationship between operational precision and diagnostic reliability. They also suggest that the diagnoses based on the CDDR would be sufficiently reliable for certain types of research projects (e.g., studies focusing on diagnostic gr","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The use of psychoactive substances is highly prevalent and contributes substantially to risk behaviours, morbidity and mortality. The United Nations Office on Drugs and Crime World Drug Report<span><sup>1</sup></span> estimated that, in 2021, one in every 17 people aged 15-64 in the world had used an illicit drug in the year before. Users increased from 240 million in 2011 to 296 million in 2021, substantially more than accounted for by population growth.</p> <p>Cannabis continued to be the most used illicit drug (219 million users, 4.3% of the global adult population); 36 million people had used amphetamines, 22 million cocaine, and 20 million methylenedioxymethamphetamine (MDMA or “ecstasy”) or related drugs in the previous year. An estimated 60 million people engaged in non-medical opioid use, 31.5 million of whom used opiates (i.e., non-synthetic opioids; mainly heroin).</p> <p>Globally, there is very limited implementation of efficient and effective prevention strategies for substance use<span><sup>2</sup></span>, and there is a substantial treatment gap for disorders due to this use<span><sup>3</sup></span>. Global evidence has called attention to the need for a new and comprehensive conceptualization of substance use disorders that incorporates the full range of relevant conditions, from risky consumption to mental disorders linked to harmful drug use<span><sup>4</sup></span>.</p> <p>In response to these challenges, the World Health Organization (WHO) adopted a public health approach to the development of the classification of disorders due to substance use in the ICD-11. By public health approach, we refer to a broader perspective that integrates health and social aspects, aiming to benefit affected individuals and their community, and focusing on population well-being<span><sup>5</sup></span>.</p> <p>From a public health perspective, it is essential to identify persons who exhibit a hazardous use of substances that increases the risk of harmful psychological or medical consequences, but whose symptoms do not meet the diagnostic requirements for substance use disorders. These individuals can benefit from education, prevention, and community interventions. People with diagnosable disorders need harm reduction and treatment services of differing intensities and settings, depending on the nature of their condition and the substance involved. Those who suffer physical or psychological harm due to others’ substance use should also be identified and may require services<span><sup>6</sup></span>.</p> <p>In line with this perspective, the range of psychoactive substances classified in the ICD-11 section on disorders due to substance use has been expanded, reflecting changes in the substances associated with public health impact in different parts of the world. An extended set of substance classes will help track patterns more accurately, in order to formulate appropriate clinical and social policy responses nationally and globally. For example
{"title":"How the ICD-11 and the CDDR address the public health dimensions of substance use","authors":"María Elena Medina-Mora, Rebeca Robles","doi":"10.1002/wps.21252","DOIUrl":"https://doi.org/10.1002/wps.21252","url":null,"abstract":"<p>The use of psychoactive substances is highly prevalent and contributes substantially to risk behaviours, morbidity and mortality. The United Nations Office on Drugs and Crime World Drug Report<span><sup>1</sup></span> estimated that, in 2021, one in every 17 people aged 15-64 in the world had used an illicit drug in the year before. Users increased from 240 million in 2011 to 296 million in 2021, substantially more than accounted for by population growth.</p>\u0000<p>Cannabis continued to be the most used illicit drug (219 million users, 4.3% of the global adult population); 36 million people had used amphetamines, 22 million cocaine, and 20 million methylenedioxymethamphetamine (MDMA or “ecstasy”) or related drugs in the previous year. An estimated 60 million people engaged in non-medical opioid use, 31.5 million of whom used opiates (i.e., non-synthetic opioids; mainly heroin).</p>\u0000<p>Globally, there is very limited implementation of efficient and effective prevention strategies for substance use<span><sup>2</sup></span>, and there is a substantial treatment gap for disorders due to this use<span><sup>3</sup></span>. Global evidence has called attention to the need for a new and comprehensive conceptualization of substance use disorders that incorporates the full range of relevant conditions, from risky consumption to mental disorders linked to harmful drug use<span><sup>4</sup></span>.</p>\u0000<p>In response to these challenges, the World Health Organization (WHO) adopted a public health approach to the development of the classification of disorders due to substance use in the ICD-11. By public health approach, we refer to a broader perspective that integrates health and social aspects, aiming to benefit affected individuals and their community, and focusing on population well-being<span><sup>5</sup></span>.</p>\u0000<p>From a public health perspective, it is essential to identify persons who exhibit a hazardous use of substances that increases the risk of harmful psychological or medical consequences, but whose symptoms do not meet the diagnostic requirements for substance use disorders. These individuals can benefit from education, prevention, and community interventions. People with diagnosable disorders need harm reduction and treatment services of differing intensities and settings, depending on the nature of their condition and the substance involved. Those who suffer physical or psychological harm due to others’ substance use should also be identified and may require services<span><sup>6</sup></span>.</p>\u0000<p>In line with this perspective, the range of psychoactive substances classified in the ICD-11 section on disorders due to substance use has been expanded, reflecting changes in the substances associated with public health impact in different parts of the world. An extended set of substance classes will help track patterns more accurately, in order to formulate appropriate clinical and social policy responses nationally and globally. For example","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The process of scientific validation of the ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) for Mental Disorders has spanned more than 10 years, being remarkably comprehensive and inclusive as well as truly international, with the involvement of many hundreds of clinicians and researchers from all regions of the world.</p> <p>The field trials of the ICD-11 CDDR – contrary to those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG) and the DSM-5 diagnostic criteria – have been genuinely “developmental” (as opposed to “summative” or “evaluative”) in their nature<span><sup>1</sup></span>. That is, they have been conducted <i>before</i> the finalization of the relevant sets of criteria or guidelines – thus allowing the identification of conceptual or terminological problems in the proposed texts, the correction of those texts, and the further testing of the revised versions – rather than being conducted or concluded <i>after</i> the finalization of the relevant sets of criteria or guidelines, thus just providing information to clinicians about what they could expect from those products. As we will see, several amendments to the CDDR were actually implemented as a consequence of this design.</p> <p>The CDDR field trials can be subdivided into two main groups: a) Internet-based trials, implemented through the Global Clinical Practice Network (involving, at the time when the trials were conducted, more than 15,000 mental health and primary health care professionals from more than 150 countries), which used a case vignette methodology to assess the effects of specific differences between the CDDR and the ICD-10 CDDG on the participants’ clinical decision making; b) clinic-based (or ecological) trials, assessing the reliability and clinical utility of the CDDR in real clinical contexts. The clinic-based trials differed from the DSM-5 field trials in that they used a joint-rater design (with two clinicians jointly interviewing each patient) rather than a test-retest design (with two clinicians separately interviewing each patient at different time points), thus controlling for information variance and more specifically testing the reliability of the proposed guidelines (rather than testing more generally the reliability of the relevant psychiatric diagnoses)<span><sup>2</sup></span>.</p> <p>Among the Internet-based CDDR field trials, of special interest have been those focusing on disorders specifically associated with stress<span><sup>3</sup></span>, and on feeding and eating disorders<span><sup>4</sup></span>. A case-control field trial on the former grouping of disorders<span><sup>3</sup></span>, conducted with 1,738 mental health professionals from 76 countries, found that several changes introduced in the ICD-11 – including the addition of complex post-traumatic stress disorder (complex PTSD) and prolonged grief disorder – resulted in significantly improved diagnostic decisions. However, the trial also identified s
{"title":"Scientific validation of the ICD-11 CDDR","authors":"Mario Maj","doi":"10.1002/wps.21226","DOIUrl":"https://doi.org/10.1002/wps.21226","url":null,"abstract":"<p>The process of scientific validation of the ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) for Mental Disorders has spanned more than 10 years, being remarkably comprehensive and inclusive as well as truly international, with the involvement of many hundreds of clinicians and researchers from all regions of the world.</p>\u0000<p>The field trials of the ICD-11 CDDR – contrary to those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG) and the DSM-5 diagnostic criteria – have been genuinely “developmental” (as opposed to “summative” or “evaluative”) in their nature<span><sup>1</sup></span>. That is, they have been conducted <i>before</i> the finalization of the relevant sets of criteria or guidelines – thus allowing the identification of conceptual or terminological problems in the proposed texts, the correction of those texts, and the further testing of the revised versions – rather than being conducted or concluded <i>after</i> the finalization of the relevant sets of criteria or guidelines, thus just providing information to clinicians about what they could expect from those products. As we will see, several amendments to the CDDR were actually implemented as a consequence of this design.</p>\u0000<p>The CDDR field trials can be subdivided into two main groups: a) Internet-based trials, implemented through the Global Clinical Practice Network (involving, at the time when the trials were conducted, more than 15,000 mental health and primary health care professionals from more than 150 countries), which used a case vignette methodology to assess the effects of specific differences between the CDDR and the ICD-10 CDDG on the participants’ clinical decision making; b) clinic-based (or ecological) trials, assessing the reliability and clinical utility of the CDDR in real clinical contexts. The clinic-based trials differed from the DSM-5 field trials in that they used a joint-rater design (with two clinicians jointly interviewing each patient) rather than a test-retest design (with two clinicians separately interviewing each patient at different time points), thus controlling for information variance and more specifically testing the reliability of the proposed guidelines (rather than testing more generally the reliability of the relevant psychiatric diagnoses)<span><sup>2</sup></span>.</p>\u0000<p>Among the Internet-based CDDR field trials, of special interest have been those focusing on disorders specifically associated with stress<span><sup>3</sup></span>, and on feeding and eating disorders<span><sup>4</sup></span>. A case-control field trial on the former grouping of disorders<span><sup>3</sup></span>, conducted with 1,738 mental health professionals from 76 countries, found that several changes introduced in the ICD-11 – including the addition of complex post-traumatic stress disorder (complex PTSD) and prolonged grief disorder – resulted in significantly improved diagnostic decisions. However, the trial also identified s","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>From a historical perspective, Engel<span><sup>1</sup></span> conceptualized psychopathology as resulting from an interaction of three orders of factors: biological, psychological and social. The first half of the 20th century has been mostly devoted to conceptualizing the psychological component of mental disorders, the second half to the understanding of the biological component. We are now, in the 21st century, busy at better understanding the role of social processes that impact treatment approaches to psychopathology as well as the psychiatrist-patient relationship.</p> <p>Even more than other medical disciplines, psychiatry is influenced by external events that plague society, such as epidemics, natural disasters and wars. These events often require the involvement of ethics committees that will determine the duties and rights of the physician in potentially conflictual ethical contexts, such as triage situations (i.e., choosing whom to treat first). The COVID-19 pandemic has shown how deeply interwoven the epidemiology of mental disorders and the access to mental health services are with both social factors and somatic health. Grief, isolation, loss of income and fear exacerbate existing mental health problems or create new ones. The pandemic has demonstrated that the biological and social dimensions of medicine and public health are inextricably linked<span><sup>2</sup></span>.</p> <p>Profound changes in social values and norms, such as the legitimization of medical procedures for transgender individuals, or the availability of euthanasia in some countries, require a redefinition of the psychiatrist's role within the medical staff, and the development of ethical guidelines that take into account a variety of emotional, religious and ideological aspects pertaining to both the patient and the physician.</p> <p>This changing scenario is extensively reflected in Galderisi et al's paper<span><sup>3</sup></span>. I will focus here on three of the issues discussed by the authors. The first is stigma related to mental disorders in society in general, and particularly in the medical world. Studies documenting the importance of social/environmental components in the development of psychopathology<span><sup>4</sup></span>, as well as those showing the close relationship between physical illness and emotional states, have contributed to reduce that stigma. The inclusion of psychiatric wards within general hospitals has been both a consequence and a further determinant of this evolution. Likewise, the importance of the psychiatrist's presence in transdisciplinary medical teams, as well as in hospital ethics committees, has become more obvious than in the past. It is also increasingly clear that codes of ethics of physical medicine and psychiatry overlap to a large extent, especially with regard to the therapist-patient relationship.</p> <p>The second topic I wish to emphasize is the changing relationship between psychiatrists and representatives of
{"title":"Ethics from the lens of the social dimension of psychiatry","authors":"Sam Tyano","doi":"10.1002/wps.21238","DOIUrl":"https://doi.org/10.1002/wps.21238","url":null,"abstract":"<p>From a historical perspective, Engel<span><sup>1</sup></span> conceptualized psychopathology as resulting from an interaction of three orders of factors: biological, psychological and social. The first half of the 20th century has been mostly devoted to conceptualizing the psychological component of mental disorders, the second half to the understanding of the biological component. We are now, in the 21st century, busy at better understanding the role of social processes that impact treatment approaches to psychopathology as well as the psychiatrist-patient relationship.</p>\u0000<p>Even more than other medical disciplines, psychiatry is influenced by external events that plague society, such as epidemics, natural disasters and wars. These events often require the involvement of ethics committees that will determine the duties and rights of the physician in potentially conflictual ethical contexts, such as triage situations (i.e., choosing whom to treat first). The COVID-19 pandemic has shown how deeply interwoven the epidemiology of mental disorders and the access to mental health services are with both social factors and somatic health. Grief, isolation, loss of income and fear exacerbate existing mental health problems or create new ones. The pandemic has demonstrated that the biological and social dimensions of medicine and public health are inextricably linked<span><sup>2</sup></span>.</p>\u0000<p>Profound changes in social values and norms, such as the legitimization of medical procedures for transgender individuals, or the availability of euthanasia in some countries, require a redefinition of the psychiatrist's role within the medical staff, and the development of ethical guidelines that take into account a variety of emotional, religious and ideological aspects pertaining to both the patient and the physician.</p>\u0000<p>This changing scenario is extensively reflected in Galderisi et al's paper<span><sup>3</sup></span>. I will focus here on three of the issues discussed by the authors. The first is stigma related to mental disorders in society in general, and particularly in the medical world. Studies documenting the importance of social/environmental components in the development of psychopathology<span><sup>4</sup></span>, as well as those showing the close relationship between physical illness and emotional states, have contributed to reduce that stigma. The inclusion of psychiatric wards within general hospitals has been both a consequence and a further determinant of this evolution. Likewise, the importance of the psychiatrist's presence in transdisciplinary medical teams, as well as in hospital ethics committees, has become more obvious than in the past. It is also increasingly clear that codes of ethics of physical medicine and psychiatry overlap to a large extent, especially with regard to the therapist-patient relationship.</p>\u0000<p>The second topic I wish to emphasize is the changing relationship between psychiatrists and representatives of","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie C. Momen, Søren Dinesen Østergaard, Uffe Heide-Jorgensen, Henrik Toft Sørensen, John J. McGrath, Oleguer Plana-Ripoll
People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.
{"title":"Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population-based cohort","authors":"Natalie C. Momen, Søren Dinesen Østergaard, Uffe Heide-Jorgensen, Henrik Toft Sørensen, John J. McGrath, Oleguer Plana-Ripoll","doi":"10.1002/wps.21242","DOIUrl":"https://doi.org/10.1002/wps.21242","url":null,"abstract":"People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":null,"pages":null},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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