Alessio M Monteleone, Fernando Fernandez-Aranda, Ulrich Voderholzer
369 leadership for a significant improvement in practice on the subject; b) through supporting and building a network of practitioners and those with lived experience of mental ill health and their supporters, in effect a movement for better practice to minimize coercion; c) by developing new materials, testing them and learning from their use in a way that strengthens knowledge on human rights and mental health more broadly, of which minimizing coercion is a central element. Ultimately, the impact we seek is that an understanding of ways to minimize coercion is developed by mental health professionals internationally, in collaboration with civil society, and that better practices are adopted. As a result, the dangers of coercive practices will also be minimized, and the supports available to people experiencing mental health problems and their families will increase significantly over time. There are people and groups across countries working actively to promote these and other initiatives that contribute to the common goal of the advancement of psychiatry and mental health for all people. All of us in the WPA leadership welcome comments and engage ment from readers and colleagues. Helen Herrman President, World Psychiatric Association
{"title":"Evidence and perspectives in eating disorders: a paradigm for a multidisciplinary approach.","authors":"Alessio M Monteleone, Fernando Fernandez-Aranda, Ulrich Voderholzer","doi":"10.1002/wps.20687","DOIUrl":"https://doi.org/10.1002/wps.20687","url":null,"abstract":"369 leadership for a significant improvement in practice on the subject; b) through supporting and building a network of practitioners and those with lived experience of mental ill health and their supporters, in effect a movement for better practice to minimize coercion; c) by developing new materials, testing them and learning from their use in a way that strengthens knowledge on human rights and mental health more broadly, of which minimizing coercion is a central element. Ultimately, the impact we seek is that an understanding of ways to minimize coercion is developed by mental health professionals internationally, in collaboration with civil society, and that better practices are adopted. As a result, the dangers of coercive practices will also be minimized, and the supports available to people experiencing mental health problems and their families will increase significantly over time. There are people and groups across countries working actively to promote these and other initiatives that contribute to the common goal of the advancement of psychiatry and mental health for all people. All of us in the WPA leadership welcome comments and engage ment from readers and colleagues. Helen Herrman President, World Psychiatric Association","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"369-370"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 18:3 October 2019 precision of the licensing of medications and other therapies replaced by a more flexible and accurate evidence-based approach as in mainstream health care. The potential value of such an approach for the redesign of mental health care cannot be overestimated, as we struggle to replace 50-year-old mindsets and work practices with a modern, dynamic 21st century approach.
{"title":"Transdiagnostic psychiatry goes above and beyond classification","authors":"W. Mansell","doi":"10.1002/wps.20680","DOIUrl":"https://doi.org/10.1002/wps.20680","url":null,"abstract":"World Psychiatry 18:3 October 2019 precision of the licensing of medications and other therapies replaced by a more flexible and accurate evidence-based approach as in mainstream health care. The potential value of such an approach for the redesign of mental health care cannot be overestimated, as we struggle to replace 50-year-old mindsets and work practices with a modern, dynamic 21st century approach.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41605541","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}
{"title":"What is \"evidence\" in psychotherapies?","authors":"Scott O Lilienfeld","doi":"10.1002/wps.20654","DOIUrl":"10.1002/wps.20654","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"245-246"},"PeriodicalIF":60.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732681/pdf/WPS-18-245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Outcomes help map out evidence in an uncertain terrain, but they are relative.","authors":"Tim Kendall","doi":"10.1002/wps.20668","DOIUrl":"10.1002/wps.20668","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"293-295"},"PeriodicalIF":60.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732678/pdf/WPS-18-293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cognitive remediation for severe mental illness: state of the field and future directions","authors":"C. Bowie","doi":"10.1002/wps.20660","DOIUrl":"https://doi.org/10.1002/wps.20660","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20660","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49216864","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}
Post‐traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM‐III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM‐5 and ICD‐11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up‐to‐date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence‐supported treatments. A major conclusion is that, although trauma‐focused cognitive behavior therapy is the best‐validated treatment for PTSD, it has stagnated over recent decades, and only two‐thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence‐based treatment, and this situation is much worse in low‐ and middle‐income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.
{"title":"Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges","authors":"R. Bryant","doi":"10.1002/wps.20656","DOIUrl":"https://doi.org/10.1002/wps.20656","url":null,"abstract":"Post‐traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM‐III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM‐5 and ICD‐11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up‐to‐date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence‐supported treatments. A major conclusion is that, although trauma‐focused cognitive behavior therapy is the best‐validated treatment for PTSD, it has stagnated over recent decades, and only two‐thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence‐based treatment, and this situation is much worse in low‐ and middle‐income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43152609","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}
J. Parnas, Karl Erik Sandsten, C. Vestergaard, J. Nordgaard
World Psychiatry 18:3 October 2019 Another illustrative example is the fact that authors themselves disagree on the ultimate aim of transdiagnostic research. Some of them claim that transdiagnostic research is a fundamental pathway to clinical utility for improving psychiatric classification and diagnosis, while others argue that the transdiagnostic approach does not primarily target the improvement of psychiatric classifi cation and diagnosis, but rather tests a general theory of psycho pathology. A further example is the fact that, until the publication of this systematic review, the empirical limitations and reporting quality of transdiagnostic research remained unaddressed: appraising and acknowledging the specific limitations of a certain domain of knowledge is equally, if not more, important as celebrating its successes. It may well be that some versions of a transdiagnostic approach are going to be necessary to improve psychiatric classification and care. What is certain is that, until studies continue to loosely and incoherently self-proclaim transdiagnostic without acknowledging any diagnostic information, it is unlikely that transdiagnostic research will bear any real-world meaning for clinicians, patients, and medical practice. Similarly, poor reporting on the number and type of (trans)diagnostic spectra prevents the appraisal, refinement, and eventual integration of categorical and dimensional approaches in psychiatric classification. The systematic review acknowledged that transdiagnostic categorical approaches that respect dimensionality are possible in organic medicine as well as in psychiatry, but this requires transparent reporting of the results. For example, the largest transdiagnostic study published to date demonstrated that it is possible to report the diagnostic information for almost all ICD-10 mental disorders. Furthermore, while it is possible that transdiagnostic interventions may display superior efficiency, cost-effectiveness, accessibility, and patient-reported satisfaction compared to specific-diagnostic interventions, demonstrating this would require robust comparative analyses specifically conducted to test the non-inferiority or superiority of the transdiagnostic approach. These analyses are infrequent in the current literature. The systematic review leveraged these caveats to put forward six empirical transdiagnostic research recommendations: TRANSD. The TRANSD recommendations are pragmatic and focus on improving the quality of appraising and reporting transdiagnostic constructs. Importantly, they do not provide any a priori restrictive definition of the transdiagnostic schemata; as such, they can be applied to different topics and stimulate critical research in the field. The first recommendation is to have a transparent definition of the gold standard (ICD, DSM, other), including specific diagnostic types, official codes, primary vs. secondary diagnoses, and diagnostic assessment interviews. Second, the primar
{"title":"Mental illness among relatives of successful academics: implications for psychopathology‐creativity research","authors":"J. Parnas, Karl Erik Sandsten, C. Vestergaard, J. Nordgaard","doi":"10.1002/wps.20682","DOIUrl":"https://doi.org/10.1002/wps.20682","url":null,"abstract":"World Psychiatry 18:3 October 2019 Another illustrative example is the fact that authors themselves disagree on the ultimate aim of transdiagnostic research. Some of them claim that transdiagnostic research is a fundamental pathway to clinical utility for improving psychiatric classification and diagnosis, while others argue that the transdiagnostic approach does not primarily target the improvement of psychiatric classifi cation and diagnosis, but rather tests a general theory of psycho pathology. A further example is the fact that, until the publication of this systematic review, the empirical limitations and reporting quality of transdiagnostic research remained unaddressed: appraising and acknowledging the specific limitations of a certain domain of knowledge is equally, if not more, important as celebrating its successes. It may well be that some versions of a transdiagnostic approach are going to be necessary to improve psychiatric classification and care. What is certain is that, until studies continue to loosely and incoherently self-proclaim transdiagnostic without acknowledging any diagnostic information, it is unlikely that transdiagnostic research will bear any real-world meaning for clinicians, patients, and medical practice. Similarly, poor reporting on the number and type of (trans)diagnostic spectra prevents the appraisal, refinement, and eventual integration of categorical and dimensional approaches in psychiatric classification. The systematic review acknowledged that transdiagnostic categorical approaches that respect dimensionality are possible in organic medicine as well as in psychiatry, but this requires transparent reporting of the results. For example, the largest transdiagnostic study published to date demonstrated that it is possible to report the diagnostic information for almost all ICD-10 mental disorders. Furthermore, while it is possible that transdiagnostic interventions may display superior efficiency, cost-effectiveness, accessibility, and patient-reported satisfaction compared to specific-diagnostic interventions, demonstrating this would require robust comparative analyses specifically conducted to test the non-inferiority or superiority of the transdiagnostic approach. These analyses are infrequent in the current literature. The systematic review leveraged these caveats to put forward six empirical transdiagnostic research recommendations: TRANSD. The TRANSD recommendations are pragmatic and focus on improving the quality of appraising and reporting transdiagnostic constructs. Importantly, they do not provide any a priori restrictive definition of the transdiagnostic schemata; as such, they can be applied to different topics and stimulate critical research in the field. The first recommendation is to have a transparent definition of the gold standard (ICD, DSM, other), including specific diagnostic types, official codes, primary vs. secondary diagnoses, and diagnostic assessment interviews. Second, the primar","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47429363","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}
355 tive symptoms or severe residual anhedonia, or in a patient with an anxiety disorder despite increased avoidance behavior, or in a patient with schizophrenia despite high levels of negative or cognitive symptoms. Functioning or distress are often not taken into account when defining an (in)adequate response, while, in some patients with schizophrenia, learning to cope with a treatment resistant hallucination can significantly decrease dis tress and hence improve quality of life. The reason why most definitions of treatment resistance re quire two previous unsuccessful treatment episodes is also unclear. The Sequenced Treatment Alternatives to Relieve De pression (STAR*D) trial documented that, with each treatment step, an incremental gain in the response rate is observed, but there is also an incremental dropout rate and a higher and faster rate of relapse. Furthermore, in defining treatment resistant schizophrenia, only pharmacotherapy is considered, while, in defining treat ment resistant anxiety disorders, both pharmacotherapy and psychotherapy are taken into account. It is remarkable that, in treatment resistant depression, psychotherapy or neuromodu lation (except electroconvulsive therapy) are most often not con sidered. The fact that outcome in trials with treatment resistant pa tients provide different results depending on whether the two treatment episodes with inadequate response were both retro spective or whether one was retrospective and the other one prospective further documents the difficulty in obtaining a ho mogeneous patient population. The recommendation that each of the two treatment epi sodes should have lasted “at least six weeks” is understandable from both a trial design and a clinical point of view, since few nonresponders within the first six weeks will respond later, but again is far away from daily practice: health insurance da tabases show that a third treatment step is on average started after 43 weeks, which is important to take into account, since duration of an illness episode predicts outcome. It is understandable that classification attempts are now moving away from two categories (nonresistant or resistant) versus staging and “levels of resistance” approaches. These are based on number of treatments (with different treatments getting diff erential weights), episode duration and symptom severity. More fundamentally, it has been suggested that the expres sion “treatment resistance” is “devoid of empathy”. Indeed, the expression seems to blame the disorder or even the patient: for example, a lay press article mentioned that a new antidepres sant “can cause rapid antidepressant effects in many people with ‘stubborn’ depression”. Finally, the concept of “treatment resistance” stems from an acute illness model with remission or cure as the goal. Unfortu nately, not all patients with psychiatric disorders can reach that symptomfree goal. That’s why the use of the more collabora tive expression “
{"title":"Factors facilitating or preventing compulsory admission in psychiatry","authors":"W. Rössler","doi":"10.1002/wps.20678","DOIUrl":"https://doi.org/10.1002/wps.20678","url":null,"abstract":"355 tive symptoms or severe residual anhedonia, or in a patient with an anxiety disorder despite increased avoidance behavior, or in a patient with schizophrenia despite high levels of negative or cognitive symptoms. Functioning or distress are often not taken into account when defining an (in)adequate response, while, in some patients with schizophrenia, learning to cope with a treatment resistant hallucination can significantly decrease dis tress and hence improve quality of life. The reason why most definitions of treatment resistance re quire two previous unsuccessful treatment episodes is also unclear. The Sequenced Treatment Alternatives to Relieve De pression (STAR*D) trial documented that, with each treatment step, an incremental gain in the response rate is observed, but there is also an incremental dropout rate and a higher and faster rate of relapse. Furthermore, in defining treatment resistant schizophrenia, only pharmacotherapy is considered, while, in defining treat ment resistant anxiety disorders, both pharmacotherapy and psychotherapy are taken into account. It is remarkable that, in treatment resistant depression, psychotherapy or neuromodu lation (except electroconvulsive therapy) are most often not con sidered. The fact that outcome in trials with treatment resistant pa tients provide different results depending on whether the two treatment episodes with inadequate response were both retro spective or whether one was retrospective and the other one prospective further documents the difficulty in obtaining a ho mogeneous patient population. The recommendation that each of the two treatment epi sodes should have lasted “at least six weeks” is understandable from both a trial design and a clinical point of view, since few nonresponders within the first six weeks will respond later, but again is far away from daily practice: health insurance da tabases show that a third treatment step is on average started after 43 weeks, which is important to take into account, since duration of an illness episode predicts outcome. It is understandable that classification attempts are now moving away from two categories (nonresistant or resistant) versus staging and “levels of resistance” approaches. These are based on number of treatments (with different treatments getting diff erential weights), episode duration and symptom severity. More fundamentally, it has been suggested that the expres sion “treatment resistance” is “devoid of empathy”. Indeed, the expression seems to blame the disorder or even the patient: for example, a lay press article mentioned that a new antidepres sant “can cause rapid antidepressant effects in many people with ‘stubborn’ depression”. Finally, the concept of “treatment resistance” stems from an acute illness model with remission or cure as the goal. Unfortu nately, not all patients with psychiatric disorders can reach that symptomfree goal. That’s why the use of the more collabora tive expression “","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41365200","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}
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
{"title":"Migration, ethnicity and psychoses: evidence, models and future directions.","authors":"Craig Morgan, Gemma Knowles, Gerard Hutchinson","doi":"10.1002/wps.20655","DOIUrl":"https://doi.org/10.1002/wps.20655","url":null,"abstract":"<p><p>There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"247-258"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20655","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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