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":"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":60.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732691/pdf/WPS-18-247.pdf","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}
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}
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}
Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non‐medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, “z‐drugs”, melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non‐selective antihistamines. A review of the available research indicates that rigorous double‐blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence‐based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.
{"title":"The assessment and management of insomnia: an update","authors":"A. Krystal, A. Prather, L. Ashbrook","doi":"10.1002/wps.20674","DOIUrl":"https://doi.org/10.1002/wps.20674","url":null,"abstract":"Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non‐medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, “z‐drugs”, melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non‐selective antihistamines. A review of the available research indicates that rigorous double‐blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence‐based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.","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.20674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44014978","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}
Joseph Firth, Scott B Teasdale, Kelly Allott, Dan Siskind, Wolfgang Marx, Jack Cotter, Nicola Veronese, Felipe Schuch, Lee Smith, Marco Solmi, André F Carvalho, Davy Vancampfort, Michael Berk, Brendon Stubbs, Jerome Sarris
The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from "nutrient supplements", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.
{"title":"The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials.","authors":"Joseph Firth, Scott B Teasdale, Kelly Allott, Dan Siskind, Wolfgang Marx, Jack Cotter, Nicola Veronese, Felipe Schuch, Lee Smith, Marco Solmi, André F Carvalho, Davy Vancampfort, Michael Berk, Brendon Stubbs, Jerome Sarris","doi":"10.1002/wps.20672","DOIUrl":"10.1002/wps.20672","url":null,"abstract":"<p><p>The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from \"nutrient supplements\", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":"308-324"},"PeriodicalIF":60.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44113255","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}
M. Forbes, Aidan G.C. Wright, K. Markon, R. Krueger
World Psychiatry 18:3 October 2019 pathic personality disorders, respectively. The obsessive-compulsive personality disorder is defined largely by maladaptive conscientiousness (e.g., perfectionism, compulsivity, workaholism, and ruminative deliberation), but most measures of FFM conscientiousness do not assess for these maladaptive variants. Measures to assess maladaptive FFM traits, though, have been developed, including the Five Factor Model Personality Disorder scales, the Personality Inventory for DSM-5, and the Personality Inventory for ICD-11. There are a number of advantages in conceptualizing the ICD and DSM personality disorders from the perspective of the FFM. Many of the ICD and DSM personality disorder syndromes have limited research interest and inadequate empirical support. The FFM brings to the personality disorders a substantial body of construct validation, including a resolution of such notable controversies as gender bias, excessive diagnostic overlap, and temporal instability. An understanding of the etiology, pathology and treatment of the personality disorders has been hindered substantially by the heterogeneity within and the overlap across the diagnostic categories. The American Psychiatric Association has been publishing treatment guidelines for every disorder within the DSM, but guidelines have been provided for only one of the ten personality disorders (i.e., borderline). The complex heterogeneity of the categorical syndromes complicates considerably the ability to develop an explicit, uniform treatment protocol. The domains of the FFM are considerably more homogeneous and distinct, lending themselves well for more distinct models of etiology, pathology and treatment. Empirically validated treatment protocols have already been developed for FFM neuroticism. A common concern regarding the FFM and any other dimensional trait model is that clinicians will be unfamiliar with this approach and will find it difficult to apply. However, the FFM organization is consistent with the manner in which persons naturally think of personality trait description. Persons who apply the FFM typically find it quite easy to use. There have in fact been a number of studies concerning the clinical utility of the FFM in comparison to the DSM syndromes. A few of these studies have favored the DSM syndromes but, when the methodological limitations of these particular studies were addressed in subsequent studies, the results consistently favored the FFM. Experienced clinicians prefer the FFM and dimensional trait models for the conceptualization of personality disorders. In sum, the FFM is the predominant model of general personality structure and offers the opportunity for a truly integrative understanding of personality structure across the fields of clinical psychiatry and basic personality science. The ICD and DSM models for the classification and diagnosis of personality disorder are shifting toward the FFM because of its empirical validatio
{"title":"The network approach to psychopathology: promise versus reality","authors":"M. Forbes, Aidan G.C. Wright, K. Markon, R. Krueger","doi":"10.1002/wps.20659","DOIUrl":"https://doi.org/10.1002/wps.20659","url":null,"abstract":"World Psychiatry 18:3 October 2019 pathic personality disorders, respectively. The obsessive-compulsive personality disorder is defined largely by maladaptive conscientiousness (e.g., perfectionism, compulsivity, workaholism, and ruminative deliberation), but most measures of FFM conscientiousness do not assess for these maladaptive variants. Measures to assess maladaptive FFM traits, though, have been developed, including the Five Factor Model Personality Disorder scales, the Personality Inventory for DSM-5, and the Personality Inventory for ICD-11. There are a number of advantages in conceptualizing the ICD and DSM personality disorders from the perspective of the FFM. Many of the ICD and DSM personality disorder syndromes have limited research interest and inadequate empirical support. The FFM brings to the personality disorders a substantial body of construct validation, including a resolution of such notable controversies as gender bias, excessive diagnostic overlap, and temporal instability. An understanding of the etiology, pathology and treatment of the personality disorders has been hindered substantially by the heterogeneity within and the overlap across the diagnostic categories. The American Psychiatric Association has been publishing treatment guidelines for every disorder within the DSM, but guidelines have been provided for only one of the ten personality disorders (i.e., borderline). The complex heterogeneity of the categorical syndromes complicates considerably the ability to develop an explicit, uniform treatment protocol. The domains of the FFM are considerably more homogeneous and distinct, lending themselves well for more distinct models of etiology, pathology and treatment. Empirically validated treatment protocols have already been developed for FFM neuroticism. A common concern regarding the FFM and any other dimensional trait model is that clinicians will be unfamiliar with this approach and will find it difficult to apply. However, the FFM organization is consistent with the manner in which persons naturally think of personality trait description. Persons who apply the FFM typically find it quite easy to use. There have in fact been a number of studies concerning the clinical utility of the FFM in comparison to the DSM syndromes. A few of these studies have favored the DSM syndromes but, when the methodological limitations of these particular studies were addressed in subsequent studies, the results consistently favored the FFM. Experienced clinicians prefer the FFM and dimensional trait models for the conceptualization of personality disorders. In sum, the FFM is the predominant model of general personality structure and offers the opportunity for a truly integrative understanding of personality structure across the fields of clinical psychiatry and basic personality science. The ICD and DSM models for the classification and diagnosis of personality disorder are shifting toward the FFM because of its empirical validatio","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.20659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42935308","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":"Psychiatry, human rights and social development: progress on the WPA Action Plan 2017‐2020","authors":"H. Herrman","doi":"10.1002/wps.20686","DOIUrl":"https://doi.org/10.1002/wps.20686","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.20686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47876935","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":"Targets and outcomes of psychological interventions: implications for guidelines and policy.","authors":"Mark van Ommeren","doi":"10.1002/wps.20669","DOIUrl":"10.1002/wps.20669","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"295-296"},"PeriodicalIF":60.5,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732699/pdf/WPS-18-295.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217722","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":"Transdiagnostic psychiatry: premature closure on a crucial pathway to clinical utility for psychiatric diagnosis","authors":"P. McGorry, B. Nelson","doi":"10.1002/wps.20679","DOIUrl":"https://doi.org/10.1002/wps.20679","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.20679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49421649","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}
World Psychiatry 18:3 October 2019 neurotransmitters, such as serotonin, can be attached to his tones and facilitate gene expression in neurons. In parallel, experimental approaches have become more so phisticated and informative. Several laboratory innovations are of particular interest for psychiatric epigenomics. First, single cell approaches are redefining the meaning of epigenetic sto chasticity and directly address the issues of cell type differences in the brain. Second, easily available somatic cells, such as fibro blasts, can be reprogrammed into neurons, partially addressing the need for brain tissue. Third, CRISPRCas9 technology can be used not only for editing genomes, but also epigenomes, which is of considerable interest for modeling disease components in tissue culture and animals. Fourth, progress in computational strategies has enabled the integration of epigenomic data with genomics, transcriptomics, and metabolomics. The compre hensive transomic approaches enable the identification of hub elements and cellular pathways centrally involved in disease. Given the rapid developments in molecular biology and brain imaging technologies, an ideal experiment – a prospective epi genomic study in the living brain of psychosispredisposed individuals – may not be science fiction in the near future. Despite the challenges thus far, epigenetics and epigenomics remain an important part of the psychiatric research agenda. There are still no better ways to explain the numerous dynamic features of complex diseases, which by definition do not con form with the stability of DNA sequence. Uncovering the mech anisms of discordance in monozygotic twins or the delayed age of psychosis onset would be of major importance for precision psychiatry. The success and progress of psychiatric epigenetics relies on the ever improving experimental and computational tools and, more importantly, on the diligence and creativity of scientists working on this very interesting, but also challenging, part of human biology.
{"title":"What is treatment resistance in psychiatry? A “difficult to treat” concept","authors":"K. Demyttenaere","doi":"10.1002/wps.20677","DOIUrl":"https://doi.org/10.1002/wps.20677","url":null,"abstract":"World Psychiatry 18:3 October 2019 neurotransmitters, such as serotonin, can be attached to his tones and facilitate gene expression in neurons. In parallel, experimental approaches have become more so phisticated and informative. Several laboratory innovations are of particular interest for psychiatric epigenomics. First, single cell approaches are redefining the meaning of epigenetic sto chasticity and directly address the issues of cell type differences in the brain. Second, easily available somatic cells, such as fibro blasts, can be reprogrammed into neurons, partially addressing the need for brain tissue. Third, CRISPRCas9 technology can be used not only for editing genomes, but also epigenomes, which is of considerable interest for modeling disease components in tissue culture and animals. Fourth, progress in computational strategies has enabled the integration of epigenomic data with genomics, transcriptomics, and metabolomics. The compre hensive transomic approaches enable the identification of hub elements and cellular pathways centrally involved in disease. Given the rapid developments in molecular biology and brain imaging technologies, an ideal experiment – a prospective epi genomic study in the living brain of psychosispredisposed individuals – may not be science fiction in the near future. Despite the challenges thus far, epigenetics and epigenomics remain an important part of the psychiatric research agenda. There are still no better ways to explain the numerous dynamic features of complex diseases, which by definition do not con form with the stability of DNA sequence. Uncovering the mech anisms of discordance in monozygotic twins or the delayed age of psychosis onset would be of major importance for precision psychiatry. The success and progress of psychiatric epigenetics relies on the ever improving experimental and computational tools and, more importantly, on the diligence and creativity of scientists working on this very interesting, but also challenging, part of human biology.","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.20677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48677023","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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