Annals of Clinical Psychiatry最新文献_第8页

Multiple facets of conflict of interest. 利益冲突的多个方面。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-05-01 DOI: 10.12788/acp.0070

R. Balon

For most physicians, the phrase “conflict of interest” (COI) usually refers to a financial COI, such as physicians receiving payments from a pharmaceutical company. Financial COI is the most frequently discussed COI, and the one disclosed at the end of articles in professional journals. However, financial COI is not the only COI an individual may have. The recent debate about the origin of the virus that causes COVID-19 and the possibility that it escaped from a laboratory in Wuhan, China, revealed another facet of COI—the impact of ideology and personal belief. Some researchers strongly opposed the lab leak theory and attacked those who proposed it. For many, the fact that President Donald J. Trump proposed the virus originated in China was argument enough to label the lab leak theory as yet another conspiracy theory. Additionally, there is what I call “ideological bias” or “ideological COI,” eg, some of the opponents of the lab leak theory were probably impacted by the fact that their reputation would be ruined if it turned out to be true. Unbelievably, Facebook and Wikipedia initially banned any suggestion that the virus may had leaked from the Wuhan laboratory. Interestingly, with President Trump’s departure from office, more people were willing to entertain the possibility that the virus that causes COVID-19 escaped from the laboratory and were willing to investigate this theory. I believe this tale does not paint a very laudatory picture of many scientists and the state of present-day science. It also raises serious questions about nonfinancial COIs. I believe that compared to financial COIs, nonfinancial COIs have a similar, if not worse, impact on scientific conduct. As a profession, psychiatry has focused on discussing and disclosing financial COIs. Yet, there are numerous nonfinancial pressures and COIs. As Korn wrote, “These pressures ... include the desire for faculty advancement, to compete successfully and repetitively for sponsored research funding, to receive academic accolades from professional peers and win Richard Balon, MD Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology Wayne State University Detroit, Michigan, USA

对于大多数医生来说，术语“利益冲突”(COI)通常指的是财务上的COI，例如医生从制药公司收取报酬。财务COI是讨论频率最高的COI，也是在专业期刊文章末尾披露的COI。然而，财务COI并不是个人可能拥有的唯一COI。最近关于导致COVID-19的病毒的来源以及病毒可能从中国武汉的一个实验室逃逸的争论，揭示了coi的另一个方面——意识形态和个人信仰的影响。一些研究人员强烈反对实验室泄漏理论，并攻击提出这一理论的人。对许多人来说，唐纳德·j·特朗普总统提出病毒起源于中国这一事实足以让实验室泄密论成为又一个阴谋论。此外，还有我所说的“意识形态偏见”或“意识形态COI”，例如，实验室泄密理论的一些反对者可能受到这样一个事实的影响，即如果它被证明是真的，他们的声誉将被毁。令人难以置信的是，Facebook和维基百科最初禁止任何关于病毒可能从武汉实验室泄露的说法。有趣的是，随着特朗普总统的离任，更多人愿意接受导致COVID-19的病毒从实验室逃逸的可能性，并愿意调查这一理论。我相信这个故事并没有描绘出许多科学家和当今科学状况的美好图景。这也引发了有关非金融投资组合的严重问题。我认为，与金融coi相比，非金融coi对科学行为的影响即使不是更糟，也是相似的。作为一种职业，精神病学一直专注于讨论和披露财务coi。然而，还有许多非金融压力和投资回报率。正如科恩所写，“这些压力……包括对教师进步的渴望，成功地竞争和反复获得赞助的研究资金，从专业同行那里获得学术荣誉，并赢得美国密歇根州底特律韦恩州立大学精神病学和行为神经科学和麻醉学博士理查德·巴隆

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引用次数: 0

Association between headache and suicidality: An analysis of universal suicide screening data at a large urban county hospital. 头痛与自杀之间的关系:对某大型城市县医院普遍自杀筛查数据的分析。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-05-01 DOI: 10.12788/acp.0068

Charles Ho, Lilian Cole, Kaylee Davis-Bordovsky, A. Eichenberger, Anna Faubion, Matthew Faubion, Colette Kendrick, Neema Khonsari, Joshua Lampley, Adeeb Masood, K. Nuako, Eduardo Rivera Mirabal, Natalie Spiller, Joshua Walther, Bernice N. Yau, M. Yung, J. Raitt, A. Kulikova, C. North, Kimberly Roaten, E. Brown

BACKGROUNDIdentifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes.METHODSThis study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality.RESULTSThere were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches.CONCLUSIONSThe association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

背景:鉴别自杀风险增加的个体是很重要的，特别是那些因非精神疾病主诉而就诊却未被发现的个体。已经发现疼痛症状，如头痛，与自杀有关，尽管这种联系需要进一步的描述。本研究调查了与头痛亚型相关的自杀行为的具体组成部分。方法:本研究回顾性分析了一家大型县医院2832835例成人非精神疾病临床就诊，该医院普遍采用标准化自杀风险筛查工具哥伦比亚自杀严重程度评定量表(C-SSRS)。C-SSRS评估自杀行为的具体组成部分:希望死亡和自杀意念、方法、意图、计划和行动。采用多变量logistic回归来评估头痛以及头痛亚型(偏头痛、紧张或丛集性)与自杀行为各组成部分之间的关系。结果出现头痛与自杀倾向的2个具体组成部分:希望死亡和自杀行为之间存在显著的正相关。与偏头痛和丛集性头痛患者相比，紧张性头痛患者希望死亡的风险可能更低。结论:头痛与自杀倾向的特定因素的关联表明，在具有非精神疾病表现的个体中，识别自杀风险的潜在收益。

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引用次数: 1

Deconstructing childhood conduct and adult antisocial criteria for the diagnosis of antisocial personality disorder. 解构儿童行为和成人反社会标准诊断反社会人格障碍。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-05-01 DOI: 10.12788/acp.0063

C. North, Vinay Kotamarti, D. Pollio

BACKGROUNDAntisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups defined by these aspects of the criteria have not been fully explored.METHODSData for ASPD were analyzed for 3,498 individuals in the St Louis, Missouri, site of the Epidemiologic Catchment Area study of general population psychiatric disorders collected in the early 1980s using structured diagnostic interviews for DSM-III criteria. Effects of the criteria on population subgroups defined by various combinations of the criteria were examined.RESULTSEarlier-onset conduct disorder was more severe than later-onset childhood conduct disorder, with more total childhood and adult symptoms and negative psychosocial adult outcomes (substance use disorders, criminality, and homelessness). Three subgroups with adult antisocial behaviors (differentiated by no conduct disorder, later-onset conduct disorder, and earlier-onset conduct disorder meeting ASPD criteria) were similar in numbers of adult antisocial symptoms, but the ASPD subgroup had more negative psychosocial adult outcomes.CONCLUSIONSThese findings provide evidence for and against reconsideration of the 15-year age-of-onset requirement for conduct symptoms in ASPD criteria.

反社会型人格障碍(ASPD)是一种严重的精神障碍，对个人和社会都可能造成丧失行为能力和昂贵的代价。反社会障碍的诊断有两个主要组成部分，儿童行为问题和成人反社会行为，有特定的年龄要求。这些标准对由标准的这些方面定义的人群亚群的病毒学影响尚未得到充分探讨。方法采用DSM-III标准的结构化诊断访谈，对密苏里州圣路易斯市3498名普通人群精神疾病流行病学集水区研究站点的反社会人格障碍数据进行分析。标准对由各种标准组合定义的人口亚群的影响进行了检查。结果早发性行为障碍比晚发性儿童行为障碍更严重，有更多的儿童和成人总症状和负面的成人社会心理结局(物质使用障碍、犯罪和无家可归)。有成人反社会行为的三个亚组(分为无品行障碍、晚发性品行障碍和早发性品行障碍，符合反社会障碍标准)在成人反社会症状的数量上相似，但反社会障碍亚组有更多负面的成人社会心理结局。结论这些发现为支持和反对重新考虑反社会人格障碍标准中行为症状的15岁发病年龄要求提供了证据。

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引用次数: 2

The psychiatrist in scrubs. 穿着外科医生服的精神病医生。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-05-01 DOI: 10.12788/acp.0066

M. Morrissette

Comments on the article, It is time for a dress code in psychiatry by R. Balon and M. K. Morreale (2020). I read with great interest the editorial by Balon and Morreale, in which a cogent case is put forth regarding the ramifications of a psychiatrist's attire on the psychiatrist-patient relationship and perceptions of psychiatric treatment. As a child and adolescent psychiatrist who provides consultation to a pediatric emergency department, the topic of appropriate attire for psychiatrists has been especially salient at a time when I, and my colleagues working in the emergency department, have been required to wear scrubs, a face mask, and eye protection when assessing and treating patients as part of hospital practices intended to mitigate the spread of COVID-19. Recent scholarly literature has highlighted potential challenges in the formation of a therapeutic alliance stemming from the use of face masks in psychiatric practice. Our choice of attire is among the manifold factors that influence our interactions with patients, and even when this choice is removed, it is essential that we remain attuned to the potential impacts of our appearances. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

对R. Balon和M. K. Morreale(2020)的文章《是时候制定精神病学着装规范了》的评论。我怀着极大的兴趣阅读了Balon和Morreale的社论，其中提出了一个令人信服的案例，关于精神科医生的着装对精神科医生与病人的关系和对精神科治疗的看法的影响。作为一名为儿科急诊科提供咨询的儿童和青少年精神科医生，当我和我在急诊科工作的同事在评估和治疗患者时被要求戴上磨牙服、口罩和护眼装置，作为减轻COVID-19传播的医院实践的一部分时，精神科医生适当着装的话题尤为突出。最近的学术文献强调了由于在精神病学实践中使用口罩而形成治疗联盟的潜在挑战。我们的着装选择是影响我们与病人互动的众多因素之一，即使这个选择被取消了，我们仍然有必要注意到我们的外表的潜在影响。(PsycInfo数据库记录(c) 2022 APA，版权所有)

引用次数: 0

Antidepressant effect of prolonged twice-weekly intranasal esketamine treatments after nonresponse to electroconvulsive therapy in a patient with treatment-resistant depression. 治疗难治性抑郁症患者电惊厥治疗无效后，延长每周两次鼻内艾氯胺酮治疗的抗抑郁作用。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0055

Audrey Evers, Matthew Klein, Amy Aloysi, James Murrough, Manish K Jha

Presents a case report of a woman with depressive episodes, which began in early 2019 and was worsened by the change of her long-standing antidepressant regimen of fluoxetine to mirtazapine. Subsequently, she received 12 right unilateral ultrabrief pulse electroconvulsive therapy (ECT) treatments without any benefit. She experienced no benefit from 4 additional trials of antidepressants and during our evaluations over several weeks, her mood remained severely depressed. After 6 treatments, she experienced >50% reduction in her depression. However, her esketamine treatments were paused for 8 weeks due to COVID-19. Her depression worsened and a 4-week-long course of twice-weekly treatments was initiated, which resulted in a >50% reduction in her depression. After switching to weekly maintenance treatments, her symptoms of low mood, anhedonia, and suicidal ideation returned to her pre-treatment baseline. As she had responded well to twice-weekly treatments, the frequency of treatments was increased. In summary, this patient responded to twice-weekly esketamine treatments, experienced symptomatic worsening after switching to weekly treatments, but was able to attain remission with prolonged twice-weekly treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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引用次数: 1

Oppositional defiant disorder: Evidence-based review of behavioral treatment programs. 对立违抗性障碍:行为治疗方案的循证回顾。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0056

Mandeep Kaur, Augustus Floyd, Ana-Maria Balta

BACKGROUNDOppositional defiant disorder (ODD) is a common clinical condition seen among children and adolescents in behavioral health settings. In this article, we review behavioral treatment programs and their clinical use in managing ODD.METHODSWe searched PubMed, PsycInfo, and Scopus from 2000 to 2020 using the terms "oppositional defiant disorder" and "treatment." We found 1,665 articles, including clinical trials, review articles, and case control studies of evidence-based ODD treatments in patients age <18. Articles were screened to identify literature focusing on evidence-based behavioral treatment programs for ODD.RESULTSThe literature search revealed abundant evidence supporting the role of behavioral treatment programs for managing ODD and other disruptive behavior disorders. In this review, we discuss the most recent findings on established and effective strategies, including Parent Management Training, Parent-Child Interaction Therapy, Collaborative Problem Solving, Incredible Years program, Triple-P Positive Parenting Program, Start Now and Plan program, and Coping Power Program.CONCLUSIONSODD can cause significant distress to patients and their caregivers. Familiarity with behavioral treatment programs provides clinicians with tools for managing this condition in clinical settings.

背景:对立违抗障碍(ODD)是在行为健康机构中儿童和青少年中常见的临床状况。在本文中，我们回顾行为治疗方案及其在治疗ODD中的临床应用。方法:我们检索PubMed, PsycInfo和Scopus从2000年到2020年，使用术语“对立违抗性障碍”和“治疗”。我们发现了1665篇文章，包括临床试验、综述文章和病例对照研究，以证据为基础的ODD治疗在年龄患者中的作用。结果:文献检索揭示了大量证据支持行为治疗方案在管理ODD和其他破坏性行为障碍中的作用。在这篇综述中，我们讨论了最新的发现和有效的策略，包括家长管理培训，亲子互动治疗，合作解决问题，不可思议的岁月计划，三重p积极育儿计划，现在开始和计划计划，和应对能力计划。结论:ODD会对患者及其护理人员造成严重的痛苦。熟悉行为治疗方案为临床医生提供了在临床环境中管理这种情况的工具。

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引用次数: 0

Skin picking disorder: Does a person's sex matter? 抠皮障碍：一个人的性别重要吗？

IF 1.5 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0049

Jon E Grant, Samuel R Chamberlain

Background: Skin picking disorder (SPD) is characterized by recurrent picking with scarring or tissue damage. Although research suggests that less than one-half of people with SPD are male, there is little clinical information about men with SPD.

Methods: We recruited 95 non-treatment-seeking adults as part of a cross-sectional study of SPD. Men (n = 17) and women (n = 78) with SPD were compared on clinical and cognitive measures. Sex differences in the demographic and clinical characteristics, skin picking sites, and presence of comorbidities were examined using analysis of variance for continuous variables and likelihood ratio Chi-square tests for categorical variables.

Results: Men were significantly more likely than women to report a first-degree relative with skin picking or hair pulling disorders (P = .0174). Men were less likely to pick from their scalps and backs and picked from fewer sites. Men and women did not significantly differ on skin picking severity, disability, impulsivity, or quality of life.

Conclusions: These data indicate that SPD is similarly impairing for men and women, but men may have higher familial loading and a somewhat different distribution and frequency of picking sites. Sex differences in SPD merit more detailed consideration in larger samples, including addressing potentially higher genetic/familial loading in males.

背景：扒皮障碍（SPD）的特征是反复的扒皮并伴有瘢痕或组织损伤。尽管研究表明不到一半的SPD患者是男性，但是关于男性SPD患者的临床信息却很少。方法：我们招募了95名未寻求治疗的成年人作为SPD横断面研究的一部分。对患有SPD的男性（n = 17）和女性（n = 78）进行临床和认知测量的比较。使用连续变量的方差分析和分类变量的似然比卡方检验来检查人口统计学和临床特征、皮肤采摘部位和合并症存在的性别差异。结果：男性比女性更有可能报告有抠皮或拔毛障碍的一级亲属（P = 0.0174）。男性不太可能从头皮和背部上摘，而且从更少的部位上摘。男性和女性在抠皮严重程度、残疾、冲动或生活质量方面没有显著差异。结论：这些数据表明，SPD对男性和女性的损害相似，但男性可能具有更高的家族负荷，并且拾取位点的分布和频率有所不同。SPD的性别差异值得在更大的样本中进行更详细的考虑，包括解决男性可能更高的遗传/家族负荷。

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引用次数: 0

Anxiety, depression, and rejection towards parents among individuals who grew up in a hoarded home. 焦虑、抑郁和对父母的排斥在一个封闭的家庭中长大。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0053

Andrew G Guzick, Suzanne Chabaud, Cecilia Garrett, Eric A Storch

Background: Limited research has investigated parent-child conflict and mental health among adult children of parents with hoarding problems.

Methods: Four hundred fourteen participants who reported clinically significant parental hoarding completed assessments of parental hoarding characteristics (clutter, insight, difficulty discarding), feelings of rejection towards their parent, depression, and generalized anxiety. These latter 3 variables were retrospectively rated across childhood (age 0 to 12), adolescence (age 13 to 20), young adulthood (age 21 to 29), and adulthood (age ≥30 years). Path analyses assessed mediated relationships.

Results: More than one-half of respondents endorsed clinically significant generalized anxiety, and more than one-third endorsed clinically significant depressive symptoms across ages, with highest rates during adolescence. Parental insight was related to rejection across ages, and clutter was related to rejection from adolescence through adulthood. Rejection was significantly positively related to depressive symptoms and generalized anxiety in childhood and adolescence and to depressive symptoms in young adulthood. Poor insight was significantly indirectly related to depressive symptoms through rejection across childhood and adolescence and to generalized anxiety in childhood.

Conclusions: Results suggest that parental hoarding may be a risk factor for anxiety and depression. Feelings of rejection towards parents may account for the link between parental hoarding and psychological distress, particularly between poor insight and depressive symptoms.

背景:关于父母有囤积问题的成年子女的亲子冲突和心理健康的研究有限。方法:414名报告有临床显著父母囤积行为的参与者完成了父母囤积特征(杂乱、洞察力、难以丢弃)、对父母的排斥感、抑郁和广泛性焦虑的评估。后3个变量在儿童期(0 - 12岁)、青春期(13 - 20岁)、青年期(21 - 29岁)和成年期(≥30岁)进行回顾性评分。通径分析评估了中介关系。结果:超过一半的受访者认可具有临床意义的广泛性焦虑，超过三分之一的受访者认可具有临床意义的抑郁症状，其中青少年的比例最高。父母的洞察力与各个年龄段的拒绝有关，而杂乱与从青春期到成年期的拒绝有关。排斥与儿童期和青春期的抑郁症状和广泛性焦虑以及青年期的抑郁症状显著正相关。缺乏洞察力与儿童期和青春期的抑郁症状以及儿童期的广泛性焦虑有显著的间接关系。结论:结果提示父母囤积可能是焦虑和抑郁的危险因素。对父母的排斥感可能解释了父母囤积与心理困扰之间的联系，特别是在洞察力差和抑郁症状之间的联系。

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引用次数: 0

Quality of life in trichotillomania: An assessment of specific life domains. 拔毛癖患者的生活质量:对特定生活领域的评估。

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0052

Stephanie Valle, Jon E Grant

Background: The Quality of Life Inventory (QOLI) gauges importance and satisfaction ratings in areas of life such as work, health, and family. An examination of QOLI scores among individuals with trichotillomania (TTM), a hair-pulling disorder, might provide insight on domain-specific interventions to counteract factors that may be contributing to lower quality-of-life (QOL) scores.

Methods: Three hundred thirty-three adults with TTM and 90 healthy controls (age 18 to 65) completed the QOLI and various symptom severity measures. We compared participants with TTM with controls on their overall QOLI scores as well as on QOL subdomains using independent sample t tests with a Bonferroni correction.

Results: Participants with TTM had significantly lower overall QOL compared with controls (t [421] = 7.858, P < .001). Additionally, participants with TTM reported significantly lower QOL scores in the following areas of their lives: health, self-esteem, goals and values, play, learning, creativity, helping, love, friends, children, and home (all P < .003).

Conclusions: Lower overall QOL and in specific domains of life highlight the complexity of overall life satisfaction measures in people with TTM. Further research may provide direction on future interventions and insight for family and/or friends supporting individuals with TTM.

背景:生活质量量表(QOLI)衡量生活领域的重要性和满意度，如工作、健康和家庭。对拔毛癖(一种拔毛障碍)患者的QOLI评分进行检查，可能会对特定领域的干预措施提供见解，以抵消可能导致生活质量(QOL)评分较低的因素。方法:333名成年TTM患者和90名健康对照者(年龄18 ~ 65岁)完成QOLI和各种症状严重程度测量。我们使用Bonferroni校正的独立样本t检验将TTM参与者与控制组的总体QOLI得分以及QOL子域进行比较。结果:与对照组相比，TTM患者的总体生活质量显著降低(t [421] = 7.858, P < 0.001)。此外，患有TTM的参与者在以下生活领域的生活质量得分显着降低:健康，自尊，目标和价值观，游戏，学习，创造力，帮助，爱情，朋友，孩子和家庭(均P < 0.003)。结论:较低的总体生活质量和特定的生活领域突出了TTM患者总体生活满意度测量的复杂性。进一步的研究可能为未来的干预提供方向，并为支持TTM患者的家人和/或朋友提供见解。

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引用次数: 5

Psychiatry Update Winter 冬季精神病学更新

IF 1.3 4区医学 Q3 PSYCHIATRY

Annals of Clinical Psychiatry

Pub Date : 2022-02-01 DOI: 10.12788/acp.0060

引用次数: 0