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Clinical decision making in Psychiatry

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https://www.readbyqxmd.com/read/29122225/-web-visit-patterns-for-the-clinical-practice-guidelines-for-management-of-depressive-disorder-and-alcohol-abuse-dependence
#1
Fernando Suárez-Obando, Carlos Gómez Restrepo
INTRODUCTION: Clinical practice guidelines (CPG) are a set of recommendations for professionals, patients, and families, in order to make decisions about health care. The CPG respond to the need for concise, accurate, practical, and up to date information. In the field of mental health, Colombia has developed three GPC; alcohol (GPC-OH), depression (GPC-TDA), and schizophrenia. OBJECTIVES: To describe the Web Portal traffic related to psychiatry guidelines, with emphasis on the number of visits, distribution throughout Colombian cities, and estimating user behaviour patterns...
October 2017: Revista Colombiana de Psiquiatría
https://www.readbyqxmd.com/read/29110776/psychiatric-syndromes-other-than-dementia
#2
Karl Bechter, Florian Deisenhammer
There is wide variability in how psychiatry guidelines and textbooks address the question of cerebrospinal fluid (CSF) diagnostics in the screening of psychiatric disorders. A United States-based textbook confirms that there is no consensus about which laboratory investigation should be routinely performed in psychiatric patients, but with respect to CSF diagnostics, the differences are even more striking. A survey among European experts showed a wide variety of opinions regarding clinical use and criteria in various countries of Europe and worldwide: some psychiatrists, mostly university hospital-based, recommended performing CSF diagnostics in every patient first experiencing severe mental illness (SMI), but especially in patients from the schizophrenia spectrum, whereas others almost never perform CSF examinations themselves and usually refer patients to neurology departments if necessary...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29052262/diversion-evaluations-a-specialized-forensic-examination
#3
Virginia Barber-Rioja, Merrill Rotter, Faith Scombs
Diversion programs screen justice-involved individuals for the presence of psychiatric disorders, and after negotiations take place with attorneys and treatment providers, these programs link participants with community-based treatment programs in lieu of incarceration. As the number of diversion programs, including mental health courts, continues to rapidly grow, so does the need for "diversion evaluations". Diversion evaluations are a type of forensic mental health assessment (FMHA) conducted to assist the courts in making decisions regarding diversion eligibility...
October 19, 2017: Behavioral Sciences & the Law
https://www.readbyqxmd.com/read/29017332/shared-decision-making-in-mental-health-the-importance-for-current-clinical-practice
#4
Victoria Alguera-Lara, Michelle M Dowsey, Jemimah Ride, Skye Kinder, David Castle
OBJECTIVES: We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. METHODS: Narrative review of published English-language articles. RESULTS: After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers...
October 1, 2017: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/28983797/clinical-factors-associated-with-decision-to-recommend-methylphenidate-treatment-for-children-with-adhd-in-france
#5
Elodie Courtabessis, Florence Pupier, Laurie Surig, Marie-Christine Picot, Erika Nogué, Valérie Macioce, Elizabeth Stein, Diane Purper-Ouakil
European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician's decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France...
October 5, 2017: European Child & Adolescent Psychiatry
https://www.readbyqxmd.com/read/28967349/the-revolution-of-personalized-psychiatry-will-technology-make-it-happen-sooner
#6
G Perna, M Grassi, D Caldirola, C B Nemeroff
Personalized medicine (PM) aims to establish a new approach in clinical decision-making, based upon a patient's individual profile in order to tailor treatment to each patient's characteristics. Although this has become a focus of the discussion also in the psychiatric field, with evidence of its high potential coming from several proof-of-concept studies, nearly no tools have been developed by now that are ready to be applied in clinical practice. In this paper, we discuss recent technological advances that can make a shift toward a clinical application of the PM paradigm...
October 2, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/28966147/understanding-psychiatric-disorder-by-capturing-ecologically-relevant-features-of-learning-and-decision-making
#7
REVIEW
Jacqueline Scholl, Miriam Klein-Flügge
Recent research in cognitive neuroscience has begun to uncover the processes underlying increasingly complex voluntary behaviours, including learning and decision-making. Partly this success has been possible by progressing from simple experimental tasks to paradigms that incorporate more ecological features. More specifically, the premise is that to understand cognitions and brain functions relevant for real life, we need to introduce some of the ecological challenges that we have evolved to solve. This often entails an increase in task complexity, which can be managed by using computational models to help parse complex behaviours into specific component mechanisms...
September 28, 2017: Behavioural Brain Research
https://www.readbyqxmd.com/read/28859585/prevalence-of-serious-emotional-disturbance-among-u-s-children-a-meta-analysis
#8
Nathaniel J Williams, Lysandra Scott, Gregory A Aarons
OBJECTIVE: Prevalence estimates of child psychiatric disorders with severe impairment vary widely, and there is a critical need for precise estimates to inform clinical practice and policy in the United States. This study presents a systematic review and meta-analysis of population-based U.S. studies estimating the prevalence of youths with serious emotional disturbance (SED), as defined by the Substance Abuse and Mental Health Services Administration. METHODS: Studies were identified through searches of the MEDLINE and PsycINFO databases and nine prior reviews...
September 1, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28822460/-french-society-for-biological-psychiatry-and-neuropsychopharmacology-and-fondation-fondamental-task-force-formal-consensus-for-the-management-of-treatment-resistant-depression
#9
T Charpeaud, J-B Genty, S Destouches, A Yrondi, S Lancrenon, N Alaïli, F Bellivier, D Bennabi, T Bougerol, V Camus, T D'amato, O Doumy, F Haesebaert, J Holtzmann, C Lançon, M Lefebvre, F Moliere, I Nieto, R Richieri, L Schmitt, F Stephan, G Vaiva, M Walter, M Leboyer, W El-Hage, E Haffen, P-M Llorca, P Courtet, B Aouizerate
Major depression represents among the most frequent psychiatric disorders in the general population with an estimated lifetime prevalence of 16-17%. It is characterized by high levels of comorbidities with other psychiatric conditions or somatic diseases as well as a recurrent or chronic course in 50 to 80% of the cases leading to negative repercussions on the daily functioning, with an impaired quality of life, and to severe direct/indirect costs. Large cohort studies have supported that failure of a first-line antidepressant treatment is observed in more than 60% of patients...
September 2017: L'Encéphale
https://www.readbyqxmd.com/read/28732477/a-web-based-clinical-decision-tool-to-support-treatment-decision-making-in-psychiatry-a-pilot-focus-group-study-with-clinicians-patients-and-carers
#10
Catherine Henshall, Lisa Marzano, Katharine Smith, Mary-Jane Attenburrow, Stephen Puntis, Jakov Zlodre, Kathleen Kelly, Matthew R Broome, Susan Shaw, Alvaro Barrera, Andrew Molodynski, Alastair Reid, John R Geddes, Andrea Cipriani
BACKGROUND: Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers...
July 21, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28700651/metric-based-vs-peer-reviewed-evaluation-of-a-research-output-lesson-learnt-from-uk-s-national-research-assessment-exercise
#11
Kushwanth Koya, Gobinda Chowdhury
PURPOSE: There is a general inquisition regarding the monetary value of a research output, as a substantial amount of funding in modern academia is essentially awarded to good research presented in the form of journal articles, conferences papers, performances, compositions, exhibitions, books and book chapters etc., which, eventually leads to another question if the value varies across different disciplines. Answers to these questions will not only assist academics and researchers, but will also help higher education institutions (HEIs) make informed decisions in their administrative and research policies...
2017: PloS One
https://www.readbyqxmd.com/read/28603434/investigating-a-self-scoring-interview-simulation-for-learning-and-assessment-in-the-medical-consultation
#12
Catherine Bruen, Clarence Kreiter, Vincent Wade, Teresa Pawlikowska
Experience with simulated patients supports undergraduate learning of medical consultation skills. Adaptive simulations are being introduced into this environment. The authors investigate whether it can underpin valid and reliable assessment by conducting a generalizability analysis using IT data analytics from the interaction of medical students (in psychiatry) with adaptive simulations to explore the feasibility of adaptive simulations for supporting automated learning and assessment. The generalizability (G) study was focused on two clinically relevant variables: clinical decision points and communication skills...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28599832/model-based-control-in-dimensional-psychiatry
#13
REVIEW
Valerie Voon, Andrea Reiter, Miriam Sebold, Stephanie Groman
We use parallel interacting goal-directed and habitual strategies to make our daily decisions. The arbitration between these strategies is relevant to inflexible repetitive behaviors in psychiatric disorders. Goal-directed control, also known as model-based control, is based on an affective outcome relying on a learned internal model to prospectively make decisions. In contrast, habit control, also known as model-free control, is based on an integration of previous reinforced learning autonomous of the current outcome value and is implicit and more efficient but at the cost of greater inflexibility...
April 23, 2017: Biological Psychiatry
https://www.readbyqxmd.com/read/28553839/a-primer-on-foraging-and-the-explore-exploit-trade-off-for-psychiatry-research
#14
REVIEW
M A Addicott, J M Pearson, M M Sweitzer, D L Barack, M L Platt
Foraging is a fundamental behavior, and many types of animals appear to have solved foraging problems using a shared set of mechanisms. Perhaps the most common foraging problem is the choice between exploiting a familiar option for a known reward and exploring unfamiliar options for unknown rewards-the so-called explore/exploit trade-off. This trade-off has been studied extensively in behavioral ecology and computational neuroscience, but is relatively new to the field of psychiatry. Explore/exploit paradigms can offer psychiatry research a new approach to studying motivation, outcome valuation, and effort-related processes, which are disrupted in many mental and emotional disorders...
September 2017: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28496402/cortico-striatal-thalamic-loop-circuits-of-the-orbitofrontal-cortex-promising-therapeutic-targets-in-psychiatric-illness
#15
REVIEW
Peter Fettes, Laura Schulze, Jonathan Downar
Corticostriatal circuits through the orbitofrontal cortex (OFC) play key roles in complex human behaviors such as evaluation, affect regulation and reward-based decision-making. Importantly, the medial and lateral OFC (mOFC and lOFC) circuits have functionally and anatomically distinct connectivity profiles which differentially contribute to the various aspects of goal-directed behavior. OFC corticostriatal circuits have been consistently implicated across a wide range of psychiatric disorders, including major depressive disorder (MDD), obsessive compulsive disorder (OCD), and substance use disorders (SUDs)...
2017: Frontiers in Systems Neuroscience
https://www.readbyqxmd.com/read/28455596/clinical-decision-support-systems-in-child-and-adolescent-psychiatry-a-systematic-review
#16
REVIEW
Roman Koposov, Sturla Fossum, Thomas Frodl, Øystein Nytrø, Bennett Leventhal, Andre Sourander, Silvana Quaglini, Massimo Molteni, María de la Iglesia Vayá, Hans-Ulrich Prokosch, Nicola Barbarini, Michael Peter Milham, Francisco Xavier Castellanos, Norbert Skokauskas
Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004)...
November 2017: European Child & Adolescent Psychiatry
https://www.readbyqxmd.com/read/28401326/clinical-judgment-moral-anxiety-and-the-limits-of-psychiatry
#17
Bradley Murray
It is common for clinicians working in psychiatry and related clinical disciplines to be called on to make diagnostic clinical judgments concerning moral anxiety, which is a kind of anxiety that is closely bound up with decisions individuals face as moral agents. To make such a judgment, it is necessary to make a moral judgment. Although it has been common to acknowledge that there are ways in which moral and clinical judgment interact, this type of interaction has remained unacknowledged. This raises questions as to the nature and limits of psychiatry-particularly concerning the extent to which psychiatric discourse ought to incorporate moral discourse, and the role of the clinician as an expert in identifying problematic anxiety...
December 2017: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/28396067/control-conditions-for-randomised-trials-of-behavioural-interventions-in-psychiatry-a-decision-framework
#18
REVIEW
Stefan M Gold, Paul Enck, Helge Hasselmann, Tim Friede, Ulrich Hegerl, David C Mohr, Christian Otte
In psychiatry, comparative analyses of therapeutic options and the aggregation of data from clinical trials across different therapeutic approaches play an important role in clinical decision making, treatment guidelines, and health policy. This approach assumes that trials of pharmacological and behavioural therapies generally produce the same level of evidence when properly designed. However, trial design for behavioural interventions has some unique characteristics and control groups vary widely, which influence the effects observed in any given trial...
September 2017: Lancet Psychiatry
https://www.readbyqxmd.com/read/28387975/insular-and-cingulate-attenuation-during-decision-making-is-associated-with-future-transition-to-stimulant-use-disorder
#19
Jennifer L Stewart, Mamona Butt, April C May, Susan F Tapert, Martin P Paulus
AIMS: To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder. DESIGN: Longitudinal study. SETTING: University of California, San Diego Department of Psychiatry, CA, USA. PARTICIPANTS: Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed 3 years later, OSU (n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using)...
September 2017: Addiction
https://www.readbyqxmd.com/read/28216782/indian-psychiatric-society-survey-on-clinical-practice-guidelines
#20
Sandeep Grover, Ajit Avasthi
AIM: This survey aimed to assess the utility of the earlier published clinical practice guidelines (CPGs) by IPS and to understand the expectations of members of Indian Psychiatric Society from the proposed revised CPGs. In addition, the survey also evaluated the current level of practice of psychiatry in terms of availability of different investigation facilities, prescription patterns in terms of use of polypharmacy, and competence in carrying out certain nonpharmacological treatments...
January 2017: Indian Journal of Psychiatry
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