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Clinical decision making in Psychiatry

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https://www.readbyqxmd.com/read/28184310/capacity-in-vacuo-an-audit-of-decision-making-capacity-assessments-in-a-liaison-psychiatry-service
#1
Benjamin W J Spencer, Gareth Wilson, Ewa Okon-Rocha, Gareth S Owen, Charlotte Wilson Jones
Aims and method We aimed to audit the documentation of decision-making capacity (DMC) assessments by our liaison psychiatry service against the legal criteria set out in the Mental Capacity Act 2005. We audited 3 months split over a 2-year period occurring before, during and after an educational intervention to staff. Results There were 21 assessments of DMC in month 1 (6.9% of all referrals), 27 (9.7%) in month 16, and 24 (6.6%) in month 21. Only during the intervention (month 16) did any meet our gold-standard (n = 2)...
February 2017: BJPsych Bulletin
https://www.readbyqxmd.com/read/28183085/reviving-research-on-medication-attitudes-for-improving-pharmacotherapy-focusing-on-adherence
#2
Carlos De Las Cuevas, Jose de Leon
There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs)...
February 10, 2017: Psychotherapy and Psychosomatics
https://www.readbyqxmd.com/read/28120116/urine-drug-screen-findings-among-ambulatory-oncology-patients-in-a-supportive-care-clinic
#3
Sherri Rauenzahn, Adam Sima, Brian Cassel, Danielle Noreika, Teny Henry Gomez, Lynn Ryan, Carl E Wolf, Luke Legakis, Egidio Del Fabbro
PURPOSE: Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making. METHODS: An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study...
January 25, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28007808/dangerous-liaisons-psychiatry-and-law-in-the-court-of-protection-expert-discourses-of-insight-and-compliance
#4
Paula Case
A finding that 'P' (as the person who is subject to Court of Protection proceedings is known) lacks mental capacity is the trigger for exposing them to decision-making by others and the powers of the Court of Protection (CoP) which, in the words of Justice Hedley, can be 'invasive and draconian' (Hedley J in PC v City of York Council cited in [2013] EWCA Civ 478 [13]). Whilst the law asserts the upper hand in the assessment of mental capacity for persons who come before the CoP, it is the discipline of psychiatry, which dominates expert witness testimony in these proceedings...
2016: Medical Law Review
https://www.readbyqxmd.com/read/27986430/computational-approaches-to-schizophrenia-a-perspective-on-negative-symptoms
#5
REVIEW
Lorenz Deserno, Andreas Heinz, Florian Schlagenhauf
Schizophrenia is a heterogeneous spectrum disorder often associated with detrimental negative symptoms. In recent years, computational approaches to psychiatry have attracted growing attention. Negative symptoms have shown some overlap with general cognitive impairments and were also linked to impaired motivational processing in brain circuits implementing reward prediction. In this review, we outline how computational approaches may help to provide a better understanding of negative symptoms in terms of the potentially underlying behavioural and biological mechanisms...
December 13, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/27977851/implementation-of-treatment-guidelines-for-specialist-mental-health-care
#6
REVIEW
Irene Bighelli, Giovanni Ostuzzi, Francesca Girlanda, Andrea Cipriani, Thomas Becker, Markus Koesters, Corrado Barbui
BACKGROUND: A huge gap exists between the production of evidence and its uptake in clinical practice settings. To fill this gap, treatment guidelines, based on explicit assessments of the evidence base, are commonly used in several fields of psychiatry, including schizophrenia and related psychotic disorders. However, it remains unclear whether treatment guidelines have any material impact on provider performance and patient outcomes, and how implementation should be conducted to maximise benefit...
15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27965330/approach-to-risk-identification-in-undifferentiated-mental-disorders
#7
REVIEW
José Silveira, Patricia Rockman, Casey Fulford, Jon Hunter
OBJECTIVE: To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. SOURCES OF INFORMATION: We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology...
December 2016: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/27886637/handling-clinical-comorbidity-in-randomized-clinical-trials-in-psychiatry
#8
Ruth O'Hara, Sherry A Beaudreau, Christine E Gould, Wendy Froehlich, Helena C Kraemer
The purpose of this paper is to a) outline the importance of including patients with clinical comorbidities in Randomized Clinical Trials (RCTs) of psychiatric treatments; and b) to propose a specific approach for best handling, analyzing and interpreting the data on clinical comorbidities in terms of their impact on treatment outcomes. To do this we first define and describe clinical comorbidity and differentiate it from other forms of comorbidity. We then describe the methodological and analytical problems associated with excluding patients with clinically comorbid conditions from RCTs, including the impact on the outcomes of RCTs in psychiatry and the impact on evidence-based clinical decision-making...
March 2017: Journal of Psychiatric Research
https://www.readbyqxmd.com/read/27798176/behavioral-and-neural-signatures-of-reduced-updating-of-alternative-options-in-alcohol-dependent-patients-during-flexible-decision-making
#9
Andrea M F Reiter, Lorenz Deserno, Thomas Kallert, Hans-Jochen Heinze, Andreas Heinz, Florian Schlagenhauf
: Addicted individuals continue substance use despite the knowledge of harmful consequences and often report having no choice but to consume. Computational psychiatry accounts have linked this clinical observation to difficulties in making flexible and goal-directed decisions in dynamic environments via consideration of potential alternative choices. To probe this in alcohol-dependent patients (n = 43) versus healthy volunteers (n = 35), human participants performed an anticorrelated decision-making task during functional neuroimaging...
October 26, 2016: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/27794549/clinicians-use-of-prescription-drug-monitoring-programs-in-clinical-practice-and-decision-making
#10
Gillian J Leichtling, Jessica M Irvine, Christi Hildebran, Deborah J Cohen, Sara E Hallvik, Richard A Deyo
OBJECTIVES:  Little is known about clinicians' use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. DESIGN : Qualitative interviews of clinician PDMP users. SETTING:  Oregon registrants in the state's PDMP. SUBJECTS:  Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery...
October 29, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27739182/cost-effectiveness-of-donepezil-and-memantine-in-moderate-to-severe-alzheimer-s-disease-the-domino-ad-trial
#11
Martin Knapp, Derek King, Renée Romeo, Jessica Adams, Ashley Baldwin, Clive Ballard, Sube Banerjee, Robert Barber, Peter Bentham, Richard G Brown, Alistair Burns, Tom Dening, David Findlay, Clive Holmes, Tony Johnson, Robert Jones, Cornelius Katona, James Lindesay, Ajay Macharouthu, Ian McKeith, Rupert McShane, John T O'Brien, Patrick P J Phillips, Bart Sheehan, Robert Howard
OBJECTIVE: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. METHODS: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial...
October 13, 2016: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27650639/how-voting-and-consensus-created-the-diagnostic-and-statistical-manual-of-mental-disorders-dsm-iii
#12
James Davies
This paper examines how Task Force votes were central to the development of Diagnostic and Statistical Manual of Mental Disorders (DSM-III and DSM-III-R). Data were obtained through a literature review, investigation of DSM archival material housed at the American Psychiatric Association (APA), and interviews with key Task Force members of DSM-III and DSM-III-R. Such data indicate that Task Force votes played a central role in the making of DSM-III, from establishing diagnostic criteria and diagnostic definitions to settling questions about the inclusion or removal of diagnostic categories...
September 21, 2016: Anthropology & Medicine
https://www.readbyqxmd.com/read/27605915/risk-factors-for-problematic-behaviors-among-forensic-outpatients-under-the-medical-treatment-and-supervision-act-in-japan
#13
Kumiko Ando, Takahiro Soshi, Kanako Nakazawa, Takamasa Noda, Takayuki Okada
The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals...
2016: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/27601502/diagnostic-evaluation-for-autism-spectrum-disorder-a-survey-of-health-professionals-in-australia
#14
Lauren J Taylor, Valsamma Eapen, Murray T Maybery, Sue Midford, Jessica Paynter, Lyndsay Quarmby, Timothy Smith, Katrina Williams, Andrew J O Whitehouse
OBJECTIVES: There is currently no agreed Australian standard for the diagnosis of autism spectrum disorder (ASD) even though there are specific diagnostic services available. We suspected inconsistency in the diagnostic practices of health professionals in Australia and aimed to assess these practices across the nation by surveying all relevant professional groups. DESIGN: In this study, we completed a survey of 173 health professionals whose clinical practice includes participating in the diagnostic process for ASD in Australia...
2016: BMJ Open
https://www.readbyqxmd.com/read/27522011/unconscious-emotion-a-cognitive-neuroscientific-perspective
#15
REVIEW
Ryan Smith, Richard D Lane
While psychiatry and clinical psychology have long discussed the topic of unconscious emotion, and its potentially explanatory role in psychopathology, this topic has only recently begun to receive attention within cognitive neuroscience. In contrast, neuroscientific research on conscious vs. unconscious processes within perception, memory, decision-making, and cognitive control has seen considerable advances in the last two decades. In this article, we extrapolate from this work, as well as from recent neural models of emotion processing, to outline multiple plausible neuro-cognitive mechanisms that may be able to explain why various aspects of one's own emotional reactions can remain unconscious in specific circumstances...
October 2016: Neuroscience and Biobehavioral Reviews
https://www.readbyqxmd.com/read/27517721/routine-outcome-monitoring-and-clinical-decision-making-in-forensic-psychiatry-based-on-the-instrument-for-forensic-treatment-evaluation
#16
Frida C A van der Veeken, Jacques Lucieer, Stefan Bogaerts
BACKGROUND: Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE)...
2016: PloS One
https://www.readbyqxmd.com/read/27461022/use-of-antidepressants-during-pregnancy-what-to-consider-when-weighing-treatment-with-antidepressants-against-untreated-depression
#17
REVIEW
Maria Muzik, Susan E Hamilton
Introduction Mood disorders impact many pregnant women, particularly those who have experienced symptoms prior to conception, and there are significant barriers, including stigma and access, to seeking and receiving appropriate treatments. Antidepressants are a helpful option in treating perinatal depression, but research on risks and benefits of antidepressant use in pregnancy is difficult given lack of "gold standard" comparative trials. Methods This paper summarizes current state of knowledge on the safety of antidepressants during pregnancy by providing a summary of the literature published in the past 3 years (January 2013-October 2015)...
November 2016: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/27443678/use-of-the-experience-sampling-method-in-the-context-of-clinical-trials
#18
Simone J W Verhagen, Laila Hasmi, Marjan Drukker, J van Os, Philippe A E G Delespaul
OBJECTIVE: The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. METHODS: ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life...
August 2016: Evidence-based Mental Health
https://www.readbyqxmd.com/read/27354926/inter-rater-reliability-assessment-of-aspect-r-a-study-pragmatic-explanatory-characterization-tool-rating
#19
Cynthia A Bossie, Larry D Alphs, David Williamson, Lian Mao, Clennon Kurut
OBJECTIVE: The increasing importance of real-world data for clinical and policy decision making is driving a need for close attention to the pragmatic versus explanatory features of trial designs. ASPECT-R (A Study Pragmatic-Explanatory Characterization Tool-Rating) is an instrument informed by the PRECIS tool, which was developed to assist researchers in designing trials that are more pragmatic or explanatory. ASPECT-R refined the PRECIS domains and includes a detailed anchored rating system...
March 2016: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/27301429/impaired-flexible-reward-based-decision-making-in-binge-eating-disorder-evidence-from-computational-modeling-and-functional-neuroimaging
#20
Andrea M F Reiter, Hans-Jochen Heinze, Florian Schlagenhauf, Lorenz Deserno
Despite its clinical relevance and the recent recognition as a diagnostic category in the DSM-5, binge eating disorder (BED) has rarely been investigated from a cognitive neuroscientific perspective targeting a more precise neurocognitive profiling of the disorder. BED patients suffer from a lack of behavioral control during recurrent binge eating episodes and thus fail to adapt their behavior in the face of negative consequences, eg, high risk for obesity. To examine impairments in flexible reward-based decision-making, we exposed BED patients (n=22) and matched healthy individuals (n=22) to a reward-guided decision-making task during functional resonance imaging (fMRI)...
February 2017: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
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