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Clinical decision making in Psychiatry

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https://www.readbyqxmd.com/read/28401326/clinical-judgment-moral-anxiety-and-the-limits-of-psychiatry
#1
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...
April 11, 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
#2
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...
April 7, 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
#3
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, 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 three 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)...
April 7, 2017: Addiction
https://www.readbyqxmd.com/read/28216782/indian-psychiatric-society-survey-on-clinical-practice-guidelines
#4
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
https://www.readbyqxmd.com/read/28184310/capacity-in-vacuo-an-audit-of-decision-making-capacity-assessments-in-a-liaison-psychiatry-service
#5
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
#6
REVIEW
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)...
2017: Psychotherapy and Psychosomatics
https://www.readbyqxmd.com/read/28120116/urine-drug-screen-findings-among-ambulatory-oncology-patients-in-a-supportive-care-clinic
#7
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...
June 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
#8
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
#9
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
#10
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...
December 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27965330/approach-to-risk-identification-in-undifferentiated-mental-disorders
#11
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
#12
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
#13
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
#14
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
#15
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
#16
REVIEW
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...
April 2017: 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
#17
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
#18
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
#19
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
#20
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
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