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Clinical decision making in Psychiatry

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
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
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
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
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
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
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)...
July 26, 2016: Maternal and Child Health Journal
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
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
Andrea Mf 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)...
June 15, 2016: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Kaoru Arai, Ayumi Takano, Takako Nagata, Naotsugu Hirabayashi
BACKGROUND: Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. AIMS: Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. METHODS: A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo...
June 13, 2016: Criminal Behaviour and Mental Health: CBMH
Roberta Sellaro, Michael A Nitsche, Lorenza S Colzato
Transcranial direct current stimulation (tDCS) is an increasingly popular noninvasive neuromodulatory tool in the fields of cognitive and clinical neuroscience and psychiatry. It is an inexpensive, painless, and safe brain-stimulation technique that has proven to be effective in modulating cognitive and sensory-perceptual functioning in healthy individuals and clinical populations. Importantly, recent findings have shown that tDCS may also be an effective and promising tool for probing the neural mechanisms of social cognition...
April 2016: Annals of the New York Academy of Sciences
John D Salamone, Samantha E Yohn, Laura López-Cruz, Noemí San Miguel, Mercè Correa
Motivation has been defined as the process that allows organisms to regulate their internal and external environment, and control the probability, proximity and availability of stimuli. As such, motivation is a complex process that is critical for survival, which involves multiple behavioural functions mediated by a number of interacting neural circuits. Classical theories of motivation suggest that there are both directional and activational aspects of motivation, and activational aspects (i.e. speed and vigour of both the instigation and persistence of behaviour) are critical for enabling organisms to overcome work-related obstacles or constraints that separate them from significant stimuli...
May 2016: Brain: a Journal of Neurology
Andreas Heinz, Florian Schlagenhauf, Anne Beck, Carolin Wackerhagen
It has been questioned that the more than 300 mental disorders currently listed in international disease classification systems all have a distinct neurobiological correlate. Here, we support the idea that basic dimensions of mental dysfunctions, such as alterations in reinforcement learning, can be identified, which interact with individual vulnerability and psychosocial stress factors and, thus, contribute to syndromes of distress across traditional nosological boundaries. We further suggest that computational modeling of learning behavior can help to identify specific alterations in reinforcement-based decision-making and their associated neurobiological correlates...
August 2016: Journal of Neural Transmission
John N Constantino
Child maltreatment is one of the most deleterious known influences on the mental health and development of children. This article briefly reviews a complement of methods that are ready to incorporate into child and adolescent psychiatric practice, by having been validated either with respect to the prevention of child maltreatment or with respect to adverse outcomes associated with maltreatment (and primarily focused on enhancing the caregiving environment); they are feasible for integration into clinical decision making, and most importantly, can be included in the training of the next generation of clinicians...
April 2016: Child and Adolescent Psychiatric Clinics of North America
Ottilie Sedgwick, Susan Young, Mrigendra Das, Veena Kumari
This systematic review aimed to examine whether neurobiological methods, or other methods independent of clinical judgment, have been investigated to assist decision making in forensic mental health services and, if so, whether this may be a useful strategy for predicting outcomes. OVID-Medline, Embase, and PsychInfo (inception-January 2015) were searched, limiting to English and human studies, using terms relating to "predict," "outcome," "psychiatry," and "forensic" to identify primary research articles reporting on predictors of outcome in forensic mental health services not reliant on clinical judgment/self-report...
January 22, 2016: CNS Spectrums
R C Kessler, H M van Loo, K J Wardenaar, R M Bossarte, L A Brenner, T Cai, D D Ebert, I Hwang, J Li, P de Jonge, A A Nierenberg, M V Petukhova, A J Rosellini, N A Sampson, R A Schoevers, M A Wilcox, A M Zaslavsky
Heterogeneity of major depressive disorder (MDD) illness course complicates clinical decision-making. Although efforts to use symptom profiles or biomarkers to develop clinically useful prognostic subtypes have had limited success, a recent report showed that machine-learning (ML) models developed from self-reports about incident episode characteristics and comorbidities among respondents with lifetime MDD in the World Health Organization World Mental Health (WMH) Surveys predicted MDD persistence, chronicity and severity with good accuracy...
October 2016: Molecular Psychiatry
E Hoch, K Petersen, I Kopp, A Batra, K Mann
BACKGROUND: From 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders. METHODS: Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht)...
January 2016: Der Nervenarzt
Manoj Kumar Sharma, Prabha S Chandra, Santosh K Chaturvedi
OBJECTIVE: The objective structured clinical examination has been in use both as an assessment and a teaching modality within the mental health profession. It focuses on individual skill enhancement, the inter-professional understanding of role obligation is helpful in promoting competence as a team as well as role of other team members. The Team OSCE (TOSCE) is an effective way in promoting inter-professional learning. MATERIALS AND METHODS: The present work assesses the trainee experience with TOSCE and its utility in clinical care...
July 2015: Indian Journal of Psychological Medicine
Christine Lochner, Samuel R Chamberlain, Martin Kidd, Naomi A Fineberg, Dan J Stein
RATIONALE: Obsessive-compulsive disorder (OCD) implicates dysfunction of orbitofrontal and insula-related circuitry and of the serotonin system. There is an on-going search in psychiatry for intermediate biological markers, termed 'endophenotypes', that exist not only in patients with a given disorder but also in their clinically unaffected first-degree relatives. OBJECTIVE: Pharmacological challenge is recognized as a means of eliciting an endophenotype, but this strategy has yet to be used in OCD...
March 2016: Psychopharmacology
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