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Clinical decision making in Psychiatry

S Richa, R Chammay, A Dargél, C Henry, M Masson
The implications of biomedical ethics principles extend to both medical care and biomedical research. They are particularly relevant for psychiatry in which pathologies are often chronic and disabling. Bipolar disorders impact the ability to make judgements and to take decisions during mood episodes and remain a stigmatised condition. Early interventions, even those in the prodromal phase, pose ethical questions for both clinicians and researchers. The degree of patients' autonomy in their clinical care must also now be considered from a biomedical ethics perspective...
February 4, 2018: L'Encéphale
Dominic B Dwyer, Peter Falkai, Nikolaos Koutsouleris
Machine learning approaches for clinical psychology and psychiatry explicitly focus on learning statistical functions from multidimensional data sets to make generalizable predictions about individuals. The goal of this review is to provide an accessible understanding of why this approach is important for future practice because of its potential to augment decisions associated with the diagnosis, prognosis, and treatment of people suffering from mental illness using clinical and biological data. To this end, the limitations of current statistical paradigms in mental health research are critiqued, and an introduction is provided to the critical machine learning methods used in clinical studies...
January 29, 2018: Annual Review of Clinical Psychology
Zahra Fatahi, Zahra Reisi, Gregor Rainer, Abbas Haghparast, Abbas Khani
Despite evidence from psychiatry and psychology clinics pointing to altered cognition and decision making following the consumption of cannabis, the effects of cannabis derivatives are still under dispute and the mechanisms of cannabinoid effects on cognition are not known. In this study, we used effort-based and delay-based decision tasks and showed that ACEA, a potent cannabinoid agonist induced apathetic and impulsive patterns of choice in rats in a dose-dependent manner when locally injected into the anterior cingulate cortex (ACC) and orbitofrontal cortex (OFC), respectively...
January 17, 2018: Neuropharmacology
Sorin Hostiuc, Mugurel Constantin Rusu, Ionut Negoi, Eduard Drima
BACKGROUND: The process of assessing the decision-making capacity of potential subjects before their inclusion in clinical trials is a legal requirement and a moral obligation, as it is essential for respecting their autonomy. This issue is especially important in psychiatry patients (such as those diagnosed with schizophrenia). The primary purpose of this article was to evaluate the degree of impairment in each dimension of decision-making capacity in schizophrenia patients compared to non-mentally-ill controls, as quantified by the (MacCAT-CR) instrument...
January 5, 2018: BMC Psychiatry
Sofian Berrouiguet, Mercedes M Perez-Rodriguez, Mark Larsen, Enrique Baca-García, Philippe Courtet, Maria Oquendo
Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-sectional observations that miss essential information about disease course. The mental health provider makes all medical decisions based on this limited information. Thanks to recent technological advances such as mobile phones and other personal devices, electronic health (eHealth) data collection strategies now can provide access to real-time patient self-report data during the interval between visits...
January 3, 2018: Journal of Medical Internet Research
Nandeeshwar Reddy Mopuru, Sam Padamadan Jose, Biju Viswanath, C Naveen Kumar, Suresh Bada Math, Jagadisha Thirthalli
Serious concerns have arisen in recent years regarding the unethical and illegal practices resorted to during clinical trials. Clinical trials in psychiatry are further complicated by issues such as 'validity of consent' and 'decision making capacity' of patients. This study was planned to explore the factors determining patient participation in clinical trials. A random sample of 123 consenting psychiatry inpatients were provided the information and consent-form of a hypothetical clinical drug trial. They were interviewed regarding their decision, the decision maker and factors that led to the decision...
February 2018: Asian Journal of Psychiatry
Marie Nicolini, Joris Vandenberghe, Chris Gastmans
In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC...
November 29, 2017: Scandinavian Journal of Caring Sciences
Rob B K Wanders, Rob R Meijer, Henricus G Ruhé, Sjoerd Sytema, Klaas J Wardenaar, Peter de Jonge
BACKGROUND: Depressive patients can present with complex and different symptom patterns in clinical care. Of these, some may report patterns that are inconsistent with typical patterns of depressive symptoms. This study aimed to evaluate the validity of person-fit statistics to identify inconsistent symptom reports and to assess the clinical usefulness of providing clinicians with person-fit score feedback during depression assessment. METHODS: Inconsistent symptom reports on the Inventory of Depressive Symptomatology Self-Report (IDS-SR) were investigated quantitatively with person-fit statistics for both intake and follow-up measurements in the Groningen University Center of Psychiatry (n = 2036)...
November 27, 2017: Psychological Medicine
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
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
Virginia Barber-Rioja, Merrill Rotter, Faith Schombs
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
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...
December 2017: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
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
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
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
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
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
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
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
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
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