Chronic pain and the psychiatrist

2001 ◽  
Vol 13 (1) ◽  
pp. 21-28
Author(s):  
B. Van Houdenhove
Keyword(s):  
Substance Abuse ◽  
Chronic Pain ◽  
Differential Diagnosis ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Essential Role ◽  
Point Of View ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual

SUMMARYChronic pain is a phenomenon with important psychiatric aspects from a diagnostic as well as a therapeutic point of view. The place of chronic pain in the different versions of the Diagnostic and Statistical Manual of Mental Disorders, and the differential-diagnosis are critically discussed. The comorbidity with depression, anxiety disorders, substance abuse and personality disorders is extensively treated. Finally, the essential role of the psychiatrist in the multidisciplinary therapeutic approach of these patients is emphasised.

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model

Assessment ◽  
2020 ◽  
pp. 107319111989711
Author(s):  
Carmen Díaz-Batanero ◽  
Antón Aluja ◽  
Pablo Sayans-Jiménez ◽  
Eva Baillés ◽  
Fermín Fernández-Calderón ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Personality Disorders ◽  
Clinical Sample ◽  
Normative Sample ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Personality Facets ◽  
New Perspective

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders–Fifth edition ( DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

scholarly journals THE DSM-5 AND THE ROLE OF PERSONALITY DISORDERS UNDER THE CRIMINAL LAW

Obiter ◽  
2014 ◽  
Vol 35 (2) ◽  
Author(s):  
Charnelle van der Bijl ◽  
Letitia Pienaar
Keyword(s):  
Mental Disorders ◽  
Personality Disorders ◽  
Criminal Law ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Dsm Iv ◽  
Definition Of ◽  
Axial System

The DSM-5 Diagnostic and Statistical Manual of Mental Disorders was published in 2013. This manual replaced and significantly revised the former DSM IV-TR, as it abolishes the Multi-Axial system that distinguished between personality and otherdisorders, which system had an impact on the disorders that were considered legally significant from those that were not. Owing to its recent publication, the DSM-5 Diagnostic and Statistical Manual of Mental Disorders, was not judicially considered in a criminal-law context. This article examines the role that personality disorders in the DSM-5 will play on the possible future of Criminal Law jurisprudential literature. Personality disorders are examined in the context of their classification, the definition of mental illness and pathological criminal incapacity. Possible solutions are suggested on how these mental disorders may be accommodated in the Criminal Law context.

ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground

2017 ◽  
Vol 52 (5) ◽  
pp. 425-434 ◽  
Author(s):  
Bo Bach ◽  
Martin Sellbom ◽  
Mathias Skjernov ◽  
Erik Simonsen
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Disorders ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Domain Models

Objective: The five personality disorder trait domains in the proposed International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition are comparable in terms of Negative Affectivity, Detachment, Antagonism/Dissociality and Disinhibition. However, the International Classification of Diseases, 11th edition model includes a separate domain of Anankastia, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model includes an additional domain of Psychoticism. This study examined associations of International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domains, simultaneously, with categorical personality disorders. Method: Psychiatric outpatients ( N = 226) were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Interview and the Personality Inventory for DSM-5. International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domain scores were obtained using pertinent scoring algorithms for the Personality Inventory for DSM-5. Associations between categorical personality disorders and trait domains were examined using correlation and multiple regression analyses. Results: Both the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models showed relevant continuity with categorical personality disorders and captured a substantial amount of their information. As expected, the International Classification of Diseases, 11th edition model was superior in capturing obsessive–compulsive personality disorder, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model was superior in capturing schizotypal personality disorder. Conclusion: These preliminary findings suggest that little information is ‘lost’ in a transition to trait domain models and potentially adds to narrowing the gap between Diagnostic and Statistical Manual of Mental Disorders, 5th edition and the proposed International Classification of Diseases, 11th edition model. Accordingly, the International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models may be used to delineate one another as well as features of familiar categorical personality disorder types. A preliminary category-to-domain ‘cross walk’ is provided in the article.

scholarly journals Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for the bipolar disorders: Phase I of the AREDOC project

2018 ◽  
Vol 52 (12) ◽  
pp. 1173-1182 ◽  
Author(s):  
Gordon Parker ◽  
Gabriela Tavella ◽  
Glenda Macqueen ◽  
Michael Berk ◽  
Heinz Grunze ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Task Force ◽  
Bipolar Disorders ◽  
International Classification Of Diseases ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Operational Criteria ◽  
International Experts

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. Method: The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge ‘impairment’ (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders. Conclusion: This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically.

Comorbidity of dsm-iii-r personality disorders in schizophrenic and unipolar mood disorders: a comparative study

1997 ◽  
Vol 12 (6) ◽  
pp. 316-318 ◽  
Author(s):  
P Oulis ◽  
L Lykouras ◽  
J Hatzimanolis ◽  
V Tomaras
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Comparative Study ◽  
Mood Disorder ◽  
Personality Disorders ◽  
Mood Disorders ◽  
Clinical Interview ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Patient Groups

SummaryWe investigated the overall prevalence and the differential comorbidity of Diagnostic and Statistical Manual (DSM)-III-R personality disorders in 166 remitted or recovered patients with schizophrenic (n = 102) or unipolar mood disorder (n = 64). Over 60% of both patient groups met the DSM-III-R criteria of at least one DSM-III-R personality disorder as assessed by means of the Structured Clinical Interview for DSM-III-R (SCID-II-R), receiving on average 3.1 personality diagnoses. Neither DSM-III-R categories of personality disorders, nor scores on its three clusters A, B and C, nor total score on SCID-II-R differed significantly across the two groups. In conclusion, DSM-III-R personality disorders, although highly prevalent in schizophrenic and unipolar mood disorders, lack any specificity with respect to these categories of mental disorders.

Social Anxiety and Premorbid Personality Disorders in Paranoid Schizophrenic Patients Treated With Clozapine

CNS Spectrums ◽  
2000 ◽  
Vol 5 (9) ◽  
pp. 29-43 ◽  
Author(s):  
Stefano Pallanti ◽  
Leonardo Quercioli ◽  
Adolfo Pazzagli
Keyword(s):  
Social Anxiety ◽  
Mental Disorders ◽  
Social Phobia ◽  
Personality Disorders ◽  
Paranoid Schizophrenia ◽  
Anxiety Symptoms ◽  
Premorbid Personality ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm Iv

AbstractThe concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R—Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (≥35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.

Pattern of Comorbidity Among Anxious and Odd Personality Disorders: The Case of Obsessive-Compulsive Personality Disorder

CNS Spectrums ◽  
2000 ◽  
Vol 5 (9) ◽  
pp. 23-26 ◽  
Author(s):  
Alessandro Rossi ◽  
Maria Grazia Marinangeli ◽  
Giancarlo Butti ◽  
Artemis Kalyvoka ◽  
Concetta Petruzzi
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Odds Ratios ◽  
Obsessive Compulsive ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Cluster A ◽  
Obsessive Compulsive Personality Disorder

AbstractThe aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the “odd” PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C (“anxious”) PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.

scholarly journals Increasing Diagnostic Emphasis on Negative Affective Dysfunction: Potentially Negative Consequences for Psychiatric Classification and Diagnosis

2019 ◽  
Author(s):  
Kasey Stanton
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Differential Diagnosis ◽  
Mental Disorders ◽  
Common Ground ◽  
Negative Mood ◽  
Mood States ◽  
Negative Consequences ◽  
Statistical Manual ◽  
Hyperactivity Disorder ◽  
Diagnostic And Statistical Manual

Maladaptive experiences of negative mood states and difficulties regulating them, collectively referred to here as “negative affective dysfunction,” are linked robustly to many disorders. Despite negative affective dysfunction being a non-specific psychopathology feature, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) introduced new (a) disorders and (b) features to existing disorders intended to capture manifestations of negative affective dysfunction. This theoretical article highlights why these additions may exacerbate issues concerning disorder overlap and differential diagnosis. Specific examples are provided to support this viewpoint, including potential consequences of emphasizing negative affective dysfunction within the attention-deficit/hyperactivity disorder diagnostic criteria. Although researchers likely will continue to disagree about how to best classify negative affective dysfunction (e.g., using dimensions versus categories), it is argued that we can reach common ground as a field by recognizing that caution is needed when proposing new DSM additions to capture non-specific psychopathology features.

An Examination of Chronic Pain Indices and the Updated Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental-Disorders-Fifth Edition

2020 ◽  
Author(s):  
Elizabeth Lehinger ◽  
David E Reed ◽  
Paul Nabity ◽  
Nicole Brackins ◽  
Robert Villarreal ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Mental Disorders ◽  
Rating Scale ◽  
Stress Disorder ◽  
Symptom Clusters ◽  
Pain Severity ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
The Relationship

ABSTRACT Introduction Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability). Materials and Methods Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system. Results The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements. Conclusion The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain–related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.

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