Clinical Staging for Youth Mental Disorders: Progress in Reforming Diagnosis and Clinical Care

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Patrick D. McGorry ◽  
Cristina Mei
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Developmental Psychology ◽  
Clinical Care ◽  
Clinical Staging ◽  
Annual Review ◽  
Publication Date ◽  
Diagnostic Systems ◽  
Illness Progression ◽  
Selection Of

Current silo-based diagnostic systems for mental disorders lack utility and fail to fulfil a fundamental purpose of diagnosis: to guide treatment planning and predict outcomes. Diagnostic reform has gained momentum, and clinical staging has emerged as a promising framework to improve the precision of diagnosis, particularly in early illness stages, and fill current gaps in linking diagnosis to more personalized and effective intervention, prognosis, and neurobiological markers. Transdiagnostic clinical staging recognizes that the early development of mental ill-health is marked by substantial fluidity and that symptoms may, although not inevitably, evolve into more stable diagnosable syndromes. Staging facilitates the selection of interventions that are proportionate to the current need and risk of illness progression and provides an efficient framework to organize biomarker data and guide service delivery. Here, we provide an overview of transdiagnostic clinical staging and summarize key evidence supporting its ability to integrate biomarkers and guide mental health care. Expected final online publication date for the Annual Review of Developmental Psychology, Volume 3 is December 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Roman Kotov ◽  
Robert F. Krueger ◽  
David Watson ◽  
David C. Cicero ◽  
Christopher C. Conway ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Clinical Practice ◽  
Research Agenda ◽  
Annual Review ◽  
Publication Date ◽  
Supporting Evidence ◽  
Clinical Implementation ◽  
Diagnostic Systems ◽  
Ongoing Development

Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinical practice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 17 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041371
Author(s):  
Alyssa Howren ◽  
J Antonio Aviña-Zubieta ◽  
Deborah Da Costa ◽  
Joseph H Puyat ◽  
Hui Xie ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Care ◽  
Mental Healthcare ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Perceived Need ◽  
Mental Health Support ◽  
Health Support

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).SettingThe survey was administered across Canada’s 10 provinces using multistage cluster sampling.ParticipantsThe study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysisThe explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.ResultsAmong 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.ConclusionComorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

Protein Reconstitution Inside Giant Unilamellar Vesicles

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Thomas Litschel ◽  
Petra Schwille
Keyword(s):  
Optical Resolution ◽  
Microscopic Investigation ◽  
Annual Review ◽  
Publication Date ◽  
Protein Encapsulation ◽  
Resolution Limit ◽  
Giant Unilamellar Vesicles ◽  
Unilamellar Vesicles ◽  
Encapsulation Methods ◽  
Selection Of

Giant unilamellar vesicles (GUVs) have gained great popularity as mimicries for cellular membranes. As their sizes are comfortably above the optical resolution limit, and their lipid composition is easily controlled, they are ideal for quantitative light microscopic investigation of dynamic processes in and on membranes. However, reconstitution of functional proteins into the lumen or the GUV membrane itself has proven technically challenging. In recent years, a selection of techniques has been introduced that tremendously improve GUV-assay development and enable the precise investigation of protein–membrane interactions under well-controlled conditions. Moreover, due to these methodological advances, GUVs are considered important candidates as protocells in bottom-up synthetic biology. In this review, we discuss the state of the art of the most important vesicle production and protein encapsulation methods and highlight some key protein systems whose functional reconstitution has advanced the field. Expected final online publication date for the Annual Review of Biophysics, Volume 50 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Early Childhood Obesity: A Developmental Perspective

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Megan H. Pesch ◽  
Julie C. Lumeng
Keyword(s):  
Risk Factors ◽  
Early Childhood ◽  
Childhood Obesity ◽  
Eating Behaviors ◽  
Developmental Psychology ◽  
Significant Risk ◽  
Annual Review ◽  
Publication Date ◽  
Special Focus ◽  
Developmental Context

Childhood obesity is a multifactorial disease, shaped by child, familial, and societal influences; prevention efforts must begin early in childhood. Viewing the problem of childhood obesity through a developmental lens is critical to understanding the nuances of a child's interactions with food and their environment across the span of growth and development. Risk factors for childhood obesity begin prior to birth, compounding across the life course. Some significant risk factors are unmodifiable (e.g., genetics) while others are theoretically modifiable. Social inequities, however, hinder many families from easily making modifications to a range of risk factors. The objective of this review is to provide background and an overview of the literature on childhood obesity in early childhood (birth to 5 years of age) in a developmental context. Special focus is placed on unique developmental considerations, child eating behaviors, and parental feeding behaviors in infancy, toddlerhood, and preschool ages. Expected final online publication date for the Annual Review of Developmental Psychology, Volume 3 is December 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Smartphones and the Neuroscience of Mental Health

2021 ◽  
Vol 44 (1) ◽  
Author(s):  
Claire M. Gillan ◽  
Robb B. Rutledge
Keyword(s):  
Mental Health ◽  
Annual Review ◽  
Publication Date ◽  
Data Sets ◽  
Daily Lives ◽  
Neuroscience Research ◽  
Health And Illness ◽  
Passive Data ◽  
Smartphone Sensors ◽  
Rich Data

Improvements in understanding the neurobiological basis of mental illness have unfortunately not translated into major advances in treatment. At this point, it is clear that psychiatric disorders are exceedingly complex and that, in order to account for and leverage this complexity, we need to collect longitudinal datasets from much larger and more diverse samples than is practical using traditional methods. We discuss how smartphone-based research methods have the potential to dramatically advance our understanding of the neuroscience of mental health. This, we expect, will take the form of complementing lab-based hard neuroscience research with dense sampling of cognitive tests, clinical questionnaires, passive data from smartphone sensors, and experience-sampling data as people go about their daily lives. Theory- and data-driven approaches can help make sense of these rich data sets, and the combination of computational tools and the big data that smartphones make possible has great potential value for researchers wishing to understand how aspects of brain function give rise to, or emerge from, states of mental health and illness. Expected final online publication date for the Annual Review of Neuroscience, Volume 44 is July 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Mental health law reforms in Uganda: lessons learnt

2014 ◽  
Vol 11 (2) ◽  
pp. 39-40 ◽  
Author(s):  
Joshua Ssebunnya ◽  
Sheila Ndyanabangi ◽  
Fred Kigozi
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Clinical Care ◽  
Health Law ◽  
Mental Health Law ◽  
Work In Progress ◽  
Lessons Learnt ◽  
Mental Health Legislation ◽  
Health Legislation

Ugandan mental health legislation, which dates from 1964, principally aims to remove persons with mental disorders from the community but also to protect their safety, by keeping them in confinement, although this has been without consideration for clinical care. In response to criticism from various stakeholders and advocates and the need to reflect modern clinical care, Uganda undertook to review and amend the mental health legislation, as part of the Mental Health and Poverty Project (MHaPP). We report on work in progress advancing new legislation.

The Prospect of Cure: Implications for Mental Health Planning

1992 ◽  
Vol 9 (4) ◽  
pp. 246-253 ◽  
Author(s):  
Gavin Andrews
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Mental Health Professionals ◽  
Health Planning ◽  
Clinical Care ◽  
Patient Treatment ◽  
Health Staff ◽  
Behaviour Therapy ◽  
Mental Health Staff ◽  
Cognitive Behaviour

The treatment of persons with mental disorders is advancing rapidly. New epidemiological information has allowed the magnitude of the task to be specified. A census of mental health professionals has allowed the workloads to be determined and organisational models which focus on treatment in the community established. As diagnosis is the first step in treatment it is timely that new, computerised structured diagnosis interviews are available. Treatment evaluation likewise is able to suggest that medication and cognitive behaviour therapy backed by good clinical care are the keys to good patient treatment. The two major problems that follow mainstreaming of the treatment of persons with mental disorders are the reallocation of money to treatment in the community, and the education of mental health staff to diagnose and deliver the proven effective treatments.

Research Domain Criteria and OCD

2017 ◽  
Author(s):  
Eyal Kalanthroff ◽  
Gideon E. Anholt ◽  
Helen Blair Simpson
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Disorders ◽  
The United States ◽  
Self Report ◽  
Research Domain Criteria ◽  
Diagnostic Systems ◽  
Behavioral Measures ◽  
Research Domain

This chapter discusses the Research Domain Criteria (RDoC) project, an initiative of the National Institutes of Mental Health (NIMH) of the United States to develop for research purposes new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures, and explores how the hallmark symptoms of OCD (obsessions, compulsions, and anxiety) can be mapped onto RDoC domains. Unlike current categorical diagnostic systems (e.g., DSM), RDoC seeks to integrate many levels of information (from genomics to self-report) to validate dimensions defined by neurobiology and behavioral measures that cut across current disorder categories. The chapter explores, for heuristic reasons, how the RDoC matrix might be used to elucidate the neurobehavioral domains of dysfunction that lead to the characteristic symptoms of OCD. It then selectively reviews the OCD literature from the perspective of the RDoC domains, aiming to guide future transdiagnostic studies to examine specific neurobehavioral domains across disorders.

Economic evaluation and costs of telepsychiatry programmes: A systematic review

2020 ◽  
pp. 1357633X2093891 ◽  
Author(s):  
John A Naslund ◽  
Lauren M Mitchell ◽  
Udita Joshi ◽  
Dipal Nagda ◽  
Chunling Lu
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Mental Disorders ◽  
Clinical Care ◽  
Mental Illnesses ◽  
Economic Evaluations ◽  
Schizophrenia Spectrum Disorders ◽  
Post Traumatic Stress

Objective Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare. Methods We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy. Results Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression ( n = 7; 27%), general mental disorders and screening ( n = 7; 27%), child mental health ( n = 4; 15%) and geriatric mental health ( n = 4; 15%). Nearly all studies ( n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes. Conclusion Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems.

scholarly journals ICD and DSM: neuroplasticity and staging are still missing

CNS Spectrums ◽  
2016 ◽  
Vol 21 (4) ◽  
pp. 276-278 ◽  
Author(s):  
Stefano Pallanti
Keyword(s):  
Mental Disorders ◽  
International Classification Of Diseases ◽  
Clinical Staging ◽  
Diagnostic Systems ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Core Concepts ◽  
First Editions

The two main diagnostic systems, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), have undergone a number of revisions since their first editions: whereas the fifth edition of the DSM has been published in 2013, the eleventh revision of the ICD is expected by 2018. Although the process of harmonization between the 2 systems is still a debated topic, the forthcoming revision of the ICD is seemingly converging toward the DSM approach in regard to the reclassification of a number of disorders. Nevertheless, the 2 systems still exhibit considerable differences, partly due to their different purposes, development and revision processes, and target audiences. Furthermore, while alternative and innovative classification approaches are emerging with the aim of integrating the latest findings from neuroscience and genomics, both the DSM and ICD still fail to incorporate core concepts such as the clinical staging of psychiatric disorders and “neuroprogression,” as well as an adequate consideration of endophenotypes.

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