scholarly journals The problem of double diagnoses in psychiatry and addictology: leaving reality, or the stage of integration?

2019 ◽  
pp. 35-43
Author(s):  
Andrey Viktorovich Antsyborov ◽  
Irina Vladimirovna Dubatova
Keyword(s):  
Mental Illness ◽  
Social Stress ◽  
Special Section ◽  
Mental Illnesses ◽  
Family Burden ◽  
Psychoactive Substances ◽  
New Paradigm ◽  
Brain Disorder ◽  
The Brain ◽  
High Comorbidity

The article points out that the existence of the problem of double diagnoses (DD) in psychiatry and addictology means recognizing the fact that «addiction» is a mental illness and, therefore, a brain disorder. There are common areas in the brain that are responsible for the formation of addictive pathology and for the development of other mental illnesses. It explains the high comorbidity between disorders associated with the use of psychoactive substances, and other mental illnesses. The factors of predisposition to the development of addictive pathology include: family burden with addictive pathology, early onset of use of psychoactive substances, social stress situation, and mental illness. The artificial separation of psychiatry and addictology into two services in Russia is a historical mistake. A new paradigm of dependent disorders emphasizes the need to create a special section on double disorders, with the revision of this archaic model.

scholarly journals Metabolic phenotyping reveals a potential link between elevated faecal amino acids, diet and symptom severity in individuals with severe mental illness

2021 ◽  
Author(s):  
Jack Jansma ◽  
Rogier van Essen ◽  
Bartholomeus C.M. Haarman ◽  
Anastasia Chrysovalantou Chatziioannou ◽  
Jenny Borkent ◽  
...  
Keyword(s):  
Amino Acids ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Symptom Severity ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Therapeutic Interventions ◽  
Schizophrenia Spectrum Disorders ◽  
Potential Link ◽  
The Brain

The brain-gut axis is increasingly recognized as an important contributing factor in the onset and progression of severe mental illnesses such as schizophrenia spectrum disorders and bipolar disorder. This study investigates associations between levels of faecal metabolites identified using 1H-NMR, clinical parameters, and dietary components of forty-two individuals diagnosed in a transdiagnostic approach to have severe mental illness. Faecal levels of the amino acids; alanine, leucine, and valine showed a significant positive correlation with psychiatric symptom severity as well as with dairy intake. Overall, this study proposes a diet-induced link between the brain-gut axis and the severity of psychiatric symptoms, which could be valuable in the design of novel dietary or therapeutic interventions to improve psychiatric symptoms.

On the Legacy of Thomas Szasz: A Reiteration of The Myth of Mental Illness and Response to Recent Criticism

2018 ◽  
Vol 19 (3) ◽  
pp. 150-160
Author(s):  
Paul Counter ◽  
Robert Spillane
Keyword(s):  
Mental Illness ◽  
British Journal ◽  
50Th Anniversary ◽  
Mental Illnesses ◽  
Recent Criticism ◽  
Anniversary Issue ◽  
Legal Fictions ◽  
Recent Editorial ◽  
The Brain ◽  
Thomas Szasz

In the 50th anniversary issue of The Myth of Mental Illness, Szasz conceded that, conceptually, his argument had been ignored because of the promulgation that mental illnesses are diseases of the brain. Responding to a recent editorial by T. Benning in the British Journal of Psychiatry Bulletin, which is somewhat critical of Szasz’s conceptual arguments, we argue that such criticisms are inaccurate. We highlight how no mental illness stands up to pathological scrutiny, yet treatments can cause iatrogenesis. In addition, we elaborate on how Szasz argued that the false concept of mental illness results in legal fictions. It is therefore important to defend and restate Szasz’s main thesis and conceptual arguments in light of recent criticism.

How Does ECT Work?

2010 ◽  
Author(s):  
Max Fink MD
Keyword(s):  
Mental Illness ◽  
Mood Disorders ◽  
Epileptic Seizures ◽  
Mental Illnesses ◽  
Behavioral Effects ◽  
Brain Waves ◽  
Moving Strip ◽  
Character Pathology ◽  
Therapeutic Event ◽  
The Brain

The major puzzle in ECT is its mechanism of action. How do seizures, which can be dangerous and damaging when they occur spontaneously, change a dysfunctional brain into one that performs normally? Why do repeated epileptic seizures relieve psychiatric disorders? The originator of the therapy, Ladislas Meduna, believed in a biological antagonism between mental illness and seizures, an antagonism we no longer consider credible. But though we may smile at this belief, we acknowledge that it led Meduna to devise methods to induce seizures safely, select patients who were likely to benefit, develop a plan for a successful course of treatments, demonstrate the safety of inducing seizures, evaluate the merits and risks of seizures as treatment, and convince others to continue his work. His observations have been repeatedly verified, leaving little doubt about the effectiveness of ECT in treating mental illnesses. We know a great deal about the essential features of a successful course of ECT. The generalized brain seizure is the central therapeutic event. The biochemical and physiological consequences of the seizure are the basis for the behavioral effects; neither anesthesia nor electric current alone is useful, nor, except rarely, is a single seizure. To be of benefit, seizures must be repeated two or three times a week for many weeks. The more recent the mood, thought, or movement disorder, the more fully it can be relieved. Illnesses involving lifelong problems, character pathology, neuroses, and the mood disorders secondary to the abuse of drugs are not amenable to this treatment. We know how to avoid the risks of anoxia, unmodified convulsions, and prolonged seizures, and we recognize that these aspects of the treatment course do not explain how ECT works. Two aspects of the brain seizure have been extensively studied. The EEG records electrical activity of the brain under electrodes that are symmetrically placed over the scalp. Immediately after the stimulus, the “seizure” EEG is recorded on a moving strip. The electrical waves show a sharp buildup of frequencies and amplitudes, then the frequencies slow, mixtures of slow brain waves and sharp spike-like waves appear, with ever higher amplitudes and slower waves in runs and bursts.

scholarly journals From the Editor's desk

2015 ◽  
Vol 207 (5) ◽  
pp. 467-468 ◽  
Author(s):  
Kamaldeep Bhui
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Life Sciences ◽  
Mental Illnesses ◽  
Psychiatric Research ◽  
Medical Illness ◽  
Positive Outcomes ◽  
Brain Disorder ◽  
Diagnostic Practice ◽  
Emotionally Intelligent

Is medical illness a myth?The National Institute of Health's (NIH's) emphasis on mental illness as a brain disorder has transformed psychiatric research and attitudes towards mental illness. Despite the departure of the Director of the National Institute of Mental Health, Thomas Insel, to join Google Life Sciences (http://www.nih.gov/about/director/09152015_statement_insel.htm), the move away from symptom-based diagnoses in favour of more neuroscientific rationales for diagnosis is necessary and likely to be sustained. The absence of demonstrable organic pathology in mental illnesses motivated the NIH programmes, yet essentially all behaviours and adaptations to context will have physiological correlates; Google and other software and technology companies may well offer better and more powerful methods for assessing pathophysiology and making diagnoses in the future. Such shifts in diagnostic practice require much disciplined research, and seem to not obviate the need for compassionate, caring and emotionally intelligent clinicians who are able to contain and negotiate meanings and experiences, and transform conversations and care packages to positive outcomes for patients.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

Effective e-health design for those with, and without, mental health disorders: shallow navigation, concentrated contents, modest number of links, one screen area for links. (Preprint)

2018 ◽  
Author(s):  
Armando Rotondi ◽  
Jonathan Grady ◽  
Barbara H. Hanusa ◽  
Michael R. Spring ◽  
Kaleab Z. Abebe ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Success Rate ◽  
Fractional Factorial ◽  
Mental Illnesses ◽  
Schizophrenia Spectrum Disorders ◽  
Design Elements ◽  
Website Usability ◽  
Schizophrenia Spectrum ◽  
Health Applications

BACKGROUND E-health applications are an avenue to improve service responsiveness, convenience, and appeal, and tailor treatments to improve relevance, engagement, and use. It is critical to user engagement that the designs of e-health applications are intuitive to navigate. Limited research exists on designs that work for those with a severe mental illness, many of whom infrequently seek treatment, and tend to discontinuation medications and psychosocial treatments. OBJECTIVE The purpose of this study was to evaluate the influence of 12 design elements (e.g., website depth, reading level, use of navigational lists) on the usability of e-health application websites for those with, and without, mental health disorders (including severe mental illness). METHODS A 212-4 fractional factorial experimental design was used to specify the designs of 256 e-health websites, which systematically varied the 12 design elements. The final destination contents of all websites were identical, only the navigational pages varied. Three subgroups of participants comprising 226 individuals, were used to test these websites (those with schizophrenia-spectrum disorders, other mental illnesses, and no mental illness). Unique to this study was that the 12 design elements were manipulated systematically to allow assessment of combinations of design elements rather than only one element at a time. RESULTS The best and worst designs were identified for each of the three subgroups, and the sample overall. The depth of a website’s navigation, that is, the number of screens/pages users needed to navigate to find desired content, had the strongest influence on usability (ability to find information). The worst performing design for those with schizophrenia-spectrum disorders had an 8.6% success rate (ability to find information), the best had a 53.2% success rate. The navigational design made a 45% difference in usability. For the subgroup with other mental illnesses the design made a 52% difference, and for those with no mental illness a 50% difference in success rate. The websites with the highest usability all had several key similarities, as did the websites with the poorest usability. A unique finding is that the influences on usability of some design elements are variable. For these design elements, whether they had a positive or negative effect, and the size of its effect, could be influenced by the rest of the design environment, that is, the other elements in the design. This was not the case for navigational depth, a shallower hierarchy is better than a deeper hierarchy. CONCLUSIONS It is possible to identify evidence-based strategies for designing e-health applications that result in a high level of usability. Even for those with schizophrenia, or other severe mental illnesses, there are designs that are highly effective. The best designs have key similarities, but can also vary in some respects. Key words: schizophrenia, severe mental illness, e-health, design, website, usability, website design, website usability, fractional factorial design.

scholarly journals Use of a Consultation Service Following Pharmacogenomic Testing in Psychiatry

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 179-180
Author(s):  
Daniel Dowd ◽  
David S. Krause
Keyword(s):  
Mental Illness ◽  
Drug Interactions ◽  
Metabolic Pathways ◽  
Patient Characteristics ◽  
Healthcare Resource Utilization ◽  
Machine Learning Algorithms ◽  
Mental Illnesses ◽  
Variable Response ◽  
Drug Induced ◽  
Commercial Laboratory

AbstractBackgroundThere is a plethora of drugs available to psychiatrists for treatment of mental illness, which can vary in efficacy, tolerability, metabolic pathways and drug-drug interactions. Psychotropics are the second most commonly listed therapeutic class mentioned in the FDA’s Table of Pharmacogenomic Biomarkers in Drug Labeling. Pharmacogenomic (PGx) assays are increasingly used in psychiatry to help select safe and appropriate medication for a variety of mental illnesses. Our commercial laboratory offers PGx expert consultations by PharmDs and PhDs to clinician-users. Our database contains valuable information regarding the treatment of a diverse and challenging population.MethodsGenomind offers a PGx assay currently measuring variants of 24 genes relevant for selection of drugs with a mental illness indication. Since 2012 we have analyzed > 250,000 DNA samples. Between 10/18 - 8/20 6,401 reports received a consult. The data contained herein are derived from those consults. Consultants record information on prior meds, reason for failure or intolerability, potential risk-associated or useful drugs based on the genetic variants. Consultants only recommend specific drugs and doses consistent with a published PGx guideline.ResultsThe 5 most commonly discussed genes were SLC6A4, MTHFR, CACNA1C, COMT and BDNF. The 3 most commonly discussed drugs were fluoxetine, lithium and duloxetine. The most common reasons for drug failure were inefficacy and drug induced “agitation, irritability and/or anxiety”. SSRIs were the most common class of discontinued drug; sertraline, escitalopram and fluoxetine were the three most commonly reported discontinuations and were also the 3 most likely to be associated with “no improvement”. Aripiprazole was the most commonly reported discontinued atypical antipsychotic. The providers rated 94% of consultations as extremely or very helpful at the time of consult. An independent validation survey of 128 providers confirmed these ratings, with 96% reporting a rating of “very helpful” or “extremely helpful”. In addition, 94% reported that these consults were superior to PGx consults provided through other laboratories. Patient characteristics captured during consults via a Clinical Global Impressions-Severity (CGI-S) scale revealed that the majority of patients were moderately (54%) or markedly ill (23%). The most frequent symptoms reported were depression, anxiety, insomnia and inattentiveness.DiscussionThe large variety of psychotropic drugs available to providers, and their highly variable response rates, tolerability, capacity for drug-drug interactions and metabolic pathways present a challenge for even expert psychopharmacologists. Consultation with experts in PGx provides additional useful information that may improve outcomes and decrease healthcare resource utilization. This database may provide future opportunities for machine learning algorithms to further inform implications of included gene variants.FundingGenomind, Inc.

scholarly journals The unbalanced reorganization of weaker functional connections induces the altered brain network topology in schizophrenia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rossana Mastrandrea ◽  
Fabrizio Piras ◽  
Andrea Gabrielli ◽  
Nerisa Banaj ◽  
Guido Caldarelli ◽  
...  
Keyword(s):  
Resting State ◽  
Functional Organization ◽  
Functional Integration ◽  
Brain Network ◽  
Modular Organization ◽  
Node Degree ◽  
Imaging Data ◽  
Brain Disorder ◽  
Functional Connections ◽  
The Brain

AbstractNetwork neuroscience shed some light on the functional and structural modifications occurring to the brain associated with the phenomenology of schizophrenia. In particular, resting-state functional networks have helped our understanding of the illness by highlighting the global and local alterations within the cerebral organization. We investigated the robustness of the brain functional architecture in 44 medicated schizophrenic patients and 40 healthy comparators through an advanced network analysis of resting-state functional magnetic resonance imaging data. The networks in patients showed more resistance to disconnection than in healthy controls, with an evident discrepancy between the two groups in the node degree distribution computed along a percolation process. Despite a substantial similarity of the basal functional organization between the two groups, the expected hierarchy of healthy brains' modular organization is crumbled in schizophrenia, showing a peculiar arrangement of the functional connections, characterized by several topologically equivalent backbones. Thus, the manifold nature of the functional organization’s basal scheme, together with its altered hierarchical modularity, may be crucial in the pathogenesis of schizophrenia. This result fits the disconnection hypothesis that describes schizophrenia as a brain disorder characterized by an abnormal functional integration among brain regions.

scholarly journals Priority vaccination for mental illness, developmental or intellectual disability

2021 ◽  
pp. medethics-2021-107247
Author(s):  
Nina Shevzov-Zebrun ◽  
Arthur L Caplan
Keyword(s):  
Mental Illness ◽  
Living Arrangement ◽  
State Level ◽  
Elevated Risk ◽  
Mental Illnesses ◽  
Healthcare Personnel ◽  
Diverse Populations ◽  
Federal Level ◽  
Control And Prevention ◽  
Prevention Guidelines

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: who else should be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need.

Determinants of somatization in primary care

1991 ◽  
Vol 21 (2) ◽  
pp. 473-483 ◽  
Author(s):  
K. Bridges ◽  
D. Goldberg ◽  
B. Evans ◽  
T. Sharpe
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Patient Care ◽  
Social Stress ◽  
Psychological Symptoms

SYNOPSISThis study explores possible determinants of somatization in primary care. Hypotheses were tested on samples of ‘somatizers’, ‘psychologizers’ and controls recruited by epidemiological procedures. Although ‘somatizers’ were found to be similar to ‘psychologizers’ in many respects, they were (i) less depressed; (ii) reported lower levels of social dissatisfaction, social stress and less dependence on their relatives; (iii) more likely to have an unsympathetic attitude towards mental illness and less likely to consult a doctor about psychological symptoms, and (iv) more likely to have received medical in-patient care as an adult before they had consulted their doctor with their current illness. These findings are discussed in the context of previous research.

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