A Novel Framework for Improving Psychiatric Diagnostic Nosology

2016 ◽  
Author(s):  
Shelly B. Flagel ◽  
Daniel S. Pine ◽  
Susanne E. Ahmari ◽  
Michael B. First ◽  
Karl J. Friston ◽  
...  
Keyword(s):  
Theoretical Basis ◽  
Diagnostic System ◽  
Signs And Symptoms ◽  
Underlying Disease ◽  
Diagnostic Process ◽  
Integrative Framework ◽  
Improve Treatment ◽  
Clinical Diagnoses ◽  
And Behavior ◽  
Underlying Pathophysiology

This chapter proposes a new framework for diagnostic nosology based on Bayesian principles. This novel integrative framework builds upon and improves the current diagnostic system in psychiatry. Instead of starting from the assumption that a diagnosis describes a specific unitary dysfunction that causes a set of symptoms, it is assumed that the underlying disease causes the clinician to make a diagnosis. Thus, unlike the current diagnostic system, this framework treats both symptoms and diagnostic classification as consequences of the underlying pathophysiology. Comorbidities are therefore easily incorporated into the framework and inform, rather than hinder, the diagnostic process. Further, the proposed framework provides a bridge that links putative constructs related to pathophysiology and clinical diagnoses related to signs and symptoms. Crucially, this novel framework explicitly provides an iterative approach, updating and selecting the best model, based on the highest-quality available evidence at any point. It can account for and incorporate the longitudinal course of an illness. This chapter details its theoretical basis and provides clinical examples to illustrate its utility and application. It is hoped that the framework will enhance our understanding of individual differences in brain function and behavior and ultimately improve treatment outcomes in psychiatry.

scholarly journals A IMPORTÂNCIA DO PROFISSIONAL ENFERMEIRO NO DIAGNÓSTICO DO AUTISMO: uma revisão integrativa da literatura

2020 ◽  
Vol 6 (2) ◽  
pp. 235-245
Author(s):  
Marcelo Cerilo dos Santos-Filho ◽  
◽  
Lais Edvirgens Lima da Cruz ◽  
Bruna Stefany Rocha do Nascimento ◽  
Julyana Constância Feitoza Marinho ◽  
...  
Keyword(s):  
Neurodevelopmental Disorder ◽  
Signs And Symptoms ◽  
Research Problem ◽  
Autism Spectrum ◽  
Diagnostic Process ◽  
Sample Number ◽  
And Behavior ◽  
First Contact ◽  
Nursing Professional

Autism is a neurodevelopmental disorder that damages social interactions, in terms of communication and behavior. As the professional who has the first contact with the child, the nurse must evaluate child development, highlighting the signs that Autism Spectrum Disorder (ASD) presents. Based on what was presented, the current study had as objecitve to present the relevance of the role of nurse in the diagnosis of autism. This research is an integrative and descriptive literature review, and with a qualitative approach of articles published between 2012 and 2019. A search was carried out in the Lilacs, Scielo, Capes Journals and Google Scholar databases. Data collection was carried out between April and October 2019. 908 articles were found, however only 8 responded to the research problem and became the sample number. It was identified that the attention of the nursing professional can not be directed only to the person with autism, but also to their family; it must try to reduce fear, prejudice and the feeling of inferiority towards society. It is the role of nurse to guide family members to communicate with the child, to stimulate their interaction with people. With this, the nurse is essential in the diagnostic process of autism, being aware of the signs and symptoms of autism, providing good nursing care to the child and their relatives, encouraging, transmitting security and tranquility to everyone.

The Nature of the Beast: Commentary on “Can There Be a Recovery-Oriented Diagnostic Practice?”

2018 ◽  
Vol 59 (3) ◽  
pp. 346-355 ◽  
Author(s):  
Golan Shahar
Keyword(s):  
Diagnostic System ◽  
Signs And Symptoms ◽  
Building Blocks ◽  
Self Report ◽  
Diagnostic Process ◽  
Diagnostic Practice ◽  
Recovery Movement ◽  
Potential Benefits ◽  
Effective Diagnosis

Pavlo, Flanagam, Leither, and Davidson attempt to reconcile the recovery movement in mental health service with a formal diagnostic practice is as courageous as it is timely. Acknowledging this, I note several points of convergence and divergence with the authors’ views. Points of convergence include (1) the inevitability of a diagnostic system when working with (severe) mental illness, (2) the importance of going beyond signs and symptoms in capturing the unique characteristics of the person, (3) the focus on humanistic values, particularly the emphasis on a collaborative assessment and on human strengths, in the diagnostic process, and (4) the role of future-oriented thinking in diagnosis. Divergence with the authors concerns (1) my own reliance on descriptive psychiatry, with its focus on signs and symptoms, as a part and parcel of an effective diagnosis, (2) the potential benefits of psychological tests, for example, self-report questionnaires and projective procedures over and above the clinical interview, and (3) my emphasis on mental representations of self-with-others, termed here and elsewhere as “agents in relations,” as the building blocks of personality and psychopathology.

scholarly journals Paediatric Idiopathic Intracranial Hypertension (IIH)—A Review

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 632
Author(s):  
Andrew Malem ◽  
Twishaa Sheth ◽  
Brinda Muthusamy
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Adult Population ◽  
Underlying Disease ◽  
Diagnostic Process ◽  
Paediatric Patients ◽  
Disease Aetiology ◽  
Sight Loss ◽  
Chronic Headaches ◽  
Work Up

Paediatric idiopathic intracranial hypertension (IIH), is a rare but important differential diagnosis in children presenting with papilloedema. It is characterised by raised intracranial pressure in the absence of an identifiable secondary structural or systemic cause and is, therefore, a diagnosis of exclusion. In the adult population, there is a strong predilection for the disease to occur in female patients who are obese. This association is also seen in paediatric patients with IIH but primarily in the post-pubertal cohort. In younger pre-pubertal children, this is not the case, possibly reflecting a different underlying disease aetiology and pathogenesis. Untreated IIH in children can cause significant morbidity from sight loss, chronic headaches, and the psychological effects of ongoing regular hospital monitoring, interventions, and medication. The ultimate goal in the management of paediatric IIH is to protect the optic nerve from papilloedema-induced optic neuropathy and thus preserve vision, whilst reducing the morbidity from other symptoms of IIH, in particular chronic headaches. In this review, we will outline the typical work-up and diagnostic process for paediatric patients with suspected IIH and how we manage these patients.

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

scholarly journals Clinical Features and Outcomes of a Racially Diverse Population with Fibrillary Glomerulonephritis

2017 ◽  
Vol 45 (3) ◽  
pp. 248-256 ◽  
Author(s):  
Fernanda Payan Schober ◽  
Meghan A. Jobson ◽  
Caroline J. Poulton ◽  
Harsharan K. Singh ◽  
Volker Nickeleit ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Disease Process ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Fibrillary Glomerulonephritis ◽  
Black Patients ◽  
End Stage ◽  
20 Nm ◽  
The University

Background: Fibrillary glomerulonephritis is characterized by randomly arranged fibrils, approximately 20 nm in diameter by electron microscopy. Patients present with proteinuria, hematuria and kidney insufficiency, and about half of the reported patients progress to end-stage kidney disease within 4 years. The dependence of patient characteristics and outcomes on race has not been explored. In this study, we describe a cohort of patients with fibrillary glomerulonephritis and compare their clinical characteristics and outcomes with those of patients previously described. Methods: The University of North Carolina (UNC) Nephropathology Database was used to retrospectively identify patients diagnosed with fibrillary glomerulonephritis between 1985 and 2015. Of these patients, those treated at UNC were selected. Their demographic and clinical characteristics - including signs and symptoms, comorbidities, laboratory values, treatments and outcomes - were compared with those of patients described earlier. Results: Among the 287 patients identified, 42 were treated at the UNC Kidney Center. When compared to earlier cohorts, a higher frequency of black race, hepatitis C virus (HCV) infection and use of hemodialysis were noted in both black and HCV-positive patients. Autoimmune diseases, infections and malignancies were frequently observed, present in over half of all cases. Conclusion: According to this study, fibrillary glomerulonephritis represents a secondary glomerular disease process (associated with autoimmune disease, infection or malignancy) in many cases and hence screening is essential. As the screening for comorbidities increased over time, more underlying causes were identified. We noted a high frequency of HCV among black patients, suggesting a possible causative association. Treatment of underlying disease is essential for patients for the best outcome.

scholarly journals Artificial intelligence assisted electrocardiography for early diagnosis of thyrotoxic periodic paralysis

2021 ◽  
Author(s):  
Chin Lin ◽  
Chin-Sheng Lin ◽  
Ding-Jie Lee ◽  
Chia-Cheng Lee ◽  
Sy-Jou Chen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Early Diagnosis ◽  
Validation Cohort ◽  
Laboratory Data ◽  
Diagnostic System ◽  
Periodic Paralysis ◽  
Medical Emergency ◽  
Diagnostic Process ◽  
Routine Laboratory ◽  
Thyrotoxic Periodic Paralysis

Abstract CONTEXT Thyrotoxic periodic paralysis (TPP) characterized by acute weakness, hypokalemia and hyperthyroidism is a medical emergency with a great challenge in early diagnosis since most TPP patients do not have overt symptoms. OBJECTIVE To assess artificial intelligence (AI)-assisted electrocardiography (ECG) combined with routine laboratory data in the early diagnosis of TPP. METHODS A deep learning model (DLM) based on ECG12Net, an 82-layer convolutional neural network, was constructed to detect hypokalemia and hyperthyroidism. The development cohort consisted of 39 ECGs from patients with TPP and 502 ECGs of hypokalemic control; the validation cohort consisted of 11 ECGs of TPP and 36 ECGs of non-TPP with weakness. The AI-ECG based TPP diagnostic process was then consecutively evaluated in 22 male patients with TTP-like features. RESULTS In the validation cohort, the DLM-based ECG system detected all cases of hypokalemia in TPP patients with a mean absolute error of 0.26 mEq/L and diagnosed TPP with an area under curve (AUC) of ~80%, surpassing the best standard ECG parameter (AUC=0.7285 for the QR interval). Combining the AI predictions with the estimated glomerular filtration rate (eGFR) and serum chloride (Cl -) boosted the diagnostic accuracy of the algorithm to AUC 0.986. In the prospective study, the integrated AI and routine laboratory diagnostic system had a PPV of 100% and F-measure 87.5%. CONCLUSIONS An AI-ECG system reliably identifies hypokalemia in patients with paralysis and integration with routine blood chemistries provides valuable decision support for the early diagnosis of TPP.

scholarly journals METHODOLOGICAL PLATFORM FOR DIAGNOSING ECONOMIC ACTIVITY OF TRADE ENTERPRISES

2021 ◽  
Author(s):  
Nataliia Kashchena
Keyword(s):  
Economic Activity ◽  
Consumer Preferences ◽  
Diagnostic System ◽  
Component Composition ◽  
Business Environment ◽  
Information Support ◽  
Diagnostic Process ◽  
Practical Implementation ◽  
Diagnostic Study ◽  
Management Decisions

The article substantiates the theoretical and methodological principles of forming a methodological platform for diagnosing the economic activity of a trading enterprise as a basis for implementing a diagnostic process focused on the formation of special information used for making management decisions. It is noted that the diagnostics of economic activity of a trade enterprise as a component of management is a set of actions aimed at providing information support to management that requires from management staff systemic theoretical knowledge and applied skills of instrumental methods of identifying economic activity, trends, assessing causes of change, forecasting and the practical implementation of the identified opportunities to increase it, taking into account changes in the business environment and the needs of stakeholders. It is proved that the efficiency of diagnostics of economic activity is ensured by the appropriate methodology, which normalizes the organization of the diagnostic process, procedures and operations into a holistic system with clearly defined prerequisites, component composition and process of their implementation. The methodology framework is determined and the problem tree analysis of the formation of the methodological platform for diagnosing economic activity of trade enterprises is carried out. The architectural structure of the system of diagnosing economic activity of a trade enterprise through a combination of functional and support components, which are defining for productive functioning of the mechanism and efficiency of the diagnostic process, is considered. The sequence of stages of the diagnostic process and procedural aspects of verification of each of them is determined. It is proved that the efficiency of the process of diagnostics of economic activity is provided by an appropriate mechanism, which through a set of rules, special tools, methods and techniques launches and maintains a diagnostic study, thus ensuring the integrity of the diagnostic system. A conceptual model of the methodological platform for diagnosing economic activity of trade enterprises is developed, which integrates the identified preconditions and component composition of the methodology on the basis of systematicity and ensures the effectiveness of the process of obtaining information for management. The developed model allows to deepen and expand understanding of the essence of the system for diagnosing economic activity of the enterprise, its structure, regularities, the purposes and tasks of functioning, to provide high-quality instrumental support of the realization of diagnostic procedures and operations, to streamline the process of reception of the information for making management decisions focused on achieving target parameters of development of economic activity taking into account the dynamic changes in the business environment and consumer preferences.

Limitations Using Neuroimaging to Reconstruct Mental State After a Crime

2021 ◽  
Vol 30 (4) ◽  
pp. 694-701
Author(s):  
Michael J. Vitacco ◽  
Alynda M. Randolph ◽  
Rebecca J. Nelson Aguiar ◽  
Megan L. Porter Staats
Keyword(s):  
Mental State ◽  
Insanity Defense ◽  
Physical Conditions ◽  
Clinical Diagnoses ◽  
History Of ◽  
Forensic Psychiatric ◽  
Brain And Behavior ◽  
And Behavior ◽  
The Relationship ◽  
The Brain

AbstractNeuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

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