The Journal of nervous and mental disease
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J. Nerv. Ment. Dis. · Jun 2012
Should prolonged grief be reclassified as a mental disorder in DSM-5?: reconsidering the empirical and conceptual arguments for complicated grief disorder.
The proposed changes to DSM-5 will create new categories of mental disorder (referred to here generically as Prolonged Grief Disorder'' [PGD]) to diagnose individuals experiencing prolonged intense grief reactions to the loss of a loved one. Individuals could be diagnosed even if they have no depressive or anxiety symptoms but only symptoms typical of grief (e.g., yearning, avoidance of reminders, disbelief, feelings of emptiness). The main challenge for such proposals is to establish that the proposed diagnostic criteria validly discriminate a genuine psychiatric disorder of grief from intense normal grief. ⋯ Upon close examination, each of these arguments turns out to have serious empirical or conceptual deficiencies. I conclude that the proposed diagnostic criteria for PGD fail to discriminate disorder from intense normal grief and are likely to yield massive false-positive diagnoses. Consequently, the proposal to add pathological grief categories to DSM-5 should be withdrawn pending further research to identify more valid criteria for diagnosing PGD.
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The evolution of medical research has vaulted randomized clinical trials to the status of current gold standard of clinical evidence. In parallel, the evolution of the science of decision-making has revealed human beings' universal tendency to make biased judgments and systematic errors in their evaluation of information and choices. ⋯ A number of these are postulated to be important, both for the investigators generating clinical evidence and for the clinical observers interpreting clinical trials. This study focuses on the field of psychiatry and on the potentially significant implications of evidence biases for psychiatric practice and clinical understanding.
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J. Nerv. Ment. Dis. · Dec 2011
Case ReportsRisperidone and lorazepam concomitant use in clonazepam refractory catatonia: a case report.
The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. ⋯ Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.
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J. Nerv. Ment. Dis. · Sep 2011
The effects of neuroticism, extraversion, and positive and negative life events on a one-year course of depressive symptoms in euthymic previously depressed patients versus healthy controls.
We investigated a) the concurrent impact of positive and negative life events on the course of depressive symptoms in persons remitted from depression and healthy controls, b) whether the impact of life events on symptom course is moderated by the history of depression and the personality traits of neuroticism and extraversion, and c) whether life events mediate possible relationships of history of depression and personality traits with symptom course. Using data from the Netherlands Study of Depression and Anxiety, we examined 239 euthymic participants with a previous depressive disorder based on DSM-IV and 450 healthy controls who completed a) baseline assessments of personality dimensions (NEO Five-Factor Inventory) and depression severity (Inventory of Depressive Symptoms [IDS]) and b) 1-year follow-up assessments of depression severity and the occurrence of positive and negative life events during the follow-up period (List of Threatening Events Questionnaire). ⋯ The impact of life events on symptom course was not moderated by history of depression or personality traits. The effect of extraversion on symptom course was partly caused by differential engagement in positive life events.
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J. Nerv. Ment. Dis. · Sep 2011
The journey through cannabis use: a qualitative study of the experiences of young adults with psychosis.
The present study explored the personal experiences of cannabis and psychosis among young adults, including the reasons and meanings of cannabis use and the perceived relationship between cannabis and mental health. Interviews with seven young adults with psychosis who described regular current or past cannabis use were conducted and analyzed using Interpretative Phenomenological Analysis. Four master themes emerged: The Journey Through Cannabis Use, The Social and Cultural World, The Struggle to Make Sense, and The Depths and Beyond. ⋯ Social and cultural factors clearly influenced the initiation of and decision whether to continue using cannabis. Individuals could simultaneously hold positive and negative views on using cannabis. Implications for clinical interventions are explored, and the relevance of motivational interviewing and the stages of change models of behavior change are noted.