Problematic, absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists' and psychiatrists' opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed. © 2014 Asociación Española de Psicología Conductual

Psychological interventions in patients with lung cancer: A review of the research literature

Cáncer de pulmón; Ansiedad; DepresiónLung cancer; Anxiety; DepressionCàncer de pulmó; Ansietat; DepressióIntroducción. El cáncer de pulmón (CP) es una de las principales causas de mortalidad en México y representa un grave problema de salud pública. Los pacientes reportan diversas afectaciones psicosociales, entre las cuales los síntomas de ansiedad, depresión y estigma percibido son los que más repercuten en su calidad de vida. Se han desarrollado diversas intervenciones psicológicas para ayudar a mejorar el estado psicológico de los pacientes con cáncer; sin embargo, la evidencia es particularmente limitada en los pacientes con CP. Objetivo. Conocer la evidencia acerca de las intervenciones psicológicas para aminorar o eliminar los síntomas de ansiedad, depresión y estigma percibido, y para mejorar por consiguiente su calidad de vida. Método. Se realizó una búsqueda PIOen las bases de datos PubMed, PsycINFO y Cochrane Library, sin restringir las fechas de publicación de los artículos. Resultados. Se obtuvo un total de 653 artículos, considerándose para esta revisión cuatro ensayos controlados aleatorizados y un cuasiexperimento. Discusión. Esta revisión propor-ciona evidencia respecto a la efectividad de diversas intervenciones psicológicas, siendo la terapia cognitivo-conductual el tipo de intervención más reportada y con mayores efectos positivos en la reducción de las variables mencionadas y la mejora de la calidad de vida, por lo que se recomienda llevar a cabo más análisis para demostrar su efectividad en pacientes con CP en población latina, y particularmente en México.Introduction. Lung cancer (LC) is one of the leading causes of mortality in Mexico, representing a serious public health problem. Patients show various psychosocial disorders, among which symptoms of anxiety, depression, and higher levels of perceived stigma are the most prevalent, affecting their quality of life. Various psychological interventions help improve the psychological state of cancer patients; however, the evidence is not as abundant in patients with LC. Objective. To explore the evidence of successful psychological interventions for symptoms of anxiety, depression, perceived stigma, and quality of life in patients with LC. Method. An IOP search was carried out in PubMed, PsycINFO, and Cochrane Library databases. There was no restriction on the publication dates. Results. 653 articles appeared, from which four random control essays and one quasi-experiment were included for this review. Discussion. The results provide evidence regarding the effectiveness of various psychological interventions, behavioral-cognitive therapy is the most frequently reported type of intervention and with the most noticeable positive effects on reducing symptoms of anxiety, depression, and perceived stigma and improving the quality of life. More research would better demonstrate its effectiveness in patients with PC in the Latino population, particularly in Mexico

Ten-year course of treated bipolar I disorder: The role of polarity at onset

Introduction: Early-stage predictors of illness course are needed in bipolar disorder (BD). Differences among patients with a first depressive versus maniac/hypomanic episode have been stated, although in most studies, memory bias and time from onset to start of specialized treatment might interfere. The aim was to compare the first 10 years of illness course according to polarity at onset. Methods: 49 type I BD patients admitted for treatment for a first-time affective episode and a following 10-year attendance to the institution were included. A retrospective year by year comparison according to polarity at onset (depressive (DPO) or maniac (MPO)) was performed. Cramer's V and Cohen d were computed to determine effect size. Results: 59.2% (n = 29) started with MPO. Both groups were similar in demographic and social outcome characteristics, clinical features, and treatment variables. Patients with DPO reported more depressive episodes than MPO patients (U = 149.0 p < .001, Cohen's d = 0.87); both groups had a similar number of manic episodes. Only during the first year of follow-up, suicide attempts (SA) were more frequent in patients with DPO while the presence of a psychotic episode and psychiatric hospitalizations were more frequent in the MPO group. Conclusion: According to these findings, it can be concluded that illness onset is only indicative of depressive predominant polarity but is not related to other poor prognostic variables after the first year of illness onset, in treated BD. SA in the first year of an affective disorder could represent a marker of BD

Remote crisis intervention and suicide risk management in COVID-19 frontline healthcare workers

IntroductionDespite the propagation of virtual mental health services for vulnerable groups during COVID-19 pandemic, the implementation and evaluation of remote evidence-based practices (EBP) to manage them in low- and middle-income countries remains scarce. In the current study, we describe and evaluate the implementation process and clinical impact of brief, remote, manualized EBP for crisis intervention and suicide risk management among healthcare workers attending patients with COVID-19 (COVID-19-HCWs) in Mexico.MethodsThe implementation process comprised community engagement of volunteer mental health specialists, creation of new clinical teams with different disciplines and skills, intervention systematization through manuals and education through 4-h remote training as main strategies. Mexican COVID-19-HCWs who had used a free 24-h helpline rated their pre- and post-intervention emotional distress. Therapists recorded patients’ pre-intervention diagnosis, severity, and suicide risk, the techniques used in each case, and their post-treatment perception of COVID-19-HCWs’ improvement at the end of the intervention.ResultsAll techniques included in the intervention manual were employed at least in one case (n = 51). At the beginning of the intervention, 65.9% of the COVID-19-HCWs were considered moderately ill or worse according to Clinical Global Impression-Severity (CGI-S) scores, whereas at the end, 79.4% of them were perceived as much or very much improved according to CGI-Improvement scores (CGI-I), and their emotional distress had been significantly reduced (p &lt; 0.001).DiscussionThis prospective study provides evidence that implementation of remote EBP is feasible and useful to reduce emotional distress and suicide risk among COVID-19-HCWs from a middle-income country. However, this study was limited by lack of a control group, improvement ratings provided by therapists and non-anonymous satisfaction ratings

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico

BackgroundPsychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support.ObjectiveThe aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not.MethodsThis was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey.Results73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support.ConclusionPsychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health

Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns

BACKGROUND: Since the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia. It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia. METHODS: A translated version of Rabinowitz's survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists. The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico. RESULTS: Recommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely. Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice. It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS. Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones. CONCLUSIONS: Some of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico

Validity of categories related to gender identity in ICD-11 and DSM-5 among transgender individuals who seek gender-affirming medical procedures

Background/Objective: The most recent versions of the two main mental disorders classifications—the World Health Organization's ICD-11 and the American Psychiatric Association's DSM–5—differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is explicitly not a mental disorder; neither distress nor dysfunction is a required feature. The objective was compared ICD-11 and DSM-5 diagnostic requirements in terms of their sensitivity, specificity, discriminability and ability to predict the use of gender-affirming medical procedures. Method: A total of 649 of transgender adults in six countries completed a retrospective structured interview. Results: Using ROC analysis, sensitivity of the diagnostic requirements was equivalent for both systems, but ICD-11 showed greater specificity than DSM-5. Regression analyses indicated that history of hormones and/or surgery was predicted by variables that are an intrinsic aspect of GI/GD more than by distress and dysfunction. IRT analyses showed that the ICD-11 diagnostic formulation was more parsimonious and contained more information about caseness than the DSM-5 model. Conclusions: This study supports the ICD-11 position that GI/GD is not a mental disorder; additional diagnostic requirements of distress and/or dysfunction in DSM-5 reduce the predictive power of the diagnostic model

Association study between the MDR1 gene and clinical characteristics in schizophrenia

Objective: Schizophrenia is a complex psychiatric disorder, characterized by disturbed patterns of thought and affecting 0.3-2.0% of the world population. Previously, the multidrug resistance 1 (MDR1) gene has been associated with schizophrenia in treatment response studies in psychotic patients. The aim of this study was to determine the association between MDR1 gene polymorphisms and clinical characteristics in patients with schizophrenia. Methods: Positive and negative symptoms of schizophrenia were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) in 158 Mexican patients with schizophrenia. Analyses of MDR1 gene polymorphisms were performed using TaqMan technology. A multivariate ANOVA was performed with MDR1 polymorphisms and gender as independent variables. Results: Males with the G/G genotype of MDR1 rs2032582 presented significantly higher levels of delusions (p = 0.02). When comparing female vs. male groups, the difference was statistically significant (p = 0.0003). Analyses of the MDR1 gene rs1045642 variant showed no significant differences. Conclusion: Our findings suggest that male carriers of the G allele of variant rs2032582 exhibit greater severity of delusions; however, these results should be taken as preliminary, and replication studies in other populations of different ethnic origins are required to confirm these findings