Mental health professionals' perceptions of clinical utility: a comparison of the current and alternate DSM-5 models for personality disorder

A research report submitted in partial fulfillment of the requirement for the degree Master of Arts in Clinical Psychology In the Faculty of Humanities at the University of the Witwatersrand, Johannesburg 15 March 2018Background: Despite its widespread international use, numerous criticisms have been aimed at the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) categorical approach towards the conceptualisation and diagnosis of personality disorders (PD). A hybrid dimensional/categorical diagnostic model was therefore developed, which was intended to replace the existing categorical PD classification system. However, due to disagreement between leading professionals, it was instead placed in Section III, “Emerging Measures and Models” of the DSM-5 as an “Alternative DSM-5 Model for Personality Disorders” (DSM-5-AMPD). Study Objective: This research aimed to explore the perceived clinical utility of the current DSM-5 categorical model for personality disorders (DSM-5-PD) in comparison to the DSM-5-AMPD. Method: A sample of 13 mental health professionals applied four diagnostic instruments comprising personality disorder features listed in the DSM-5-PD model and DSM-5-AMPD to a common patient case file. Subsequent to the completion of each instrument, participants evaluated its clinical utility with respect to the following six areas: (1) ease of use, (2) professional communication, (3) patient communication, (4) comprehensive coverage, (5) treatment planning, and (6) global personality description. Appropriate decision rules for each model were then employed by the researcher to assign implied PD diagnoses. Information regarding the comparison of utility judgements and implied personality disorder diagnoses were then presented to the sample at a focus group discussion. During the discussion, professionals were requested to draw on this information, as well as the process of applying both diagnostic models to the common case file, to inform a more in-depth discussion regarding the perceived clinical utility of the DSM-5-PD model in relation to the DSM-5-AMPD. Results and Discussion: There were no statistically significant differences in perceived clinical utility between the DSM-5-PD model and the DSM-5-AMPD. However, a noticeable trend in the data revealed that using the DSM-5-AMPD may reduce the extensive co-occurrence of personality disorders in diagnosis, an often-cited criticism of the DSM-5-PD model. The qualitative analysis demonstrated advantages of both models: the DSM-5-PD model is more familiar, easier to use, and provides a shorthand, common diagnostic language for faster professional communication, while the DSM-5- AMPD provides more individualised and informative personality disorder descriptions. The latter may allow for more accurate personality disorder diagnoses, precise professional communication, improved patient communication, and effective treatment. Conclusion: A cost-benefit analysis between efficiency versus accuracy is required in order to determine which diagnostic model is more clinically useful. However, both the DSM-5-PD model and the DSM-5-AMPD fail to address cultural differences in relation to mental illness, such as South Africa’s collectivist and ancestral ideology and cultural practices. Therefore, future revisions of the DSM’s taxonomy of personality pathology should account for cultural differences with regard to mental illness.MT 201

Links between core promoter and basic gene features influence gene expression

<p>Abstract</p> <p>Background</p> <p>Diversity in rates of gene expression is essential for basic cell functions and is controlled by a variety of intricate mechanisms. Revealing general mechanisms that control gene expression is important for understanding normal and pathological cell functions and for improving the design of expression systems. Here we analyzed the relationship between general features of genes and their contribution to expression levels.</p> <p>Results</p> <p>Genes were divided into four groups according to their core promoter type and their characteristics analyzed statistically. Surprisingly we found that small variations in the TATA box are linked to large differences in gene length. Genes containing canonical TATA are generally short whereas long genes are associated with either non-canonical TATA or TATA-less promoters. These differences in gene length are primarily determined by the size and number of introns. Generally, gene expression was found to be tightly correlated with the strength of the TATA-box. However significant reduction in gene expression levels were linked with long TATA-containing genes (canonical and non-canonical) whereas intron length hardly affected the expression of TATA-less genes. Interestingly, features associated with high translation are prevalent in TATA-containing genes suggesting that their protein production is also more efficient.</p> <p>Conclusion</p> <p>Our results suggest that interplay between core promoter type and gene size can generate significant diversity in gene expression.</p

Unique translation initiation of mRNAs-containing TISU element

Translation Initiator of Short 5′ UTR (TISU) is a unique regulatory element of both transcription and translation initiation. It is present in a sizable number of genes with basic cellular functions and a very short untranslated region (5′ UTR). Here, we investigated translation initiation from short 5′ UTR mRNAs with AUG in various contexts. Reducing 5′ UTR length to the minimal functional size increases leaky scanning from weak and strong initiators but hardly affects translation initiation and ribosomal binding directed by TISU. Ribosome interaction with TISU mRNA is cap dependent and involves AUG downstream nucleotides that compensate for the absent 5′ UTR contacts. Interestingly, eIF1 inhibits cap-proximal AUG selection within weak or strong contexts but not within TISU. Furthermore, TISU-directed translation is unaffected by inhibition of the RNA helicase eIF4A. Thus, TISU directs efficient cap-dependent translation initiation without scanning, a mechanism that would be advantageous when intracellular levels of eIF1 and eIF4A fluctuate

PSYCHOLOGICAL RESPONSES TO CONTINUOUS TERROR: A STUDY OF TWO COMMUNITIES IN ISRAEL.

מטרה: הערכת תגובות פסיכולוגיות למצב של טרור מתמשך. נבדקים: 167 אנשים שגרים באפרת, אזור שהיה חשוף לפגיעה ישירה של אירועי טרור, ו-89 אנשים שגרים בבית שמש, אזור שהיה חשוף לפגיעה באופן עקיף. שיטה וכלי מחקר: המשתתפים השיבו על השאלונים הבאים: מידת החשיפה לאירועי טרור במשך 8 החודשים שקדמו למחקר הוערכה על ידי גרסה של שאלון היסטוריה טראומתית של גודמן (1998 Goodman, et al.) , סימפטומים של הפרעה פוסט טראומתית -PTSD הוערכו על ידי דיווח עצמי (1993Foa, et al. ) ,תחושת מתח כללית הוערכה על ידי שאלון סימפטומים קצר ( Derogatis, et1983, 1982 al.) ונמדדה הערכת נזק לתפקוד ( .Pearlin, et al1978). מן הממצאים: נבדקים שחיים באיזור שספג פגיעה ישירה של אירועי טרור דיווחו באופן מובהק על הפרעה גדולה יותר לאורח החיים היומיומי. שתי הקבוצות דיווחו על שיעורים דומים של סימפטומים של הפרעה פוסט טראומתית על פי ה-IV - .DSMכשליש מהאנשים שסבלו מהפרעה פוסט טראומתית גם דיווחו על תחושת לחץ משמעותית וחוסר תפקוד

Efficient and Accurate Translation Initiation Directed by TISU Involves RPS3 and RPS10e Binding and Differential Eukaryotic Initiation Factor 1A Regulation

International audienc

Gene sets which differ in their core promoter, as described in the text, were analyzed for the length of their genes (A), mRNA (B) and introns (C)

The boxplots present the median, 25% and 75% quartile values that were calculated from 527 TATA, 694 TATA-1, 3916 TATA-2 and 9491 TATA-less genes. The p-values of the differences in the median value between each two gene sets as indicated. NS is non-significant difference (p > 0.05).<p><b>Copyright information:</b></p><p>Taken from "Links between core promoter and basic gene features influence gene expression"</p><p>http://www.biomedcentral.com/1471-2164/9/92</p><p>BMC Genomics 2008;9():92-92.</p><p>Published online 25 Feb 2008</p><p>PMCID:PMC2279122.</p><p></p

The median, 25% and 75% quartiles of tissue average expression for each gene sets

The gene sets were divided into short (intron 8000 nt, grey box), and the median, 25% and 75% quartile of the avarage expression for each gene set is shown. The p-values of the differences in the median value between each two gene sets as indicated. NS is non-significant difference (p > 0.05).<p><b>Copyright information:</b></p><p>Taken from "Links between core promoter and basic gene features influence gene expression"</p><p>http://www.biomedcentral.com/1471-2164/9/92</p><p>BMC Genomics 2008;9():92-92.</p><p>Published online 25 Feb 2008</p><p>PMCID:PMC2279122.</p><p></p

Reduced Endocannabinoid Tone in Saliva of Chronic Orofacial Pain Patients

Background: the endocannabinoid system (ECS) participates in many physiological and pathological processes including pain generation, modulation, and sensation. Its involvement in chronic orofacial pain (OFP) in general, and the reflection of its involvement in OFP in salivary endocannabinoid (eCBs) levels in particular, has not been examined. Objectives: to evaluate the association between salivary (eCBs) levels and chronic OFP. Methods: salivary levels of 2 eCBs, anandamide (AEA), 2-arachidonoylglycerol (2-AG), 2 endocannabinoid-like compoundsN-palmitoylethanolamine (PEA), N-oleoylethanolamine (OEA), and their endogenous precursor and breakdown product, arachidonic acid (AA), were analyzed using liquid chromatography/tandem mass spectrometry in 83 chronic OFP patients and 43 pain-free controls. The chronic OFP patients were divided according to diagnosis into musculoskeletal, neurovascular/migraine, and neuropathic pain types. Results: chronic OFP patients had lower levels of OEA (p = 0.02) and 2-AG (p = 0.01). Analyzing specific pain types revealed lower levels of AEA and OEA in the neurovascular group (p = 0.04, 0.02, respectively), and 2-AG in the neuropathic group compared to controls (p = 0.05). No significant differences were found between the musculoskeletal pain group and controls. Higher pain intensity was accompanied by lower levels of AA (p = 0.028), in neuropathic group. Conclusions: lower levels of eCBs were found in the saliva of chronic OFP patients compared to controls, specifically those with neurovascular/migraine, and neuropathic pain. The detection of changes in salivary endocannabinoids levels related to OFP adds a new dimension to our understanding of OFP mechanisms, and may have diagnostic as well as therapeutic implications for pain