Neurologists' understanding and management of conversion disorder

BACKGROUND: Conversion disorder is largely managed by neurologists, for whom it presents great challenges to understanding and management. This study aimed to quantify these challenges, examining how neurologists understand conversion disorder, and what they tell their patients. METHODS: A postal survey of all consultant neurologists in the UK registered with the Association of British Neurologists. RESULTS: 349 of 591 practising consultant neurologists completed the survey. They saw conversion disorder commonly. While they endorsed psychological models for conversion, they diagnosed it according to features of the clinical presentation, most importantly inconsistency and abnormal illness behaviour. Most of the respondents saw feigning as entangled with conversion disorder, with a minority seeing one as a variant of the other. They were quite willing to discuss psychological factors as long as the patient was receptive but were generally unwilling to discuss feigning even though they saw it as their responsibility. Those who favoured models in terms of feigning were older, while younger, female neurologists preferred psychological models, believed conversion would one day be understood neurologically and found communicating with their conversion patients easier than it had been in the past. DISCUSSION: Neurologists accept psychological models for conversion disorder but do not employ them in their diagnosis; they do not see conversion as clearly different from feigning. This may be changing as younger, female neurologists endorse psychological views more clearly and find it easier to discuss with their patients

DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions

The recent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association has led to much debate. For this forum article, we asked BMC Medicine Editorial Board members who are experts in the field of psychiatry to discuss their personal views on how the changes in DSM-5 might affect clinical practice in their specific areas of psychiatric medicine. This article discusses the influence the DSM-5 may have on the diagnosis and treatment of autism, trauma-related and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders (including major depression and bipolar disorders), and schizophrenia spectrum disorders

Are the Armed Forces Understood and Supported by the Public?:A View from the United Kingdom

Despite the importance of public opinion in supporting the military and their missions, little is known about how the UK public perceive their Armed Forces. This article reviews and evaluates available research and opinion poll data of public attitudes toward the UK military and situates the evidence within the civil–military gap literature. Current evidence suggests public regard for the UK Armed Forces is high despite low levels of support for the Iraq and Afghanistan missions. Public understanding of the work of the Armed Forces is limited. Nonetheless, the United Kingdom’s long history of military deployments may have given the public an “intuitive understanding” of the basic realities of the military compared with other European states. There are indications of differences in attitudes between the UK Armed Forces and wider British society, but no firm evidence that the civil–military “gap” has become a “gulf” as claimed by some military leaders. </jats:p

Alcohol misuse in the United Kingdom Armed Forces:A longitudinal study

Objectives We assessed changes in Alcohol Use Disorders Identification Test (AUDIT) scores over time. We investigated the impact of life events and changes in mental health status on AUDIT scores over time in UK military personnel. Methods A random representative sample of regular UK military personnel who had been serving in 2003 were surveyed in 2004–2006 (phase 1) and again in 2007–2009 (phase 2). The impact of changes in symptoms of psychological distress, probable post-traumatic stress disorder (PTSD), marital status, serving status, rank, deployment to Iraq/Afghanistan and smoking was assessed between phases. Results We found a statistically significant but small decrease in AUDIT scores between phases 1 and 2 (mean change = −1.01, 95% confidence interval = −1.14, −0.88). Participants reported a decrease in AUDIT scores if they experienced remission in psychological distress (adjusted mean −2.21, 95% CI −2.58, −1.84) and probable PTSD (adjusted mean −3.59, 95% CI −4.41, −2.78), if they stopped smoking (adjusted mean −1.41, 95% CI −1.83, −0.98) and were in a new relationship (adjusted mean −2.77, 95% CI −3.15, −2.38). On the other hand, reporting new onset or persistent symptoms of probable PTSD (adjusted mean 1.34, 95% CI 0.71, 1.98) or a relationship breakdown (adjusted mean 0.53, 95% CI 0.07, 0.99) at phase 2 were associated with an increase in AUDIT scores. Conclusions The overall level of hazardous alcohol consumption remains high in the UK military. Changes in AUDIT scores were linked to mental health and life events but not with deployment to Iraq or Afghanistan.</p

Mental health outcomes in US and UK military personnel returning from Iraq

BackgroundResearch of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel.AimsTo compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq.MethodData were from one US (n= 1560) and one UK (n= 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007–2008. Analyses were stratified by high- and low-combat exposure.ResultsSignificant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure: OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms.ConclusionsDifferences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.</jats:sec