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The DSM-5’s proposed new categories of sexual disorder: the problem of false positives in sexual diagnosis
- Author:
- WAKEFIELD Jerome C.
- Journal article citation:
- Clinical Social Work Journal, 40(2), 2012, pp.213-223.
- Publisher:
- Springer
- Place of publication:
- New York
The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, the author closely examines the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5—hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a “nonconsent” or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. The author argues, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i.e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in “sexually violent predator” civil commitment proceedings. (Publisher abstract)
Controversies in psychiatry and DSM-5: the relevance for social work
- Authors:
- LITTRELL Jill, LACASSE Jeffrey R.
- Journal article citation:
- Families in Society, 93(4), October 2012, pp.265-269.
- Publisher:
- The Alliance for Children and Families
In this essay, the authors address recent controversies surrounding the forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the first major revision of the DSM since 1994. The essay reports that mental health professionals across a wide range of professions in the US have signed a petition to the DSM-5 Task Force asking for reconsideration of its intention to loosen and expand criteria for a variety of diagnoses, and notes that critiques of psychiatric medications are increasingly disseminated in the media. It suggests that these issues have particular relevance for children in foster care, who receive diagnoses and medication at high rates. It also discusses diagnoses and the relationship between academic psychiatry and the pharmaceutical industry in the US. The authors argue that it is important that social work practitioners are informed about these issues, and consider implications and potential action strategies for social workers.
A prospective study of PTSD following recovery from first-episode psychosis: the threat from persecutors, voices, and patienthood
- Authors:
- BRUNET Kat, et al
- Journal article citation:
- British Journal of Clinical Psychology, 51(4), November 2012, pp.418-433.
- Publisher:
- Wiley
Focusing on post-traumatic symptoms and people with psychosis, this prospective study tested hypotheses based on retrospective findings that threat appraisals of voices, persecutors, or the new label of 'mental health patient' predict symptoms of post-traumatic stress disorder (PTSD). Fifty patients in Birmingham in the acute phase of a first psychotic episode were assessed for appraisals of threat from voices, other persecutors, and the diagnosis. 39 patients completed the follow-up stage 18 months later, which was designed to establish PTSD symptom levels and diagnosis. The article describes the study methodology, analysis, and results. It reports that 31% of participants who completed the follow up phase met criteria for PTSD diagnosis, and 49% were still distressed by memories of their psychosis or the associated treatment. Appraisals of threat from voices and persecutors during the acute phase of psychosis were generally not predictive of subsequent post-traumatic stress. The authors discuss the findings and suggest that further research is required to assess the true impact of psychosis on PTSD.
UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen
- Author:
- PALMER Ian P.
- Journal article citation:
- Psychiatrist (The), 36(7), July 2012, pp.263-270.
- Publisher:
- Royal College of Psychiatrists
This study describes an interim service set up to examine the breadth of UK ex-service personnel’s concerns in relation to their mental health and military service and provides a record of the first 150 individuals assessed following conformation of military service and examination of all available military and civilian medical records. The majority of attendees were White male ex-soldiers. Average age, service and time to assessment were 44.5, 15.8 and 11.7 years respectively. Two-thirds were receiving help from the National Health Service and ex-service non-governmental organisations. Rates of post-traumatic stress disorder were similar to previous UK studies. Obsessional symptoms were of relevance to the clinical presentation in a third. Fabrication and/or exaggeration occurred in about 10%. The authors note that the spread of diagnoses and delay in help-seeking are similar to civilians. They believe that the link between mental disorders and military service is seldom straightforward and fabrication or exaggeration is difficult for civilians to recognise. Verification and contextualisation of service using contemporaneous service medical records is of value given the possible occupational origin of mental health conditions.
Mental health and Asperger's syndrome: what clinicians need to know
- Authors:
- LEATHER JoAnn, LEARDI Matthew
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 22(8), 2012, pp.1014-1020.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
In today’s psychotherapy practice, there is an increase in the number of clients with Asperger’s syndrome (AS) seeking treatment for a variety of mental health issues. This paper aims to explain what clinicians need to know and understand when treating individuals with AS. It addresses the presentation of AS and what clinicians need to focus on during intake, while establishing a therapeutic relationship, and the range and severity of co-morbid issues within this population. The paper also discusses diagnosis of AS and the effectiveness of cognitive-behavioural therapy in the treatment of symptoms of AS and explains the use of medication and psychosocial support. Implications for practice are discussed.
Diagnosing, diagnoses, and the DSM in clinical social work
- Author:
- PROBST Barbara
- Journal article citation:
- Families in Society, 93(4), October 2012, pp.255-263.
- Publisher:
- The Alliance for Children and Families
Using data collected within a larger study, this article presents findings about how clinical social workers think about and use diagnoses deriving from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and differential use of diagnostic categories. The US-based qualitative study gathered information from a sample of 30 clinical social workers in Westchester County who took part in face-to-face interviews. The article describes the methodology and the results of thematic analysis of the interviews. It discusses the findings, covering 7 specific themes: diagnosis can provide useful indications for treatment decisions, the importance of a diagnosis depends on the disorder, diagnoses can be affected by preference for a familiar or popular category, clinical social workers prefer to select the mildest diagnosis available, diagnosis is more problematic for children than for adults, experience changes attitudes towards and use of DSM categories, and DSM categories are not exact so choice can be a struggle. It reports that participants distinguished between thinking diagnostically and using the DSM, and considered symptoms a more useful analytic focus than psychiatric categories.
Application of DC-LD to an intellectual disability population
- Authors:
- TULLY John, SCHIRLIU Diana, MORAN Maria
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 6(5), 2012, pp.259-264.
- Publisher:
- Emerald
The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD), introduced in 2003, was designed to improve accuracy of diagnosis in individuals with intellectual disability. An Irish study aimed to investigate its usefulness in a clinical setting. It involved interviews and review of chart notes with a sample of 50 patients within an intellectual disability service. This article describes the study methodology and results, and discusses the findings. It reports that there was considerable discrepancy between the rates of psychiatric diagnoses after application of DC-LD and rates of previously documented diagnoses within the sample, and that use of DC-LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. It concludes that the study adds to the evidence regarding the usefulness of the criteria, and highlights the shortcomings of non-systematic methods of diagnosis.
Person-centered diagnosis and treatment in mental health: a model for empowering clients
- Authors:
- LADD Peter D., CHURCHILL AnnMarie
- Publisher:
- Jessica Kingsley
- Publication year:
- 2012
- Pagination:
- 352p.
- Place of publication:
- London
The authors suggest that clients with mental health conditions are often diagnosed and treated using a strictly medical model of diagnosis. This book takes a more person-centred, holistic approach to diagnosis and treatment. It sees the client as the expert on their condition and encourages their involvement and collaboration. The authors explore the reasons behind clients’ feelings and behaviour and take the whole person into account with the aim of finding meaning in their experiences. Designed to complement DSM assessments, the manual covers a range of mental health conditions as well as mental health patterns of behaviour. In each case, the client is involved in the diagnosis and treatment plan. Extended case studies, sample questions and treatment plans are included throughout. The first part of the book on mental health disorders covers: attention-deficit/hyperactive disorder; borderline personality disorder; bulimia nervosa; depression; general anxiety disorder; obsessive compulsive disorder; oppositional defiant disorder; and post traumatic stress disorder. The second section of the book covers discussion of the following mental health patterns; abuse; bullying; compassion fatigue; lateral violence; loneliness; loss; and self-hatred. The book is aimed at all those involved in mental health diagnosis and treatment, including psychologists, psychiatrists, mental health counsellors, clinical social workers, school counsellors and therapists.
DSM-5 research: assessing the mental health needs of older adults from diverse ethnic backgrounds
- Authors:
- ROSE Alexis Lee, CHEUNG Monit
- Journal article citation:
- Journal of Ethnic and Cultural Diversity in Social Work, 21(2), April 2012, pp.144-167.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is being updated and expanded by the American Psychiatric Association, based on scientific criteria for developing comprehensive assessments and culturally appropriate interventions to meet the psychological and behavioural needs of individuals. As a clinical manual, it identifies appropriate care through diagnoses and classifications of mental and behavioural health needs. This article analyses current trends and limitations in the design of the DSM, focusing particularly on its application to older adults from diverse ethnic backgrounds. It is based on a literature review which identified 54 articles published between 2001 and 2011 discussing DSM and its applicability to assessing ethnically diverse older adults' mental health. 5 themes emerged from qualitative analysis of the material: assessment issues related to acculturation, limitations with culture elements, health disparities, evidence-based practice with dementia, and prevalence of anxiety and depression. The article discusses incorporation of additional considerations into the DSM in the light of the literature review findings.
Age differences in symptom expression in patients with major depression
- Authors:
- HYBELS Celia F., LANDERMAN Lawrence R., BLAZER Dan G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.601-611.
- Publisher:
- Wiley
Symptom expression was compared in middle-aged (below 60) and older (60+) depressed patients to determine whether symptom profiles differed by age. Patients diagnosed with major depression (N=664) were screened using the Center for Epidemiologic Studies Depression scale and sections of the Diagnostic Interview Schedule. They were separated into homogeneous clusters based on symptom endorsement. Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events. It appears that there are age differences in symptom endorsement; however the data did not support a symptom profile unique to late-life depression.