Genodermatoses with behavioural sequelae

Children with genodermatoses are at an increased risk of developing behavioural disorders which may impart lasting damage on the individual and their family members. As such, early recognition of childhood mental health disorders via meticulous history taking, thorough physical examination, and disorder-specific testing is of paramount importance for timely and effective intervention. If carried out properly, prompt psychiatric screening and intervention can effectively mitigate, prevent or even reverse, the psychiatric sequela in question. To that end, this review aims to inform the concerned physician of the manifestations and treatment strategies relevant to the psychological sequelae of genodermatoses.

Use of Parametric Methods and Questionnaires for the Study of Depressive and Anxiety Disorders in Schizophrenia

Objective of the Review: To develop scales and questionnaires used to diagnose depressive disorders in schizophrenia patients. Key Points. We have analysed Russian and foreign publications for a period of 10 years (2010–2020) in the following databases: Clinicalkeys, Google Scholar, PubMed, Springer, Wiley Online Library, Taylor & Francis Online, US National Library of Medicine National Institutes of Health, ScienceDirect, and eLIBRARY.RU. Depression and anxiety disorders are diagnosed and their dynamics is evaluated using both standardized psychiatric screening and valid scales and questionnaires. Timely diagnosis and follow-up of depressive disorders in schizophrenia patients are based on a wide range of scales and questionnaires. However, they are useful not only for diagnosis and evaluation of the severity and/or the rate of depressive disorders, but also sometimes complicate comparison of observation results in different clinics, countries and globally. There is currently no unified methodology or algorithm for using of scales and questionnaires for depressive disorders in schizophrenia in general and depending on the condition stage and severity. Conclusion. Depressive disorders diagnosis in schizophrenia patients requires a multidisciplinary approach with participation of psychiatrists, neurologists and clinical pharmacologists to improve therapy results and patients’ quality of life. Depression and anxiety disorders are diagnosed and their dynamics is evaluated using both standardised psychiatric screening and valid scales and questionnaires. However, currently there is no a unified protocol for using a wide range of diagnostic scales and questionnaires for schizophrenia patients at high risk of depressive disorders, thus complicating continuation in follow-up of these patients both in inpatient and outpatient settings. Keywords: research methods, depressive disorders, schizophrenia, scale, questionnaire.

Correlation of the Standardized Cosmesis and Health Nasal Outcomes Survey With Psychiatric Screening Tools

Background Identifying mental health disorders, including body dysmorphic disorder (BDD), is important prior to rhinoplasty surgery; however, these disorders are underdiagnosed, and screening tools are underutilized in clinical settings. Objectives The authors sought to evaluate the correlation of a rhinoplasty outcomes tool (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) with psychiatric screening tools. Methods Patients presenting for rhinoplasty consultation were prospectively enrolled and administered mental health instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and BDD (BDD Questionnaire-Aesthetic Surgery [BDDQ-AS]) as well as the SCHNOS rhinoplasty outcomes scale. Convergent validity of SCHNOS scores with these mental health instruments was assessed as well as calculation of an optimal SCHNOS-C score to screen for BDD. Results A total 76 patients were enrolled in the study. The average SCHNOS-O score (standard deviation) was 46.1 (34.0) and the average SCHNOS-C score was 61.1 (27.0). Five (7%) patients screened positive for depression, and 24 (32%) patients screened positive for mild, 5 (7%) for moderate, and 4 (5%) for severe anxiety. Twenty-four (32%) patients screened positive for BDD by BDDQ-AS scores. SCHNOS-O and SCHNOS-C did not correlate with Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 scores; SCHNOS-C did correlate with BDDQ-AS. A score of 73 or greater on SCHNOS-C maximized the sensitivity and specificity of also screening positive for BDD with BDDQ-AS. This score correlated with a sensitivity of 62.5%, specificity of 80.8%, and number needed to diagnose of 2.3, meaning for every 2 patients with a score of ≥73 on SCHNOS-C, 1 will have a positive BDDQ-AS score. Conclusions SCHNOS-C correlates with BDDQ-AS and may help screen rhinoplasty patients at higher risk for BDD. Level of Evidence: 2

Convergent and Discriminant Validity of Personality Inventory for DSM-5-BF in a Primary Care Sample

A growing body of research supports the validity of the Personality Inventory for DSM-5 (PID-5) in evaluating community and psychiatric samples. Although maladaptive personality also has significant relevance in primary care settings, research on the PID-5 in primary care samples is limited. In this study, the authors examined the intercorrelations, convergent validity, and discriminant validity of the brief form of the PID-5 (PID-5-BF) in 100 primary care outpatients. Results are consistent with findings in other samples in suggesting that PID-5 domains are moderately intercorrelated and associated with a variety of mental health variables. Smaller associations with physical health variables support the discriminant validity of the instrument. Overall, results suggest that the PID-5-BF can provide a useful psychiatric screening tool in primary care settings.

The developmental origins of hoarding disorder in adolescence: a longitudinal clinical interview study following an epidemiological survey

BACKGROUND: Hoarding disorder (HD) is hypothesized to originate in childhood/adolescence but little is known about the presentation of hoarding symptoms in youth and their natural history. In this longitudinal study, we tracked and conducted in-depth psychiatric interviews with twins who participated in an epidemiological survey and screened positive on a measure of hoarding symptoms at age 15. METHODS: Twins screening positive for clinically significant hoarding symptoms at age 15 (n=42), their co-twins (n= 33), a group of screen negative twins (n=49), and their parents underwent a clinical assessment a median of 3 years after the initial screening. The assessment included psychiatric screening, hoarding symptoms and cognitions, in-home or photographic assessment of clutter levels, parental accommodation and familial burden.RESULTS: None of the participants had significant levels of clutter at follow-up and thus did not meet strict criteria for HD. However, twins meeting partial criteria (i.e. DSM-5 criteria A and B) for HD (n=28) had more psychiatric disorders and scored significantly higher on all measures of hoarding symptoms including researcher-rated levels of clutter in their homes, compared to twins who did not meet criteria for HD (n=46).CONCLUSIONS: As currently defined in DSM-5, HD may be rare in young people. A non-negligible proportion of young people who were screen positive on hoarding symptoms at age 15 had substantial hoarding symptoms and other psychopathology at follow-up. Whether and how many of these individuals will develop full-blown HD is unknown but the results offer unique insights about the probable origins of HD.

Testes de rastreio para alterações psiquiátricas em esclerose múltipla – Revisão sistemática com metanálise

RESUMO Objetivo Realizar uma revisão sistemática com metanálise visando evidenciar as ferramentas de rastreio psiquiátrico mais adequadas na abordagem de pacientes adultos com esclerose múltipla avaliadas por estudos de acurácia diagnóstica. Métodos As bases de dados Medline, SciELO, PubMed e Lilacs foram utilizadas para pesquisa de artigos referentes ao tema proposto. Para essa busca, foram utilizados os termos “ multiple sclerosis psychiatric symptoms ” e “ multiple sclerosis psychiatric screening ”, sendo incluídos artigos na língua portuguesa e inglesa publicados entre 2007 e 2017. A qualidade dos estudos incluídos foi avaliada utilizando o método QUADAS. Uma metanálise foi conduzida com o auxílio do programa RevMan 5.3. Resultados Sete artigos foram selecionados para análise. A concordância dos revisores foi calculada com um kappa de 0,95. A maioria dos estudos selecionados realizou avaliação de ferramentas de rastreio para depressão, tendo apenas dois deles abordado a busca de transtornos de ansiedade. O rastreio de transtorno depressivo foi realizado a partir da avaliação de 11 instrumentos diferentes, enquanto o de ansiedade, por apenas dois. A maior parte dos testes analisados apresentou boa acurácia, e a ferramenta BAI foi a única com desempenho regular na análise da curva ROC (0,77 de área sob a curva). Os demais testes apresentaram desempenho bom ou excelente, cursando com mais de 83% na avaliação de área sob a curva. Conclusões As ferramentas HADS ( Hospital Anxiety and Depression Scale ), CESD ( Center for Epidemiological Scale – Depression ) e PHQ-9 ( Patient Health Questionnaire-9 ) parecem ser as mais indicadas para o rastreio psiquiátrico de pacientes com esclerose múltipla. Registro PROSPERO: CRD42017082741.

Veterans, the hidden wounds of war, and soul repair

To better understand how deployment in war zones and/or combat may inflict emotional wounds upon veterans, researchers, clinicians, and caregivers it was recently started to focus on the concepts of moral and spiritual injuries. Such injuries may remain undiscovered during psychiatric screening for posttraumatic stress disorder. What is often missing, however, is a conceptualization of the part of the self which is implicitly related to emotional wounds caused by moral and spiritual injuries. This article utilizes a number of historical and contemporary conceptualizations of what is called the soul, and their implications for pastoral and spiritual care of emotionally wounded veterans. Moreover, it explores the use of biblical stories in pastoral and spiritual care among veterans suffering from moral and spiritual injuries.