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Concept: Classification of mental disorders


BACKGROUND: Some patients report a preoccupation with a specific aversive human sound that triggers impulsive aggression. This condition is relatively unknown and has hitherto never been described, although the phenomenon has anecdotally been named misophonia. METHODOLOGY AND PRINCIPAL FINDINGS: 42 patients who reported misophonia were recruited by our hospital website. All patients were interviewed by an experienced psychiatrist and were screened with an adapted version of the Y-BOCS, HAM-D, HAM-A, SCL-90 and SCID II. The misophonia patients shared a similar pattern of symptoms in which an auditory or visual stimulus provoked an immediate aversive physical reaction with anger, disgust and impulsive aggression. The intensity of these emotions caused subsequent obsessions with the cue, avoidance and social dysfunctioning with intense suffering. The symptoms cannot be classified in the current nosological DSM-IV TR or ICD-10 systems. CONCLUSIONS: We suggest that misophonia should be classified as a discrete psychiatric disorder. Diagnostic criteria could help to officially recognize the patients and the disorder, improve its identification by professional health carers, and encourage scientific research.

Concepts: Medical terms, Greek loanwords, Mental disorder, Clinical psychology, Psychiatry, Cross-cultural psychiatry, Classification of mental disorders, American Psychiatric Association


Schizophrenia is an idiopathic mental disorder with a heritable component and a substantial public health impact. We conducted a multi-stage genome-wide association study (GWAS) for schizophrenia beginning with a Swedish national sample (5,001 cases and 6,243 controls) followed by meta-analysis with previous schizophrenia GWAS (8,832 cases and 12,067 controls) and finally by replication of SNPs in 168 genomic regions in independent samples (7,413 cases, 19,762 controls and 581 parent-offspring trios). We identified 22 loci associated at genome-wide significance; 13 of these are new, and 1 was previously implicated in bipolar disorder. Examination of candidate genes at these loci suggests the involvement of neuronal calcium signaling. We estimate that 8,300 independent, mostly common SNPs (95% credible interval of 6,300-10,200 SNPs) contribute to risk for schizophrenia and that these collectively account for at least 32% of the variance in liability. Common genetic variation has an important role in the etiology of schizophrenia, and larger studies will allow more detailed understanding of this disorder.

Concepts: Genetics, Genome-wide association study, Mental disorder, Schizophrenia, Bipolar disorder, Suicide, Schizoaffective disorder, Classification of mental disorders


This study sought to estimate i) the prevalence of the co-occurrence of, ii) the association between, and iii) the sequence of onset of chronic pain and mental disorders in adolescents. We used weighted data (N=6483) from the National Comorbidity Survey Replication Adolescent Supplement (participants' age: 13-18 years). Lifetime chronic pain was assessed by adolescent self-report, lifetime DSM-IV mental disorders by the WHO CIDI, complemented by parent report. Among the study’s subjects, 1600 out of 6476 (25.93%) had experienced any type of chronic pain and any mental disorder in their lifetime. All types of pain were related to mental disorders. The most substantial temporal associations were those with onset of mental disorders preceding onset of chronic pain, including those between affective disorders and headaches and any chronic pain; between anxiety disorders and chronic back/neck pain, headaches, and any chronic pain; between behavior disorders and headaches and any chronic pain; and between any mental disorder and chronic back/neck pain, headaches, and any chronic pain.

Concepts: Psychology, Mental disorder, Abnormal psychology, Schizophrenia, Mental illness diagnosis by DSM and ICD, Classification of mental disorders


Objective: Few studies of ADHD prevalence have used population-based samples, multiple informants, and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Moreover, children who are asymptomatic while receiving ADHD medication often have been misclassified. Therefore, we conducted a population-based study to estimate the prevalence of ADHD in elementary school children using DSM-IV criteria. Method: We screened 7,587 children for ADHD. Teachers of 81% of the children completed a DSM-IV checklist. We then interviewed parents using a structured interview (DISC). Of these, 72% participated. Parent and teacher ratings were combined to determine ADHD status. We also estimated the proportion of cases attributable to other conditions. Results: Overall, 15.5% of our sample met DSM- (4th ed.; text rev., DSM-IV-TR) criteria for ADHD (95% CI [14.6%, 16.4%]); 42% of cases reported no previous diagnosis. With additional information, other conditions explained 9% of cases. Conclusion: The prevalence of ADHD in this population-based sample was considerably higher than 3% to 7%. To compare study results, the DSM criteria need standardization. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Concepts: Statistics, Schizophrenia, Borderline personality disorder, Diagnostic and Statistical Manual of Mental Disorders, Interview, Teacher, Elementary school, Classification of mental disorders


The bromodomain containing 1 (BRD1) gene has been implicated with transcriptional regulation, brain development, and susceptibility to schizophrenia and bipolar disorder. To advance the understanding of BRD1 and its role in mental disorders, we characterized the protein and chromatin interactions of the BRD1 isoforms, BRD1-S and BRD1-L.

Concepts: DNA, Gene expression, Mental disorder, Schizophrenia, Disability, Suicide, Schizoaffective disorder, Classification of mental disorders


The stigma and social rejection faced by people with a mental disorder constitute a major barrier to their well-being and recovery. Medicalization has been welcomed as a strategy to reduce blame and stigma, although critics have cautioned that attributing mental disorders to biogenetic causes may have unintended side effects that could exacerbate prejudice and rejection. The present study presents a quantitative synthesis of the literature on relationships between biogenetic explanations for mental disorders and three key elements of stigma, namely blame, perceptions of dangerousness, and social distance. A comprehensive search yielded 25 studies meeting the inclusion criteria. Separate meta-analyses (Ns = 4278-23,816) were conducted for the three stigma types, and assessed the consistency of effects across subgroups of studies involving different types of biogenetic explanations, mental disorders, and samples. We found that people who hold biogenetic explanations for mental disorders tend to blame affected persons less for their problems (r = -0.19), but perceive them as more dangerous (r = 0.09) and desire more distance from them (r = 0.05). The negative association with blame was significant for schizophrenia, belief in genetic causation, and in student samples. The positive association with dangerousness was significant for all disorders, belief in general biogenetic causation, and in community samples. The positive association with social distance was significant for schizophrenia, beliefs in neurochemical and general biogenetic causation, and in community samples. Nevertheless, across all analyses, biogenetic explanations were only weakly related to stigma. We conclude that biogenetic explanations for mental disorders confer mixed blessings for stigma.

Concepts: Psychology, Sociology, Mind, Interpersonal relationship, Mental disorder, Schizophrenia, Disability, Classification of mental disorders


Background Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather ‘the worried well’. Aims To examine the association of past-year mental health treatment with DSM-IV disorders. Method The World Health Organization’s World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs. Results Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment. Conclusions The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.

Concepts: Psychology, Medical ethics, Mental health, Mental disorder, Schizophrenia, Psychiatry, World Health Organization, Classification of mental disorders


The Scale to Assess Unawareness in Mental Disorder (SUMD) is widely used in clinical trials and epidemiological studies but more rarely in clinical practice because of its length (74 items). In clinical practice, it is necessary to provide shorter instruments. The aim of this study was to investigate the validity and reliability of the abbreviated version of the SUMD.

Concepts: Epidemiology, Clinical trial, Psychometrics, Validity, Reliability, Mental disorder, Test, Classification of mental disorders


In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM–whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

Concepts: Mental disorder, Abnormal psychology, Schizophrenia, Borderline personality disorder, Psychiatry, Diagnostic and Statistical Manual of Mental Disorders, Classification of mental disorders, American Psychiatric Association


In a previous study (Van Ditzhuijzen et al., 2017) we investigated the incidence and recurrence of mental disorders 2.5 to 3 years post-abortion. The aim of the current study was to extend these findings with longer term follow up data, up until 5-6 years post-abortion. We compared data of women who had had an abortion of the Dutch Abortion and Mental Health Study (DAMHS) to women who did not have an abortion from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) (Ntotal = 2227). We used 1-to-1 matching on background confounding variables and measured post-abortion incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, and substance use disorders) using the Composite International Diagnostic Interview (CIDI) version 3.0. After matching on confounding variables, abortion did not increase the likelihood that women had incident or recurrent mental disorders in the 5-6 years post-abortion (any incident mental disorder: OR = 3.66, p = .16; any recurrent mental disorder: OR = 0.22, p = .47). We found no evidence that experiencing an abortion increases the risk on new or recurrent mental disorders on the longer term.

Concepts: Experimental design, Mental health, Mental disorder, Abnormal psychology, Schizophrenia, Netherlands, Psychiatry, Classification of mental disorders