Tag: Diagnosis

Is Neuroanalysis a Useful Method for Brain-Related Neuroscientific Diagnosis of Mental Disorders?

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Research Paper Title

Neuroanalysis: a method for brain-related neuroscientific diagnosis of mental disorders.

Background

As an Ancient Chinese proverb says “The beginning of wisdom is to call things by their right names” thus we must start calling mental disorders by the names of their underlying brain disturbances. Without knowledge of the causes of mental disorders, their cures will remain elusive.

Methods

Neuroanalysis is a literature-based re-conceptualisation of mental disorders as disturbances of brain organisation. Psychosis and schizophrenia can be re-conceptualised as disturbances to connectivity and hierarchical dynamics in the brain; mood disorders can be re-conceptualised as disturbances to optimization dynamics and free energy in the brain, and finally personality disorders can be re-conceptualised as disordered default-mode networks in the brain.

Results and Conclusions

Knowledge and awareness of the disease algorithms of mental disorders will become critical because powerful technologies for controlling brain activity are developing and becoming available. The time will soon come when psychiatrists will be asked to define the exact ‘algorithms’ of disturbances in their psychiatric patients. Neuroanalysis can be a starting point for the response to that challenge.

Reference

Peled, A. (2020) Neuroanalysis: a method for brain-related neuroscientific diagnosis of mental disorders. Medical Hypotheses. 78(5), pp.636-640. doi: 10.1016/j.mehy.2012.01.043. Epub 2012 Feb 18.

Book: Mental: Everything You Never Knew You Needed to Know about Mental Health

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Book Title:

Mental: Everything You Never Knew You Needed to Know about Mental Health.

Author(s): Dr Steve Ellen and Catherine Deveny.

Year: 2018.

Edition: First (1st).

Publisher: Anima.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.

Synopsis:

How do we define mental illness? What does a diagnosis mean? What should you ask your doctor before you begin treatment? Are there alternatives to medication? What does the research show actually works?

Practitioner and professor of psychiatry Dr Steve Ellen and popular comedian Catherine Deveny combine forces to demystify the world of mental health. Sharing their personal experiences of mental illness and an insider perspective on psychiatry, they unpack the current knowledge about conditions and treatments coveing everything from depression and anxiety to schizophrenia, personality disorders and substance abuse.

Whether you have a mental illness or support someone who does, Mental offers clear practical help, empowering you with an arsenal of tips and techniques to help build your resilience.

Book: The ADHD Explosion

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Book Title:

The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance.

Author(s): Stephen P. Hinshaw and Richard M. Scheffler.

Year: 2014.

Edition: First (1st).

Publisher: Oxford University Press.

Type(s): Hardcover and Kindle.

Synopsis:

Attention-deficit/hyperactivity disorder (ADHD) is one of the most controversial and misunderstood medical conditions today.

With skyrocketing rates of diagnosis and medication treatment, it has generated a firestorm of controversy.

Alarming questions have been raised about ADHD in recent years:

  • Why are over 10% of children and adolescents in the US now diagnosed with ADHD, with projected rates quickly rising?
  • Why do over two-thirds of those diagnosed with ADHD receive medication?
  • In some southern states, why are boys diagnosed at rates of almost one in three?
  • What is causing the fast-rising diagnosis and medication of adults? Why are over a quarter of all college students using stimulants for academic performance?
  • What drives the current ADHD “tsunami” – is it parents, clinicians, schools, culture, the healthcare system, or Big Pharma? When will it end?
  • Can we trust the stories we read and hear about ADHD, even in major media outlets?

The ADHD Explosion and Today’s Push for Performance uniquely blends clinical wisdom, current science, new information on medical and school policy, and global trends to debunk myths and set the record straight.

Hinshaw and Scheffler describe the origins of ADHD and its huge costs to society; the science regarding causes as well as medication and behavioural treatment; and the major variation in diagnosis and treatment across the US, highlighting the key roles of educational policy and high-stakes testing. Dealing directly with stimulants as “smart pills,” they describe the epidemic of medicalisation, arguing that accurate diagnosis and well-monitored care could ease the staggering economic burden linked to ADHD.

In novel ways, they unravel the many poignant issues facing children, teachers, clinicians, and family members who contend with ADHD each day. The recommendations in this book can improve the quality of life for those touched by ADHD and potentially improve the productivity and safety of all society.

Do Psychiatric Conditions Shift Over Time?

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Diagnoses for mental health conditions often morph into each other, suggesting that psychiatry’s reliance on specific diagnoses may be misguided.

A team led by Avshalom Caspi and Terrie Moffitt (2020) at Duke University, North Carolina, analysed data from the Dunedin Birth Cohort Study, which follows a nationally representative group of more
than 1,000 New Zealanders born in 1972 and 1973.

As the participants in the Dunedin Study have grown up, they have been assessed nine times to measure aspects of their health and behaviour, including their mental health. Caspi and Moffitt’s team found that by the age of 45, 86% of participants had met the criteria for at least one psychiatric diagnosis in one assessment. This did not mean that they had received a psychiatric diagnosis, but if they had seen a psychiatrist, they could have been given one.

A third of the cohort met the criteria for a psychiatric diagnosis before they reached the age of 15. Yet over time, people’s mental health usually shifted into a different category of psychiatric conditions.

This could suggest that an excessive focus on a current diagnosis is short-sighted and that therapy should not just address the presenting disorder, but must build fundamental skills for maintaining general mental health.

However, one must caution against ditching diagnostic categories as some disorders are linked to specific causes and respond better to certain treatments than others. It could do harm to ignore these distinctions, at least in some cases.

Reference

Caspi, A., Houts, R.M., Ambler, A., Danese, A., Elliott, M.L., Hariri, A., Harrington, H., Hogan, S., Poulton, R., Ramrakha, S., Rasmussen, L.J.H., Reuben, A., Richmond-Rakerd, L., Sugden, K., Wertz, J., Williams, B.S. & Moffitt, T.E. (2020) Longitudinal Assessment of Mental Health Disorders and Comorbidities Across 4 Decades Among Participants in the Dunedin Birth Cohort Study. JAMA Network Open. 3(4), pp.e203221. doi:10.1001/jamanetworkopen.2020.3221

Book: Substance Abuse – Assessment & Diagnosis

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Book Title:

Substance Abuse – Assessment & Diagnosis.

Author(s): Gerald A. Juhnke.

Year: 2002.

Edition: 1ed.

Publisher: Routledge.

Type(s): Hardcover, Paperback and Kindle.

Synopsis:

Substance abuse counselling has gone beyond being viewed as optional training; instead it is fast becoming an essential part of the education of helping professionals. In this book, Dr. Gerald Juhnke presents an innovative, practical model to be used in the assessment and diagnosing of substance abuse and related co-morbid disorders.

Substance Abuse Assessment and Diagnosis includes practical “nuts and bolts” direction on how to facilitate a thorough, multi-tiered substance abuse assessment. This book uniquely incorporates detailed examples of how to use individual and significant other clinical interviews, including the CAGE, SUBSTANCE -Q, etc, standardised specialty instruments, drug detection types, and personality instruments to accomplish this feat. This is the only book of its kind that provides practical detail on how to use and score these varied assessment instruments-including the newest “cornerstone instruments,” the MMPI-2, the SASSI-3 and the recently released SASSI-A2.

Students and practitioners alike will benefit from this comprehensive volume on the assessment and diagnosis of substance abuse.

Linking Opioid Use Disorder & High Levels of Out-patient Care Prior to Diagnosis

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Research Paper Title

The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada.

Background

The ‘cascade of care’ framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia, Canada.

The researchers estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially.

Methods

Retrospective study using a provincial-level linkage of four health administrative databases.

All PWOUD in BC from 01 January 1996 to 30 November 2017.

The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: ≥ 1, ≥ 3, ≥ 12 and ≥ 24 months).

Health-care use, homelessness and other demographics were obtained from physician billing records, hospitalisations, and drug dispensation records. Receipt of income assistance was indicated by enrolment in Pharmacare Plan C.

Results

A total of 55 470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (n = 39 456; 71%) received OAT during follow-up; however, only 33% (n = 18 519) were currently engaged in treatment and 16% (n = 8960) had been retained for at least 1 year.

Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45 years [adjusted odds ratio (aOR) = 1.75, 95% confidence interval (CI) = 1.64, 1.89], male (aOR = 1.72, 95% CI = 1.64, 1.82), with concurrent substance use disorders (aOR = 2.56, 95% CI = 2.44, 2.70), hepatitis C virus (HCV) (aOR = 1.22, 95% CI = 1.14, 1.33) and either homeless or receiving income-assistance (aOR = 4.35, 95% CI = 4.17, 4.55).

Regular contact with the health-care system-either in out-patient or acute care settings-was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.

Conclusions

People with opioid use disorder in British Columbia, Canada show high levels of out-patient care prior to diagnosis.

Younger age, male sex, urban residence, lower income level and homelessness appear to be independently associated with increased opioid agonist treatment engagement.

Reference

Piske, M., Zhou, H., Min, J.E., Hongdilokkul, N., Pearce, L.A., Homayra, F., Socias, M.E., McGowan, G. & Nosyk, B. (2020) The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada. Addiction (Abingdon, England). doi: 10.1111/add.14947. [Epub ahead of print].

Children: Foster Care & Mental Health

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Research Paper Title

A Comparison Study of Primary Care Utilisation and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results & Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. doi: 10.1177/0009922819898182. [Epub ahead of print].

Identifying Mental Illness

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Mental illness cannot always be clearly differentiated from normal behaviour.

For example, distinguishing normal bereavement from depression may be difficult in people who have had a significant loss, such as the death of a spouse or child, because both involve sadness and a depressed mood.

In the same manner, deciding whether a diagnosis of anxiety disorder applies to people who are worried and stressed about work can be challenging because most people experience these feelings at some time.

The line between having certain personality traits and having a personality disorder can be blurry.

Thus, mental illness and mental health are best thought of as being on a continuum.

Any dividing line is usually based on the following:

  • How severe the symptoms are;
  • How long symptoms last; and
  • How much symptoms affect the ability to function in daily life.

Use Your Smartphone to Spot Schizophrenia, Soon

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Speaking into your smartphone for two minutes could reveal whether you have a mental health condition!

That is according to the developers of an app that analyses facial expressions and speech to diagnose schizophrenia.

The company behind the app, AICure, hopes it could be used to better support and monitor people with schizophrenia, and eventually those who have other mental health conditions.

The current version was developed to measure symptoms of schizophrenia like low mood and difficulty thinking, which are normally harder to measure than symptoms like hallucinations and delusions.

To do this, the app tracks facial movements, as well as the content, tone and pitch of a person’s speech. Some people with schizophrenia move more slowly, and show less emotion on their faces. The app can then send a score to the person’s doctor, rating these symptoms.

However, it is not designed to spot other symptoms associated with the condition, such as hallucinations.

AICure tested the app with 21 people who have schizophrenia and nine people who do not. The participants made weekly recordings over 12 weeks. Each person was also evaluated by a clinician at Mount Sinai Hospital in New York at the start and end of the study.

The results of this small trial suggest that the app’s ratings “are highly correlated” with those of a clinician, states AICure. However, AICure does not yet have enough data to prove its app works, because the sample size is very small. The results can be viewed more as a proof of concept than as a diagnostic tool, which is a little way off.

Reference

Hamzelou, J. (2019) Smartphone App Could Spot Signs of Schizophrenia. New Scientist. 28 September 2019, pp.7.