Criterios diagnósticos de los pacientes con demencia en el Hospital Psiquiátrico Universitario René Vallejo Ortiz

Introducción: La Organización Mundial de la Salud reconoce la demencia como una prioridad de salud pública. Afecta a 50 millones de personas en todo el mundo y se registran alrededor de 10 millones de nuevos casos cada año. Objetivo: Aplicar los criterios diagnósticos a los pacientes con demencia de acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales-V y la Clasificación Internacional de Enfermedades-10, en el Hospital Psiquiátrico Universitario René Vallejo Ortiz entre junio de 2016 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal. El universo estuvo compuesto por todos los pacientes ingresados en la mencionada institución. La muestra no probabilística y a criterio de los autores la integraron 66 pacientes adultos, con el diagnóstico en el periodo de estudio señalado. Se utilizó estadística descriptiva e inferencial. Los datos se presentaron en tablas y gráficos. Resultados: De los 66 pacientes investigados el 33,3 % presentaban entre 60 y 69. El sexo femenino representó el 57,6 %. De acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales- V, 24 pacientes para un 36,4 % se encontraban dentro de los A9, mientras que 12 (18,2 %) en los A10. Sin embargo, según la Clasificación Internacional de Enfermedades-10 el 93,9 % cumplen los criterios de demencia. Conclusiones: Las principales manifestaciones clínicas fueron la desorientación y la hipomnesia con asociación al deterioro cognitivo leve. En la asociación de las clasificaciones se constató que solo la mitad de los estudiados cumplían los criterios diagnósticos de forma unánime.

Introduction: The World Health Organization recognizes dementia as a public health priority. It affects 50 million people worldwide, with around 10 million new cases reported each year. Objective: To apply the diagnostic criteria to patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders-V and the International Classification of Diseases-10 at the René Vallejo Ortiz University Psychiatric Hospital between June of 2016 and December 2022. Methods: An observational, descriptive, cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned institution. The non-probabilistic sample and at the discretion of the authors was made up of 66 adult patients with the diagnosis in the indicated study period. Descriptive and inferential statistics were used. The data was presented in tables and graphs. Results: Of the 66 patients investigated, 33.3% were between 60 and 69. The female sex represented 57.6%. According to the DSM-V, 24 patients, 36.4%, were within A9, while 12 (18.2%) were within A10. However, according to ICD -10, 93.9% meet the criteria for dementia. Conclusions: The main clinical manifestations were disorientation and hypomnesia associated with mild cognitive impairment. In the association of the classifications, it was found that only half of those studied unanimously met the diagnostic criteria.

DSM-5 e as alterações dos transtornos de humor: uma análise crítica à luz da teoria psicanalítica / DSM-5 and mood disorders: a critical analysis in the light of psychoanalytic theory / DSM-5 y los trastornos del estado de ánimo: un análisis crítico a la luz de la teoría psicoanalítica

Ao partir do pressuposto de que a psicopatologia possui um caráter transitório, e diante das discussões acerca do DSM-5, questiona-se: a quem serve as alterações das classes diagnósticas, em especial as dos Transtornos de Humor? Responder a essa questão passa por refletir sobre os modos de se lidar com o sofrimento psíquico na sociedade hodierna. Nesses termos, objetiva-se analisar criticamente as transformações da classe dos Transtornos de Humor sofridas na última versão do DSM. Utilizou-se como método a pesquisa bibliográfica de caráter exploratório e comparativo. Depreendeu-se que a classe diagnóstica do Transtorno de Humor presente no DSM-IV foi extinta do DSM-5 e suas categorias diagnósticas originaram duas novas classes: Transtorno Bipolar e Transtornos Relacionados e Transtornos Depressivos. Concluiu-se que as alterações referentes aos Transtornos de Humor sugerem uma tendência, cada vez mais, crescente de se patologizar estados de ânimos decorrentes de condições de sofrimento normais do sujeito. Por outro lado, a sociedade contemporânea parece fornecer as insígnias próprias para a constituição subjetiva de indivíduos altamente fragilizados especialmente no tocante aos estados de humor.

Starting from the assumption that psychopathology has a transitory character, and in view of the discussions about the DSM-5, the question is: who serves the alterations of the diagnostic classes, especially those of Mood Disorders? Answering this ques-tion involves reflecting on the ways of dealing with psychological suffering in today's society. In these terms, the objective is to critically analyze the changes in the class of Mood Disorders suffered in the latest version of the DSM. Exploratory and comparative bibliographic research was used as a method. It appeared that the diagnostic class of Mood Disorder present in DSM-IV was extinguished from DSM-5 and its diagnostic categories gave rise to two new classes: Bipolar Disorder and Related Disorders and Depressive Disorders. It was concluded that the alterations referring to Mood Disorders suggest an increasing tendency to pathologize states of mind resulting from the subject's normal suffering conditions. On the other hand, contemporary society seems to provide its own insignia for the subjective constitution of highly fragile individuals, especially with regard to mood states.

Partiendo del supuesto de que la psicopatología tiene un carácter transitorio, y a la vista de las discusiones sobre el DSM-5, la pregunta es: ¿quién atiende las alteraciones de las clases diagnósticas, especialmente las de los trastornos del estado de ánimo? Responder a esta pregunta implica reflexionar sobre las formas de afrontar el sufrimiento psicológico en la sociedad actual. En estos términos, el objetivo es analizar críticamente las transformaciones de la clase de Trastornos del Estado de Ánimo sufridas en la última versión del DSM. Se utilizó como método la investigación bibliográfica exploratoria y comparativa. Parecía que la clase diagnóstica de trastorno del estado de ánimo presente en el DSM-IV se extinguió del DSM-5 y sus categorías de diagnóstico dieron lugar a dos nuevas clases: trastorno bipolar y trastornos relacionados y trastornos depresivos. Se concluyó que las alteraciones referidas a los Trastornos del Estado de Ánimo sugieren una tendencia creciente a patologizar los estados de ánimo derivados de las condiciones normales de sufrimiento del sujeto. Por otro lado, la sociedad contemporánea parece proporcionar su propia insignia para la constitución subjetiva de individuos muy frágiles, especialmente en lo que respecta a los estados de ánimo.

Prevalence of internet gaming disorder in India: a technological hazard among adolescents

Background: Internet gaming disorder (IGD) refers to the problematic use of on-line or off-line video games. Presently the prevalence of IGD among the adolescent group was between 1.3% to 19.9% and males reported more prevalence than females. Aims of this study was to know the prevalence and the various factors associated with the development IGD among adolescents.Methods: Settings and Design was to a cross sectional study was conducted among students of High schools for a period of 3 months from July 2018 - September 2018. Four hundred adolescent students were included in the study. English version of the DSM–5 short (9-item) dichotomous scale with cut-off point of five or more criteria was used for diagnosing the IGD.Statistical analysis used descriptive statistics were represented with frequencies and percentages. Chi-square and Fisher Exact tests were applied to find significance difference. P<0.05 was considered as statistically significant.Results: An overall prevalence estimate of IGD was 3.50% among the school children and it is higher among male students (8.8%) than female students (0.8%) and it was found statistically significant with a p value of <0.001.Conclusions: The prevalence differences between Age groups, gender, class of the student and availability of smart phone with internet facility act as an important risk factors for the occurrence of IGD among adolescents.

New direction in diagnosis and assessment of personality disorders / 上海交通大学学报（医学版）

The diagnosis of personality disorders was formally presented in the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-1). DSM-3 proposed a systematic framework for understanding personality disorders, and mentioned the multi-axis diagnosis strategy and category diagnosis criteria. The following editions of DSM still mentioned the strategy and criteria. DSM-5, published in 2013, mentioned the alternative model for personality disorders (AMPD), which indicated a new direction in the diagnosis and assessment of personality disorders. AMPD had a dimensional assessment of the severity of personality pathology (criterion A), and a dimensional assessment of features of personality pathology (criterion B). The criterion A was influenced by the concepts of psychodynamics, like the distinction and integration of self and object in the Kernberg model of personality organization. Level of Personality Functioning Scale (LPFS) and Personality Inventory for DSM-5 were developed to assess personality disorders mentioned in AMPD. The reliability and validity of the tools were demonstrated. Structured Interview of Personality Organization, an assessment tool based on Kernberg model of personality organization, was proved to have significant correlation with LPFS.

Diagnóstico de autismo no século XXI: evolução dos domínios nas categorizações nosológicas / Autism diagnosis in the 21st century: evolution of subdomains in nosological categorizations / Diagnostic de lautisme au 21e siècle: évolution des domaines dans les catégorisations nosologiques / Diagnóstico del autismo en el siglo XXI: evolución de dominios en categorizaciones nosológicas

Resumo Os critérios que subsidiaram o diagnóstico do autismo passaram por diversas mudanças ao longo dos anos, acompanhando os pressupostos conceituais hegemônicos no período. O objetivo deste estudo é analisar a evolução do diagnóstico do autismo no século XXI, a partir dos domínios e subdomínios em que se baseiam as categorizações nosológicas. Adicionalmente, são sinalizados instrumentos auxiliares utilizados e algumas tecnologias diagnósticas em desenvolvimento, além de modelos conceituais que tratam do perfil neuropsicológico. Trata-se de pesquisa documental, tendo como referência os manuais diagnósticos existentes no período. Os domínios de interação social, comunicação e padrão restrito e repetitivo de comportamento foram mantidos nos diferentes manuais diagnósticos abordados. Os subdomínios de interação social e comunicação foram reduzidos, enquanto o padrão restrito e repetitivo teve consolidação no DSM-5. Compreender a evolução dos critérios diagnósticos tende a promover o desenvolvimento da clínica, potencializando a antecipação do diagnóstico e as intervenções necessárias para um melhor prognóstico.

Abstract The criteria that subsidized the diagnosis of autism have undergone several changes over the years, following the hegemonic conceptual assumptions of the period. This study analyzed the evolution of the diagnosis of autism during the 21st century with use of the domains and subdomains that served as basis for nosological categorizations. Additionally, the auxiliary instruments used, some diagnostic technologies under development, and conceptual models that address neuropsychological profiles are presented. This documentary research utilized diagnostic manuals of the period. The domains of social interaction, communication, and restricted and repetitive behavior patterns were maintained in the different diagnostic manuals addressed. The subdomains of social interaction and communication were reduced, while restricted and repetitive pattern was consolidated in DSM-5. Understanding the evolution of diagnostic criteria tends to promote clinical development, potentiating the anticipation of the diagnosis and the interventions necessary for a better prognosis.

Résumé Les critères qui subsidient le diagnostic de l'autisme ont subi plusieurs changements, suivant les hypothèses conceptuelles hégémoniques de la période. Cette étude vise à analyser l'évolution du diagnostic de l'autisme au 21e siècle, à partir des domaines et sous-domaines sur lesquelles reposent les catégorisations nosologiques. En outre, les instruments auxiliaires utilisés et certaines technologies de diagnostic en cours de développement sont signalés, en plus des modèles conceptuels sur le profil neuropsychologique. Il s'agit d'une recherche documentaire, basée sur les manuels de diagnostic existant à l'époque. Les domaines de l'interaction sociale, de la communication et des comportements restreints et répétitifs ont été maintenus dans les manuels de diagnostic abordés. Les sous-domaines de l''interaction sociale et de la communication ont été réduits, tandis que le norme restreint et répétitif a été consolidé dans le DSM-5. Comprendre l'évolution des critères diagnostiques tend à favoriser le développement clinique, l'anticipation du diagnostic, et les interventions nécessaires à un meilleur pronostic.

Resumen Los criterios que ayudaron el diagnóstico de autismo han sufrido varios cambios, siguiendo los supuestos conceptuales hegemónicos en el período. El objetivo de este estudio es analizar la evolución del diagnóstico de autismo en el siglo XXI, en función de los dominios y subdominios que se basan las categorizaciones nosológicas. Además, se señalan los instrumentos auxiliares utilizados, algunas tecnologías de diagnóstico en desarrollo y modelos conceptuales que abordan el perfil neuropsicológico. Esta es una investigación documental, basada en los manuales de diagnóstico existentes en el período. Los dominios de interacción social, comunicación y patrones de conducta restringidos y repetitivos se mantuvieron en los manuales de diagnóstico abordados. Los subdominios de interacción social y comunicación se redujeron, mientras que el patrón restringido y repetitivo se consolidó en el DSM-5. Comprender la evolución de los criterios de diagnóstico tiende a promover el desarrollo clínico, fomentando la anticipación diagnóstica e intervenciones necesarias para un mejor pronóstico.

Del trastorno conversivo a los trastornos neurológicos funcionales. ¿Superando el diagnóstico por descarte? / From Conversion Disorders to Functional Neurological Disorders. Overcoming the Rule-out Diagnosis?

RESUMEN Los trastornos neurológicos funcionales, antes llamados trastornos conversivos, son un problema clínico frecuente en los servicios de neurología y psiquiatría y en atención primaria. En las nuevas categorías diagnósticas se hace énfasis en las características positivas necesarias para el diagnóstico de este trastorno. Se realizó una revisión narrativa de la literatura médica para determinar las diferencias y las ventajas clínicas que la actual clasificación aporta al diagnóstico y el tratamiento de los trastornos neurológicos funcionales. Se identifican las diferencias conceptuales entre los trastornos conversivos y los trastornos neurológicos funcionales y las implicaciones de estos cambios en el abordaje clínico. La nueva propuesta diagnóstica para los trastornos neurológicos funcionales brinda la oportunidad de transformar un diagnóstico realizado a partir del descarte de otras afecciones en otro en el que se verifica la presencia de signos neurológicos que apuntan al trastorno y se pueden ensenar al paciente, y a partir de ellos, plantear estrategias de tratamiento.

ABSTRACT Functional neurological disorders, formerly referred to as conversion disorders, are a frequent clinical problem in neurology, psychiatry and primary care departments. In the new diagnostic categories, emphasis is placed on the positive characteristics necessary to diagnose this disorder. A narrative review of the scientific medical literature related to the subject was performed in order to determine the differences and advantages that the new classification of functional neurological disorders gives to doctors and patients. Historical, diagnostic, clinical and treatment concepts related to functional neurological disorders are reviewed. The conceptual differences between conversion disorders and functional neurological disorders and the implications of these changes in the clinical approach are identified. The new proposed diagnosis for functional neurological disorders provides the opportunity to transform a diagnosis made by ruling out other pathologies to a diagnosis where the presence of neurological signs suggestive of the disorder are verified and can be taught to the patient, and based on them, treatment strategies posed. © 2017 Asociacion Colombiana de Psiquiatria. Published by Elsevier España, S.L.U. All rights reserved.

DSM-5. ¿La incorporación definitiva de la psiquiatría en la medicina? / DSM-5: the definitive inclusion of psychiatry in medicine?

DSM-5 is a significant factor in promoting the "remedicalization" of psychiatry as the focus of psychiatric knowledge, developed by the evidence-based medicine movement, shifted from the clinically-based biopsychosocial model to a research-based medical model. DSM-5 purposes are 1]clinical: diagnosis, prevention, early identification, management, outcome, assessment of improvement; 2] clinical research: etiology, course, effective treatments, cost-effective treatments, reliability and validity and utility of diagnosis; 3] a worldwide common language of diagnostic criteria used by mental health professionals; and 4] to improve communication with users of services, caregivers, and society in general. In the absence of a "gold standard" there are two basic questions still without answers 1] what kind of entities are psychiatric disorders?; and 2] How to integrate the multiple explanatory perspectives of psychiatric illness?.

Factor Structure of the Hamilton Depression Rating Scale for Patients with Major Depression with the Anxious Distress Specifier in DSM-5 / 우울ㆍ조울병

BACKGROUND: The factor structure of the Hamilton Depression Rating Scale (HDRS) is well validated for patients with major depressive disorder (MDD). We examined whether HDRS factors can measure the anxious distress specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in patients with MDD.METHODS: A retrospective chart review of patients with MDD between March 2012 and June 2015 was conducted. We extracted data on anxious distress symptoms and detailed clinical information and examined how the 5 HDRS factors (anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia, and appetite) were related to the anxious distress specifier using the receiver operating characteristic (ROC) curve analysis and the area under the ROC curve analysis.RESULTS: We observed significant differences in the HDRS and Beck Depression Inventory scores between anxious distress and non-anxious distress groups at the index episode. The score for guilt/agitation factor was significantly higher than that for other factors in the anxious distress group and exhibited good predictive efficiency at baseline.CONCLUSION: Further investigation of the anxious distress specifier as a diagnostic entity would be worthwhile. In addition, the scores for guilt/agitation factor on the HDRS might be a promising marker for distinguishing patients with anxious distress from those with other subtypes of major depression, especially for the index episode.

Diagnosis of neurodevelopmental disorders in children: interpretation of International Statistical Classification of Diseases and Related Health Problems-11 and The Diagnostic and Statistical Manual of Mental Disorders-5 / 中华实用儿科临床杂志

Interpretation of The International Statistical Classification of Diseases and Related Health Problems-11 published by World Health Organization(WHO) and The Diagnostic and Statistical Manual of Mental Disorders of Fifth published by American Psychological Association(APA), and reference of literature in recent 10 years.In order to be in agreement with international standards which used to classify the diagnosis of neurodevelopmental disorders in children and to provide a reference for clinical diagnosis.

Controvérsias sobre o uso do DSM para diagnósticos de transtornos mentais / Controversies about the use of DSM for mental disroders diagnoses

Resumo O número de diagnósticos de transtornos mentais cresceu significativamente em paralelo à disseminação das edições do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM). Neste contexto, desenvolvemos este ensaio com a finalidade de compreender o uso do DSM como instrumento para fundamentar os diagnósticos de transtornos mentais. Para embasar o presente estudo, lançou-se mão de publicações científicas de autores que discutiram as edições do DSM, assim como as classificações psiquiátricas. Constatamos que há controvérsias em relação ao Manual, as quais descrevemos por um lado como conveniências e, por outro, como críticas. Há lugares em que esta lógica do DSM é conveniente, uma vez que gera benefícios a diversos setores, como seguros de saúde e indústria farmacêutica. As principais críticas ao DSM ressaltam o fato de o Manual transformar o sofrimento psíquico em patologias de cunho cerebral.

Abstract The number of diagnoses of mental disorders has grown significantly parallel to the dissemination of the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In this context, we developed this essay in order to understand the use of DSM as an instrument to support the diagnosis of mental disorders. To do so, we have used scientific publications by authors who have discussed DSM issues, as well as psychiatric classifications. We find that there are controversies regarding the Manual, which we describe on the one hand as conveniences, and on the other, as criticisms. There are places where this logic of the DSM is convenient, since it generates benefits to several sectors, such as health insurance and pharmaceutical industry. The main criticisms of DSM are the fact that the Manual transforms psychic suffering into cerebral pathologies.

Un análisis crítico de los debates acerca del duelo y el trastorno depresivo en la era del Manual Diagnóstico y Estadístico de los Trastornos Mentales / A critical analysis of debates on grief and depressive disorder in the age of the Diagnostic and Statistical Manual of Mental Disorders

RESUMEN Desde la incorporación del trastorno depresivo mayor en el Diagnostic and Statistical Manual of Mental Disorders (DSM-III) de 1980, hasta su actualización en el DSM-IV-TR, el sistema clasificatorio DSM consideró necesario incluir el criterio de "exclusión por duelo", con el objetivo de diferenciar la tristeza normal, vinculada a una pérdida, de un trastorno mental, como el trastorno depresivo mayor. En su última versión (DSM-5), esta excepción fue suprimida, dando lugar a una controversia que se extiende hasta nuestros días. El debate ha confrontado a quienes están a favor de mantener y extender la exclusión a otros estresores y aquellos que han querido erradicarla. Nuestra hipótesis es que estas posiciones darían cuenta de dos matrices clínicas y epistemológicas cualitativamente diversas ligadas a las trasformaciones mayores que han experimentado las ciencias de la salud y la psiquiatría. Mostramos que este debate involucró una renovación profunda del sentido de la práctica psiquiátrica, un cambio en la función del diagnóstico y el modo de concebir la etiología de la enfermedad mental, así como, una reformulación del estatuto del sufrimiento del paciente para el acto médico.

ABSTRACT Since the incorporation of the major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, and until its update in the DSM-IV-TR, the DSM classification system considered it necessary to include the criterion of "bereavement exclusion", with the aim of differentiating normal sadness linked to a loss, from a mental disorder, such as the major depressive disorder. In its latest version (DSM-5), this exception was removed, giving rise to a controversy that continues to this day. The debate has set those who are in favor of maintaining this exclusion and extending it to other stressors against those who have intended to eradicate it. Our hypothesis is that these positions account for two qualitatively diverse clinical and epistemological matrices, linked to major transformations in health sciences and in psychiatry. We show that this debate involved a profound renewal of the meaning of psychiatric practice, a change in the function of diagnosis and in the way of conceiving the etiology of mental disorders, as well as a reformulation of the patient's suffering status for the medical act.

A Validation Study of the Korean Child Behavior Checklist 1.5-5 in the Diagnosis of Autism Spectrum Disorder and Non-Autism Spectrum Disorder

OBJECTIVES: The purpose of this study was to analyze the discriminant validity and the clinical cut off scores of the Child Behavior Checklist 1.5-5 (CBCL 1.5-5) in the diagnosis of autism spectrum disorder (ASD) and non-ASD. METHODS: In total, 104 ASD and 441 non-ASD infants were included in the study. T-test, discriminant analysis, receiver operating characteristic (ROC) curve analysis, and odds ratio analysis were performed on the data. RESULTS: The discriminant validity was confirmed by mean differences and discriminant analysis on the subscales of Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, and Total problems, along with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales between the two groups. ROC analysis showed that the following subscales significantly separated ASD from normal infants: Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems. Moreover, the clinical cut off score criteria adopted in the Korean-CBCL 1.5-5 were shown to be valid for the subscales Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems. CONCLUSION: The subscales of Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems significantly discriminated infants with ASD.

Diagnostic Issues of Depressive Disorders from Kraepelinian Dualism to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Because the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was mainly influenced by the neo-Kraepelinian approach, its categorical approach to defining mental disorders has been criticized from the viewpoint of etiological neutrality. In the context of bridging the gap between “presumed etiologies-based symptomatology” and “identifiable pathophysiological etiologies,” the content in 5th edition, the DSM-5, has been revised to incorporate a combination of categorical and dimensional approaches. The most remarkable change of note regarding the diagnostic classification of depressive disorders in the DSM-5 is the splitting of mood disorders into bipolar disorders and depressive disorders, which is in accordance with the deconstruction of the Kraepelinian dualism for psychoses. The transdiagnostic specifiers “with mixed features,” “with psychotic features,” and “with anxious distress” are introduced to describe the relationships of depressive disorders with bipolar disorders, schizophrenia, and generalized anxiety disorder, respectively, in a dimensional manner. The lowering of the diagnostic threshold for major depressive disorder (MDD) may be caused by the addition of “hopelessness” to the subjective descriptors of depressive mood and the elimination of “bereavement exclusion” from the definition of MDD. Since the heterogeneity of MDD is equivalent to the Wittgensteinian “games” analogy, the different types of MDD are related not by a single essential feature but rather by “family resemblance.” Network analyses of MDD symptoms may therefore need further review to elucidate the connections among interrelated symptoms and other clinical elements.

A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013) / Uma revisão histórica das categorias de propensão à esquizofrenia do DSM-I ao DSM-5 (1952-2013) / Un rappel historique des catégories de prédisposition à la schizophrénie du DSM-I au DSM-5 [1952-2013] / Una revisión histórica de las categorías de propensión a la esquizofrenia del DSM-I al DSM-5 [1952-2013]

The history of diagnostic classifications in psychiatry has been recognized as a privileged means of access to the vicissitudes inherent to the configuration of a scientific and professional field, also bringing significant contributions to conceptual history. We have taken as primary sources the five editions of the DSM (1952-2013) to examine the construction of diagnostic categories related to schizophrenia proneness, indicating the scientific and social contexts related to the development of DSM and psychiatry itself. Along this process we highlight the conditions of possibility for the emergence of the Attenuated Psychosis Syndrome, a highly controversial diagnostic proposal, in the elaboration of DSM-5. This proposal ended up being rejected not only on scientific grounds, but also because of feared unintended consequences.

A história das classificações diagnósticas na psiquiatria tem sido reconhecida como meio privilegiado de acesso às vicissitudes inerentes à configuração do campo científico e profissional, além de trazer aportes significativos para a história conceitual. Tomamos como principais fontes primárias as cinco edições do DSM (1952-2013) para examinar a construção de categorias diagnósticas relacionadas à propensão para a esquizofrenia, indicando os contextos sociais e científicos relacionados ao desenvolvimento do DSM e da própria psiquiatria. Nesse processo, destacamos as condições de possibilidade para a emergência da Síndrome Psicótica Atenuada, uma proposta diagnóstica altamente controversa, na preparação do DSM-5. Essa proposta foi rejeitada não somente no plano científico, mas também em razão de temidas consequências indesejadas.

L'histoire des classifications diagnostiques en psychiatrie a été reconnue comme un moyen privilégié d'accès aux vicissitudes inhérentes à la configuration du champ scientifique et professionnel, apportant également des contributions importantes à l'histoire conceptuelle. Comme sources primaires principales, nous avons utilisé les cinq éditions du DSM (1952-2013) pour examiner la construction des catégories diagnostiques liées à la prédisposition à la schizophrénie, en indiquant les contextes scientifiques et sociaux du développement du DSM et de la psychiatrie elle-même. Au cours de ce processus, nous mettons en évidence les conditions de possibilité d'émergence du Syndrome Psychotique Atténué, une proposition diagnostique fortement controversée, dans l'élaboration du DSM-5. Cette proposition a fini par être rejetée, non seulement pour des raisons scientifiques, mais aussi par crainte des conséquences non désirées.

La historia de las clasificaciones diagnósticas en psiquiatría, ha sido reconocida como un medio privilegiado de acceso a las vicisitudes inherentes a la configuración de un campo científico y profesional, además de traer aportes significativos a la historia conceptual. Como recursos primarios, hemos utilizado las cinco ediciones del DSM (1952-2013), para examinar la construcción de categorías de diagnóstico relacionadas a la propensión a la esquizofrenia, indicando los contextos sociales y científicos relacionados al desarrollo del DSM y de la propia psiquiatría. A lo largo del proceso, destacamos las condiciones de posibilidad para el surgimiento del Síndrome de Psicosis Atenuada, una propuesta de diagnóstico altamente controvertida, durante la elaboración del DSM-5. Esta propuesta fue rechazada, no solo por motivos científicos, sino también por las temidas consecuencias indeseadas.

Die Geschichte der diagnostischen Klassifizierungen in der Psychiatrie wird als privilegiertes Mittel des Zuganges zu dem Wandel im Rahmen der Gestaltung eines wissenschaftlichen, beruflichen Gebietes anerkannt und trägt wesentlich zur Begriffsgeschichte bei. Als primäre Quellen wurden die fünf Auflagen des DSM (1952-2013) berücksichtigt, um den Aufbau der diagnostischen Kategorien mit Neigung zur Schizophrenie und den sozialen und wissenschaftlichen Zusammenhang der Entwicklung des DSM und der Psychiatrie zu untersuchen. Dabei heben wir die Möglichkeiten der Notbehandlung für „Attenuated Psychosis Syndrome", eines sehr umstrittenen diagnostischen Vorschlages bei der Vorbereitung des DSM-5, hervor. Dieser Vorschlag wurde nicht nur aus wissenschaftlichen Gründen, sondern auch aufgrund befürchteter, unerwünschter Folgen abgelehnt.

Novedades, críticas y propuestas al DSM-5: el caso de las disfunciones sexuales, la disforia de género y los trastornos parafílicos / Innovations, Reviews and Proposals on the DSM-5: the Case of Sexual Dysfunctions, Gender Dysphoria and Paraphilic Disorders

RESUMEN Los comportamientos humanos tienen diferentes significados según el momento histórico y el contexto. En este artículo se toman los comportamientos sexuales como categoría que permite analizar la manera en que se estructura la nosología psiquiátrica manifiesta en textos como el DSM-5. El desarrollo de estos manuales diagnósticos dista de hacerlos herramientas libres de subjetividades y de la injerencia de elementos de poder, expresados en cómo se asumen la salud, la enfermedad, la salud mental y los trastornos mentales, en suma, lo normal y lo patológico. Cada nuevo diagnóstico o incluso su eliminación y la recomposición de los distintos criterios diagnósticos, especialmente en el campo de los comportamientos sexuales, representan visiones de cómo se concibe la vida humana individual y colectiva y una expresión de los intentos certeros de controlar las sexualidades humanas por medio de la medicalización de los comportamientos, a lo cual se suman consideraciones morales, religiosas e incluso legales. Categorías como la disforia de género, las parafilias o los trastornos parafílicos son ejemplos de cómo los límites que se pretende instituir a una perspectiva biomédica son, además de incompletos e imprecisos, hechos que violentan la construcción individual y social de las sexualidades y la concepción misma de salud mental, con lo que se evidencian las dificultades y las controversias persistentes en cómo se elaboran las clasificaciones psiquiátricas.

ABSTRACT Human behaviours have different meanings according to the historical moment and context. In this article sexual behaviours are taken as a category in order to analyse how psychiatric nosology is structured, as manifested in texts such as the DSM-5. The development of these diagnostic manuals are tools that are far from being free of subjectivities and interference of elements of power, expressed in the way health, illness, mental health, and mental disorders, are assumed; in short, the normal and pathological. Each new diagnosis, or even its elimination, and the recomposing of the different diagnostic criteria, especially in the field of sexual behaviour, present visions of how individual and collective human life is conceived, as well as an expression of accurate attempts to control human sexualities through the medicalisation of behaviour, coupled with moral, religious, and even legal considerations. Categories such as gender dysphoria, paraphilia or paraphilic disorders are examples of how the limits intended to establish a biomedical perspective are also incomplete and imprecise. These violate individual and social construction of sexualities and the conception of mental health, showing persistent difficulties and controversies that are evident in the way psychiatric classifications are made.

Autism Spectrum Disorder Diagnosis in Diagnostic and Statistical Manual of Mental Disorders-5 Compared to Diagnostic and Statistical Manual of Mental Disorders-IV

OBJECTIVES: The objective of this study was to investigate the concordance of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) diagnostic criteria for autism spectrum disorder (ASD). METHODS: We retrospectively reviewed the medical records of 170 subjects (age range: 3–23, 140 boys) with developmental delay or social deficit from January 2011 to July 2016 at the Department of Psychiatry of Asan Medical Center. The Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and intelligence tests were performed for each subject. Diagnosis was reviewed and confirmed for each subject with DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 ASD criteria, respectively. RESULTS: Fifty-eight of 145 subjects (34.1%) who were previously diagnosed as having PDD in DSM-IV did not meet DSM-5 ASD criteria. Among them, 28 (48.3%) had Asperger's disorder based on DSM-IV. Most algorithm scores on ADOS and all algorithm scores on ADI-R were highest in subjects who met both DSM-IV PDD criteria and DSM-5 ASD criteria (the Convergent group), followed by subjects with a DSM-IV PDD diagnosis who did not have a DSM-5 ASD diagnosis (the Divergent group), and subjects who did not meet either DSM-IV PDD or DSM-5 ASD criteria (the non-PDD group). Intelligence quotient was lower in the Convergent group than in the Divergent group. CONCLUSION: The results of our study suggest that ASD prevalence estimates could be lower under DSM-5 than DSM-IV diagnostic criteria. Further prospective study on the impact of new DSM-5 ASD diagnoses in Koreans with ASD is needed.

Sobrediagnóstico de trastornos mentales y criterios diagnósticos del DSM: la perspectiva de Jerome Wakefieldx / Mental Disorders Over-Diagnosis and DSM diagnosis criteria: Jerome Wakefield's perspective

Resumen El sobrediagnóstico de trastornos mentales es una preocupación creciente, que se acentuó tras la publicación del DSM-V. Jerome Wakefield es un destacado crítico de la psicopatologización que, sin embargo, ha desarrollado un intenso trabajo para intentar delimitar mejor qué es un trastorno mental sin rechazar este concepto. Se realizó una revisión estructurada de la obra de este autor. Se resumen sus principales planteamientos y se realiza una valoración de su aporte al debate relativo a este tema.

Overdiagnosis of mental disorders is an increasing concern, which was accentuated after the publication of the DSM-V. Jerome Wakefield is a renowned critic of the psycopathologization that, however, has developed an intense work to try to better delimit what a mental disorder is without rejecting this concept. A structured review of the work of this author was carried out. His main approaches are summarized and an assessment of his contribution to the discussion in regards of this issue is performed.

Psicose e esquizofrenia: efeitos das mudanças nas classificações psiquiátricas sobre a abordagem clínica e teórica das doenças mentais / Psychosis and schizophrenia: effects of changes in psychiatric classifications on clinical and theoretical approaches to mental illness

Resumo Abordam-se as mudanças nos sistemas de classificação diagnóstica das doenças mentais, em especial o enfraquecimento conceitual da categoria “psicose” e a dominância da esquizofrenia como psicose única. As classificações atuais priorizam uma abordagem fisicalista da patologia mental. Ocorrem, então, a medicalização das condições antes associadas à neurose e à subjetividade; a localização de quadros antes reconhecidos como psicóticos na rubrica dos transtornos de personalidade; e a redução da psicose à esquizofrenia, abordada como deficit das funções psíquicas. Aponta-se a validade clínica e operatória da noção de “psicose” como categoria nosográfica que permite abordagem mais complexa da “esquizofrenia”, última noção, na psiquiatria, com o peso simbólico da loucura.

Abstract This article discusses changes in the diagnostic classification systems for mental illness, especially the conceptual weakening of the “psychosis” category while schizophrenia became the only psychosis. Current pathological classifications prioritize a physicalist approach. Consequently, conditions that previously were associated with neurosis and subjectivity are being medicalized, conditions previously recognized as psychotic are relocated under the heading of personality disorders, and psychosis has been reduced to schizophrenia and considered a deficit of psychic functions. This article indicates the clinical and operational validity of the notion of “psychosis” as a nosographic category permitting a more complex approach to “schizophrenia”, which in psychiatry is the last concept that bears the symbolic weight of madness.

Clinical application of the integrated visual and auditory continuous performance test on Tourette syndrome children with attention deficit hyperactivity disorder / 中华实用儿科临床杂志

Objective To explore the value of the integrated visual and audio continuous performance test (IVA-CPT) in the diagnosis of Tourette syndrome(TS) patients who have comorbid attention deficit hyperactivity disorder(ADHD).Methods IVA-CPT was performed in 519 TS patients with comorbid ADHD (observation group)and 857 patients with pure ADHD (control group).The gold standard for the diagnosis of ADHD was based on the Diagnostic and Statistical Manual of Mental Disorders (4th version,USA) (DSM-Ⅳ).Results (1) When DSM-Ⅳ was used as the gold standard,the sensitivity,specificity and coincidence rate of IVA-CPT were 62.4％,81.9％ and 75.7％,respectively.(2) IVA-CPT misdiagnosed 62 cases in TS + ADHD group,including 30.3％ (10/33 cases) inattentive subtype (ADHD-I),51.4％ (37/72 cases) hyperactive subtype (ADHD-H) and 25.0％ (15/60 cases) combined subtype (ADHD-C).Significant difference in misdiagnosis rate was found among ADHD-H and ADHD-I and ADHD-C (x2=10.646,P＜0.05).(3) There were 449 cases in which 2 diagnostic methods were both positive in both observation group and control group,including 103 cases in observation group and 346 cases in control group.The full scale response control quotient,visual reaction control,auditory reaction control in observation group and control group were 89.0±19.5/77.4±18.2,92.4±19.0/84.3±18.9,89.6±16.8/77.4±19.7,and there were significant differences between 2 groups (t=-5.024,-3.533,-5.255,all P＜0.05).The full scale response control quotient,visual response control quotient,full scale attention quotient and visual attention quotient between the 2 groups were statistically significant (t=2.510,-2.836,-1.402,-2.501,all P＜0.05).Conclusions (1) IVA-CPT can be used as an effective and objective tool for the diagnosis of TS children with comorbid ADHD.(2)Comparcd with TS childrcn with comorbid ADHD,pure ADHD children have a higher attention and control impairment.

Validity of Alcohol Use Disorder Identification Test-Korean Revised Version for Screening Alcohol Use Disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria / 가정의학회지

BACKGROUND: The Alcohol Use Disorder Identification Test (AUDIT) has been widely used to identify alcohol use disorder (AUD). This study evaluated the validity of the AUDIT-Korean revised version (AUDIT-KR) for screening AUD according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. METHODS: This research was conducted with 443 subjects who visited the Chungnam National University Hospital for a comprehensive medical examination. All subjects completed the demographic questionnaire and AUDIT-KR without assistance. Subjects were divided into two groups according to DSM-5 criteria: an AUD group, which included patients that fit the criteria for AUD (120 males and 21 females), and a non-AUD group, which included 146 males and 156 females that did not meet AUD criteria. The appropriate cut-off values, sensitivity, specificity, and positive and negative predictive values of the AUDIT-KR were evaluated. RESULTS: The mean±standard deviation AUDIT-KR scores were 10.32±7.48 points in males and 3.23±4.42 points in females. The area under the receiver operating characteristic curve (95% confidence interval, CI) of the AUDIT-KR for identifying AUD was 0.884 (0.840–0.920) in males and 0.962 (0.923–0.985) in females. The optimal cut-off value of the AUDIT-KR was 10 points for males (sensitivity, 81.90%; specificity, 81.33%; positive predictive value, 77.2%; negative predictive value, 85.3%) and 5 points for females (sensitivity, 100.00%; specificity, 88.54%; positive predictive value, 52.6%; negative predictive value, 100.0%). CONCLUSION: The AUDIT-KR has high reliability and validity for identifying AUD according to DSM-5 criteria.