Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice.

Psychiatric disorders are associated with significant social and economic burdens, many of which are related to issues with current diagnosis and treatments. The coronavirus (COVID-19) pandemic is estimated to have increased the prevalence and burden of major depressive and anxiety disorders, indicating an urgent need to strengthen mental health systems globally. To date, current approaches adopted in drug discovery and development for psychiatric disorders have been relatively unsuccessful. Precision psychiatry aims to tailor healthcare more closely to the needs of individual patients and, when informed by neuroscience, can offer the opportunity to improve the accuracy of disease classification, treatment decisions, and prevention efforts. In this review, we highlight the growing global interest in precision psychiatry and the potential for the National Institute of Health-devised Research Domain Criteria (RDoC) to facilitate the implementation of transdiagnostic and improved treatment approaches. The need for current psychiatric nosology to evolve with recent scientific advancements and increase awareness in emerging investigators/clinicians of the value of this approach is essential. Finally, we examine current challenges and future opportunities of adopting the RDoC-associated translational and transdiagnostic approaches in clinical studies, acknowledging that the strength of RDoC is that they form a dynamic framework of guiding principles that is intended to evolve continuously with scientific developments into the future. A collaborative approach that recruits expertise from multiple disciplines, while also considering the patient perspective, is needed to pave the way for precision psychiatry that can improve the prognosis and quality of life of psychiatric patients.

Online Reporting of Military Sexual Trauma.

Case finding and treatment of military sexual trauma (MST) remains a serious problem in military and veteran populations as well as in the civilian population. This report provides descriptive examples, with statistics, of persons serving in the military or while living/working on a military base when they experienced unwanted sex. Males, more than females, never disclosed MST before online survey, had more physical injuries as a result and reported chronic disturbing thoughts of the experience. Undisclosed and unreported intrafamilial childhood sexual experiences were cited before an MST by some respondents. Interprofessional collaboration is recommended between military nurse practitioners and behavioral health clinicians as well as innovative strategies using telecommunication and online counseling.

To Tell or Not to Tell.

The underreporting of rape is well known; however, there is less information on women who fail to disclose to anyone. This online study suggests that 24% of 242 women who were non-disclosing compared with those who had disclosed were significantly less likely to seek treatment for emotional injuries. Also, almost two thirds of non-disclosing women believed the abuse was their fault versus 39.1% of women with prior disclosure. Of clinical interest is that regardless of disclosure pattern, there was no significant difference in reports of depression, anxiety, or posttraumatic stress disorder, and the majority of respondents endorsed support for online counseling over telephone or individual contact.

Gaps in Crisis Mental Health: Suicide and Homicide-Suicide.

Gaps in crises of mental health emerge from poor distinction between the qualities of people who suicide and those who murder and then kill themselves. The role, if any, that substance use has in such lethal violence is an example of such a lack of distinction. In this study, a sample of medical examiner investigative and toxicology reports from Los Angeles and Orange counties in California were available for analysis for 432 suicide cases and 193 homicide-suicide cases. This informed clearer toxicological and pharmacological distinction of suicide from homicide-suicide. Blood alcohol levels were higher in persons committing suicide than in homicide-suicide perpetrators (p=.004). Homicide-suicide perpetrators had almost twice the level of stimulants in their system than people who suicide (p=.022) but did not have comparatively elevated levels of drugs or alcohol. Predictors of suicide included the following: substance abuse history, high number of drugs in system, death inside a house, and legal impairment by alcohol. Predictors of homicide-suicide included gunshot as the cause of death, female gender, domestic conflict, children living in the home, and prior arrest for substance abuse.

To Tell or Not to Tell.

The underreporting of rape is well known; however, there is less information on women who fail to disclose to anyone. This online study suggests that 24% of 242 women who were non-disclosing compared with those who had disclosed were significantly less likely to seek treatment for emotional injuries. Also, almost two thirds of non-disclosing women believed that the abuse was their fault versus 39.1% of women with prior disclosure. Of clinical interest is that regardless of disclosure pattern, there was no significant difference in reports of depression, anxiety, or posttraumatic stress disorder (PTSD), and the majority of respondents endorsed support for online counseling over telephone or individual contact.

Homicide-suicide and duty to warn.

This retrospective study of medical examiner records from three counties reported on 252 persons who killed 302 victims before killing themselves and reviews the Tarasoff ruling that set the standard for duty to warn and/or protect third parties whose lives are threatened by a patient. The three sites varied significantly for the perpetrator in terms of race, employment, cause of death, and motive. Female offenders killed more children under the age of 10 and adolescents than did male offenders. Evidence of premeditation included suicide notes and weapon brought to the crime scene, while strangulation indicated a spontaneous domestic homicide. Implications for practice are discussed including the importance of evaluating violent thoughts, fantasies, and behaviors in acute emergency settings and recommendations include second opinion consultation for Tarasoff-type cases and psychological autopsy review for completed homicide-suicide cases.

Hope, hopelessness, and anxiety: a pilot instrument comparison study.

BACKGROUND AND PURPOSE: Hope has a powerful influence on living. This pilot study compared three measures of hope and one hopelessness measure, and examined their associations with a measure of anxiety. METHODS: In this cross-sectional study, 23 adult mental health patients ≥18 years old completed the: Herth Hope Index, Miller Hope Scale, Snyder Hope Scale, Beck Hopelessness Scale, and STAI-S, STAI-T. RESULTS: Cronbach's alpha from each instrument ranged from 0.85 to 0.96. Correlations ranged from -.802 to .780.

Symptom responses to a continuum of sexual trauma.

This study reports the findings of an anonymous web-based survey to test differences in symptom presentation (depression, anxiety, posttraumatic stress disorder [PTSD]) among women who experienced different types of sexual trauma (forcible, pressured, sex stress). The study used a descriptive cross-sectional design with an online convenience sample of 243 adult females living primarily in the United States. The findings revealed that there was a statistically significant difference among type of sexual trauma groups for depression (p = .013) and PTSD (p = .044) but not for anxiety (p = .183). Post hoc analysis of the overall difference in depression revealed that the multiple rape type group (p = .010) and the forcible sex group (p = .016) had higher levels of depression.

Patterns of federal Internet offenders: a pilot study.

Internet-facilitated sexual offending is receiving increased forensic and clinical attention. Two issues confront this field. First, studies are equivocal as to whether (or not) the possession of Internet pornography can escalate to contact sexual offenses against a child, and second, federal judges have been questioning the length of sentences for users only of child pornography. The findings of this pilot study of 101 federal Internet offenders revealed over half of the men at the time of arrest were employed, educated, were in (or had been in) a relationship, had children, and did not have a prior criminal offense, suggesting a changing profile of a convicted sex offender. Forensic and psychiatric nurses who evaluate users of child pornography contraband need to be knowledgeable of Internet file transfer technology and the various types of contraband viewed specifically for the age of the preferred child, extreme acts to the child (e.g., bondage, S&M), and whether the user prefers images of adults with children or images of children only.

Domestic violence: a worldwide exploration.

The concept of domestic violence is important to nursing because further knowledge of this phenomenon can help drive more effective intervention and prevention approaches. Domestic violence, also known as gender violence, interpersonal violence, and domestic abuse, is a daily and often a deadly fact of life for millions of women and girls around the world. Attacks are perpetrated in settings that include public streets, at places of employment, in the home, while serving in the military, and in prisons and jails. The costs of this violence, both monetary and in human lives, are tremendous. Although nurses are in a unique position to screen for domestic violence and provide assistance and advocacy for victims, barriers exist related to victim disclosure and staff training and comfort levels. Advanced practice nurses can address the issue directly through appropriate treatment facilitation, including both physical and psychosocial intervention.

Nursing care of posttraumatic stress disorder after anesthesia awareness.

Anesthesia awareness can cause adverse psychological symptoms in patients after surgery. Although rare, posttraumatic stress disorder (PTSD) has been documented in surgical patients who have a history of previous trauma or maladaptive coping patterns. Plastic surgical nurses should assess all patients for anesthesia awareness postoperatively, recognize the diagnostic criteria of PTSD, and offer support of psychiatric referrals if indicated.