A current challenge in classification and treatment of DSM-5-TR prolonged grief disorder.

This letter discusses the current challenge in classification and treatment of DSM-5-TR prolonged grief disorder. Prolonged grief disorder (PGD) is among the new mental disorders included in the DSM-5-TR section II, a chapter about trauma and stressor-related disorders. By definition, PGD is a maladaptive response to the death of a loved one characterized by a period of at least 12 months of persistent yearning for or preoccupation with the deceased and disabling symptoms such as disbelief about the death, avoidance, emotional numbness, identity disruption, intense emotional pain, loneliness, a sense that life is meaningless, and failure to move forward. This syndrome occurs in 9.8% of bereaved survivors and may be associated with increased risk of medical conditions (e.g., cardiovascular disease, cancer, and immunological dysfunction), substance use disorders (particularly increased tobacco and alcohol use), suicidality, and diminished quality of life. Given that PGD has clinical similarities with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), recent studies have evaluated selective serotonin reuptake inhibitors (SSRIs) in the treatment of this novel DSM-5-TR diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parenting styles, maladaptive coping styles, and disturbed eating attitudes and behaviors: a multiple mediation analysis in patients with feeding and eating disorders.

Background: Although preliminary studies support the roles of unhealthy parenting styles and maladaptive coping styles in increasing rates of disturbed eating attitudes and behaviors (EAB) and clinically significant feeding and eating disorders (FED), underlying mechanisms have not been well-recognized. This study aims to investigate the factors associated with disturbed EAB and the mediating roles of overcompensation and avoidance coping styles in the relationship between different types of parenting styles and disturbed EAB among patients with FED. Methods: A total of 102 patients with FED in Zahedan, Iran, participating in this cross-sectional study (from April to March 2022) completed a sociodemographic information form and self-report measures of parenting styles, maladaptive coping styles, and EAB. Model 4 of Hayes' PROCESS macro in SPSS was employed to identify and explain the mechanism or process that underlies an observed relationship between study variables. Results: The results showed that authoritarian parenting style, overcompensation and avoidance coping styles, and female gender might be related to disturbed EAB. The overall hypothesis that overcompensation and avoidance coping styles mediated the effect of fathers' and mothers' authoritarian parenting styles on disturbed EAB was also supported. Conclusions: Our findings highlighted the necessity of evaluating particular unhealthy parenting styles and maladaptive coping styles as the important possible risk factors in the development and maintenance of higher level of disturbance in EAB among patients with FED. However, more research is needed to explore individual, family, and peer risk factors for disturbed EAB among these patients.

The relationship between neuroticism and suicidal thoughts among medical students: Moderating role of attachment styles.

AIM: The present study strives to find an experimental response to these questions: "Is the relationship between neuroticism and suicidal thoughts a simple relationship? Or are there other psychopathological variables such as attachment styles that also affect it?" SUBJECTS AND METHODS: In this cross-sectional study, 376 medical students were selected from the three major cities of Iran using multi-stage sampling method from July 2018 to September 2018 and were evaluated using the demographic information questionnaire, Beck Scale for Suicidal Ideation (BSSI), the Revised NEO Personality Inventory (NEO-FFI), and the Adult Attachment Questionnaire (AAQ). RESULTS: The overall prevalence of having suicidal thoughts among Iranian medical students was 17%. Moreover, the prevalence of suicide among the female, widowed, separated, and divorced students was higher than others. There was also a significant correlation between suicidal thoughts, gender, relational status, neuroticism, avoidant insecure attachment style, secure attachment style, and anxious/ambivalent insecure attachment style. Additionally, the attachment styles have a moderating role in the relationship between neuroticism and suicidal thoughts. CONCLUSION: Based on the current study, it is concluded that despite the presence of neuroticism in medical students, the attachment styles can reduce the risk of suicide as moderator variables. Hence, attachment styles can be considered a potential treatment goal in the prevention of suicide.

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity.

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke's physical activity questionnaire, and Breso's academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Reasons for Increasing Daily Methadone Maintenance Dosage among Deceptive Patients: A Qualitative Study.

Methadone maintenance treatment might be commonly associated with lying for several causes or manipulating psychiatrists and therapists by a number of patients. Deceptive patients tend to manipulate their psychiatrists for multiple causes. This study aims to improve clinicians' therapeutic decision-making by identifying the reasons for increasing daily methadone maintenance dosage among deceptive patients. One hundred ninety-six patients undergoing the Methadone Maintenance Treatment (MMT) with no statistically significant difference between the overall Addiction Severity Index (ASI) scores at different doses of methadone (< 60 mg/d and ≥ 60 mg/d) and Ahvaz Reality Distortion Inventory (ARDI) scores > 30, were examined in the current qualitative study with multiple semi-structural interviews about the reasons for increasing daily methadone maintenance dosage. The investigation results revealed that the most common reasons for increasing daily methadone maintenance dosage among deceptive patients were opium craving, patient willingness to feel euphoria, fear of the withdrawal signs, earn money through the sale of surplus methadone, improve the symptoms of physical and psychiatric comorbidity, forgetting painful memories, curiosity, the influence of others, sexual issues, feeling of well-being, and appearance changes. Given these reasons, any increase in daily methadone maintenance dosage is not necessarily accompanied by improvement in the clinical condition of patients. However, clinicians can make the most appropriate therapeutic decision by putting the psychological assessments and clinical interviews into play.