Littérature scientifique sur le sujet « Mental illness Diagnosis »

We examine some limitations of the psychiatric diagnosis, particularly in the assessment of the seriousness of a patient';;s mental illness. The bureaucratic or technocratic use of the concept ‘serious mental illness’ is contrasted with the perspective of the clinician who provides ongoing patient care. A decline in the clinical skills of psychiatrists is likely if proposed mental health reforms regulate psychiatric practice according to bureaucratic and technocratic definitions of serious mental illness rather than the realities of the clinical encounter between patient and doctor.

Background There are limitations to psychiatric classification, which affects the utility of diagnosis in general practice. Objective The aim of this article is to explore the principles of science, art and ethics to create clinically useful psychiatric diagnoses in general practice. Discussion Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of ‘what is going on’. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self‑concept. The science, art and ethics of diagnosis need to be integrated to provide a complete assessment.

At present, due to the lack of sufficient treatment institutions as well as professional psychotherapists, numerous patients with mental illnesses do not receive help from professional psychiatrists, thus worsening their conditions. In order to determine the condition of mental illness patients at an early stage, this paper applies natural language processing technology to the psychological field and proposes a text-based and deep learning model for mental illness recognition. The BERT (Bidirectional Encoder Representations from Transformers) pre-trained language model is used to complete the sentence-level feature vector representation of mental health text data, and the obtained feature vectors are subsequently targeted and input to a classifier for classification, which can effectively identify depression, anxiety, post-traumatic stress, and unmet mental illness multiple classifications, breaking the previous common depression identification, improving from the original simple depression dichotomous classification to a mental illness multiple classification task, and focusing on a few focal points, which not only saves human and material resources, but also can achieve twice the result with half the effort. Finally, the algorithm is validated using mental health text dataset, and the experimental results show that the lowest F1 value of the trained model on the test set is 0.77, which can achieve fast screening of text content with the tendency of mental illness, reduce the expert labeling workload, improve the labeling efficiency, and provide a new idea for the recognition of mental illness.

138 Background: Guideline-concordant care (GCC) of breast cancer greatly improves survival. Women with mental illness experience worse survival after breast cancer; in this study, we examined whether women with mental illnesses pre-existing their breast cancer diagnosis receive GCC for breast cancer as often as women without. Methods: We used Surveillance and Epidemiology and End Results (SEER) cancer registry and Medicare claims (SEER-Medicare) to select cases of women (67+ years old) with Stage I-III breast cancers (n = 89,172). Mental illness was measured through diagnostic codes within 2 years before cancer diagnosis and categorized as serious mental illness (SMI: schizophrenia, bipolar disorder, depression with psychosis, and other psychotic disorders); depression or anxiety; or other mental illnesses. To determine receipt of GCC we used the National Comprehensive Cancer Network’s (NCCN) treatment guidelines, commonly referenced by oncologists as best practices. Outcomes included 1. surgery and radiation completion for all cancers (complete/incomplete treatment/no surgery); 2. surgery, radiation completion, and chemotherapy initiation (complete/incomplete/no surgery) for triple negative and HER2+ breast cancers; and 3. radiation completion after mastectomy for Stage III cancers with lymph involvement. We used generalized ordinal logistic regression to compare outcomes with mental illness categories, controlling for demographic, cancer-related, and clinical factors. Results: We found that 28.8% of women in this study had at least one diagnosis of a mental illness in the two years prior to their breast cancer diagnosis and 1.7% had SMI. Women with SMI are more likely to not receive surgery than women without (OR = 1.24, CI = 1.02-1.60). Women with mental illnesses have a higher risk of not completing radiation after breast conserving surgery (SMI: OR = 1.24, CI = 1.01-1.30, Depression and anxiety: OR = 1.11, CI = 1.06-1.16, other mental illnesses: OR = 1.09 CI = 1.01-1.16). Women with SMI and triple negative or HER2+ cancers are more likely to not complete all treatment (OR = 1.65, CI = 1.22-2.24). Conclusions: Women with mental illnesses may be at higher risk for incomplete treatment or lack of treatment initiation, especially for multi-part treatment, such as completion of radiation and initiation of chemotherapy, which may contribute to worse survival outcomes. Breast cancer and mental illness are both common illnesses among older women in the United States. Health systems should consider strategies for improving GCC among women with mental illness and breast cancer.

Individuals with mental retardation are at a greater than average risk of developing psychiatric disorders. Many of these individuals are being seen by rehabilitation counselors through various community settings. The accurate diagnosis of psychopathology within this at-risk population helps the rehabilitation counselor to develop and implement appropriate service delivery. Thus, the diagnostic process is a critical aspect of the counseling process. This article examines diagnostic issues and challenges for determining psychopathology in individuals with mental retardation. Aspects of mental retardation that influence the diagnostic process, assessment measures, the importance of the clinical interview, and implications for rehabilitation counselors who are working with this population are also addressed.

Category: Ankle; Other Introduction/Purpose: Ankle instability is an extremely common clinical entity. Chronic ankle instability (CAI) can develop in some patients, leading to continued pain and dysfunction. However, there is very limited data to date on what impact common psychiatric pathology may have on patients' experience with CAI. This study aimed to investigate the association between psychiatric diagnosis and CAI, and whether having a diagnosed psychiatric illness impacts the outcome of CAI. We hypothesized that a concomitant diagnosis of psychiatric pathology with CAI would be significantly associated with lower postoperative patient- reported outcome measures (PROMs). Methods: A retrospective review was conducted of 276 patients (280 ankles) treated between 2005 and 2021 at an academic medical center by one of three fellowship-trained foot and ankle orthopaedic surgeons, of which 56 underwent surgery and 130 had a concomitant psychiatric diagnosis (i.e., anxiety=111, depression=105, post-traumatic stress disorder [PTSD]=19, obsessive- compulsive disorder [OCD]=6, bipolar disorder [BPD]=5). Data collected included demographics, conservative treatment history, and patient-reported outcome measures (PROMs), such as Visual Analogue Scale (VAS), Brief Resiliency Scale (BRS), 12-Item Short-Form Survey (SF-12), Somatic Symptom Scale (SSS-8), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: Preoperatively, patients with these concomitant psychiatric diagnoses had worse preoperative PROMs. However, the overall cohort improved postoperatively across all PROMs. In particular, the FAOS Total score relatively increased by 35.28% (preop=57.29%, postop=77.50%, p=.011) and the FAAM Total by 49.86% (preop=45.87%, postop=68.74%, p=.027). Both improvements were significant. Of note, the relative change of pre- to postoperative FAOS and FAAM scores was greater among the mental illness group in all scores but FAOS Sports and Recreation. (Table 1) However, no postoperative PROM among the mental illness group, aside from the FAOS Symptoms and Stiffness score, was as high as the postoperative score of those without mental illness. Although patients with these psychiatric illnesses more often failed conservative measures and subsequently received surgical treatment, this was not significant. Conclusion: CAI patients with a concomitant psychiatric diagnosis improved more following surgery than those without mental illness, as measured by FAOS and FAAM scores. However, the mental illness group did not report postoperative FAOS and FAAM scores as high as those without mental illness. Furthermore, CAI patients with a concomitant mental illness more often failed conservative treatment and went on to receive surgery. Physicians should be aware of this information when counseling CAI patients with a concomitant mental illness.

For years research has demonstrated a varying incidence of medical disorders manifesting with psychiatric symptoms. A relatively conservative estimate of such so called "medical masquerades" is around 10%. It is important to ascertain whether health care professionals are aware of possible medical masquerades perhaps most especially in a mental health center outpatient setting where non-medically trained clinicians are the first line therapists for treatment in the majority of cases. This study set about to find out how aware three types of health care clinicians (psychiatrists, nonpsychiatrically trained medical doctors, and non-medically trained mental health psychotherapists) are of the prevalence of medical masquerades, and whether these three types of clinicians perform differently on three types of clinical vignettes (psychiatric, somatoform, and medical masquerades). Results revealed that all health care professionals surveyed are aware that there are a percentage of medical masquerades in the clinical population. Results also revealed that the three types of clinicians performed differently on the case vignettes.

Cognitive theory of depression predicts that the illness is associated with an information processing bias that interprets ambiguous information in a mood-congruent or depressive fashion. This negative interpretative bias may serve as a vulnerability factor or maintenance mechanism for a depressive illness. The majority of studies investigating such interpretative biases rely primarily on subjective experimental methodologies (eg., evaluative feedback and self-report) that are vulnerable to experimenter demand effects, response selection biases, and the influence of autobiographical memories. In addition, the results from these studies have been mixed, leading to no firm evidence for the existence of a depression-linked interpretative bias for ambiguous material. In order to avoid the limitations that have plagued subjective research, the present study utilised two of the most promising objective physiological measures of assessing interpretation: the Rapid Serial Viewing Presentation (RSVP) procedure and the affective modulation of the human eye blink reflex. The modified RSVP experiment recorded the reaction time of participants reading a textual scenario that was composed of an opening ambiguous sentence and various emotionally valenced continuations. Interpretation of the ambiguous sentence could be inferred from the reaction time as comprehension latency is inversely related to perceived plausibility. The affective modulation experiment recorded the blink amplitudes of participants startled while performing an imagery task. Blink amplitudes are augmented by negative stimuli and inhibited by hedonic stimuli. Thus, the affective interpretation of ambiguous stimuli could be inferred from the size of the recorded blink response. The results of both experiments did not support the predictions made by cognitive theory. There was no difference in the reaction time responses to the various textual stimuli between 2 depressed outpatients and healthy controls. However, antidepressant medication did have an influence upon the ability of patients to correctly judge the plausibility of the emotionally valenced continuation sentences. With regard to the eye blink experiment, there was also no difference between the depressed outpatients and the controls in terms of size of blink amplitude to the various categories of affective stimuli. Depressive, ambiguous, and distorted stimuli did not augment blink amplitudes in healthy controls or depressed patients without social anxiety disorder. However, depressed patients with a comorbid diagnosis of social anxiety disorder did react to the ambiguous stimuli in an aversive and anxious manner as indicated by increased blink amplitudes. This may be due to the social aspect of the experimental context, which engenders fears of evaluation and performance anxiety. The eye blink procedure can therefore be compromised by group selection, as the comorbidity of anxiety and depression can confound the investigation of depression-linked interpretative biases. In addition, the failure of depressive stimuli to augment blink amplitudes may render the procedure insensitive to the selection of such biases

Mental major illness, including psychotic disorders and mood disorders, has been linked to early prenatal/childhood factors and subsequent behavioral health concerns. For example, Watson et al. (1999) found that maternal illness and extreme stress during pregnancy disrupts fetal brain development, increasing the likelihood of depression or schizophrenia in later life. Research has also shown a dose-response effect between the number of adverse childhood experiences (ACEs) and mental health outcomes, with increasing ACEs linked to more severe mental health problems and suicide attempts (Merrick et al., 2017). Persons with major mental illness, like schizophrenia or bipolar disorder, are also at increased risk of suicidal and self-harm behaviors (Happell et al., 2012; Morden et al., 2009). These individuals also demonstrate a higher rate of substance use (Linszen et al., 1995) that often contributes to poor medical health (Dixon et al., 2000; Jeste et al., 1996). The current study sought to differentiate adolescents with and without major mental illness (i.e., psychotic or mood disorders) by investigating a sample of youth who were in a residential treatment facility for sexually abusive behaviors (N = 296). Data related to participants’ prenatal/birth concerns, ACE scores, history of suicide attempts and self-harm, and use of alcohol, tobacco, marijuana, and inhalants were gathered from archival records. Results indicated that there were a number of adolescents diagnosed with a psychotic disorder (n = 33) or mood disorder (n = 189). Two separate logistic regressions assisted with differentiating adolescents with and without psychotic or mood disorders using the specified predictors. A significant model (χ2 = 94.910, Nagelkerke’s R2 = 0.412, p < 0.001) correctly classified 76.4% of participants with a mood disorder. Adolescents with a mood disorder were 4 times as likely to have had prenatal or birth concerns (OR: 4.404, p < 0.001), and were significantly more likely to have higher ACE scores (OR: 1.148, p =.024). Further, those with a mood disorder were 2.5 times as likely to have self-harmed (OR: 2.673, p=.009), and approximately 23 times more likely to have attempted suicide (OR: 22.858, p=.003). Another significant model (χ2 = 29.842, Nagelkerke’s R2 = 0.210, p < 0.001) correctly classified 88.3% of participants with a psychotic disorder. Adolescents with a psychotic disorder diagnosis were significantly more likely to have higher ACE scores (OR: 1.237, p =.020), and were 4 times as likely to have a self-harm history (OR: 4.474, p=.005) compared to those without a psychotic disorder. Results indicate that prenatal/birth concerns appear to be a significant factor for those who are diagnosed with a mood disorder, but not with a psychotic disorder. Also, those with mood disorders, but not psychotic disorders, were more likely to have attempted suicide. Adolescents with either a mood or psychotic disorder both tended to self-harm and have experienced more ACEs. Interestingly, substance use was not higher among adolescents with mood or psychotic disorders, despite predictions and previous research findings.

Schizophrenia is a debilitating mental illness that strikes approximately 1 in 100 people in the population during their lifetimes. It is an illness that can have a severe impact on the sense of self of people affected. It is the purpose of this thesis to examine the processes by which such a sense of self is disrupted, rebuilt and maintained in people diagnosed with schizophrenia. Twelve people diagnosed with schizophrenia were interviewed with regards to the ongoing impact of their illness. In particular, interviews focused on processes relevant to their sense of identity before, during and after the diagnosis of schizophrenia. The thesis also thematises issues of power and social structure surrounding the person diagnosed with schizophrenia. It was found that, after medication, a number of social processes were important to rebuilding a sense of identity. These included the development of illness narratives, interaction with family and friends, illness management, life management, the setting of life goals and, in some cases, participation in organised religion. Identity was typically maintained through processes of stigma concealment and passing. The influence of psychiatrists, psychopharmaceutical companies and a deinstitutionalised environment in which severe mental illness is treated all emerged as significant factors in the process of rebuilding a sense of identity. The thesis seeks to make contributions to the sociology of schizophrenia and severe mental health concerns more widely. In particular, it deploys concepts of biographical crisis to make sense of the intensity of identity disruption people diagnosed with schizophrenia may experience. It also seeks to revise the perspectives of symbolic interactionism and phenomenology to better understand the emotive and embodied nature of identity processes in schizophrenia. Beyond this, the thesis explores the relationship between language, power and agency and its significance in shaping the experience of the patient diagnosed with schizophrenia. The concept of negotiated power networks is put forward to help make sense of these power relationships in a deinstitutionalised environment. Finally, the thesis proposes the concept of identity work as a way of understanding the operations of agency and relevant processes affecting identity.

This study examined the clinical utility of the recently released National Institute of Mental Health's (NIMH) research domain criteria (RDoC) by replicating and extending earlier work by using a demographically novel sample. Information retrieval and natural language processing of archival clinical records was used to achieve two main objectives: (1) estimate how well the RDoC domains match language used by clinicians by creating domain scores and (2) examine the differences between the DSM's and RDoC's ability to predict treatment outcome using these domain scores and DSM diagnoses. The social systems RDoC category was found to be the strongest predictor of treatment outcome across all diagnostic measures.

Dual Diagnosis (DD) refers to the co-existence of a Severe Mental Illness (SMI) and a Substance Use Disorder (SUD) in the same individual. The comorbid prevalence of these two diagnoses is very common, with Schizophrenia (SZ), Bipolar Disorder (BD), and Major Depressive Disorder (MDD) as the three most prevalent SMI among patients with SUD. The co-existence of SUD and these SMIs includes several clinical characteristics, related to evolution and prognosis, which may complicate a patient`s recovery from both disorders. However, nowadays there is an evident need to carry out studies that provide both theoretical and practical knowledge transferable to the clinical management of patients with DD. The present study aimed, as the first objective, to study personality characteristics in a sample of patients with SUD taking into account their comorbid SMI. We evaluated a sample of 104 male patients undergoing SUD treatment, considered in three groups according to the comorbid SMI: SZ+ Group (SUD and SZ; N=37), BD+ Group (SUD and BD, N=32), and MDD+ Group (SUD and MDD; N=35). Two instruments were used to measure personality, the Cloninger's Temperament and Character Inventory-Revised (TCI-R) and the Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), both based on psychobiological models. In addition, we explored the influence of the SMI in the relationship among personality and clinical variables related to both SUD and SMI diagnoses. Our second objective was to explore the influence of DD in the coping strategies used in relation to addiction treatment. SUD treatment represents a challenging situation for all patients, but given DD clinical complications, we studied the possible differential profile in the coping strategies used between patients with SZ+ (the most prevalent diagnosis in our sample) and SUD only. To elucidate the influence of comorbidity, a sample of 89 male patients undergoing treatment for addiction was included and distributed in two groups: SZ+ Group (SUD and SZ; N=39) and SUD Group (SUD only; N=43); these patients were assessed using the Coping Strategies Inventory (CS) from Tobin and completed an exhaustive clinical evaluation as well. The main personality results indicate that patients with SZ+ are characterized by an increased anxiety and fear of uncertainty (high Harm Avoidance from the TCI-R), difficulties in persevering when facing frustration and fatigue (lower Persistence from TCI-R), and the preference for solitary activities or small groups (lower Sociability from ZKPQ). Our findings suggest that patients with SZ+ are the ones who would especially need strategies to manage negative expectations and anxiety, motivational strategies, and if possible, a gradual incorporation to the group therapy sessions used during SUD treatment. Regarding personality characteristics for patients with BD+, these are characterized by an exploratory activity in response to novel stimulation, being more impulsive, getting easily bored, and by the willingness to experiment strong emotions for the sake of these types of experiences (high Novelty Seeking from the TCI-R and Impulsivity- Sensation Seeking from the ZKPQ). In addition, BD+ diagnosis is highlighted by a higher level of worries, fears, tension, and general emotional upset (high Neuroticism-Anxiety from the ZKPQ). Therefore, patients with BD+ are the ones who would require a therapeutic approach which emphasizes impulsivity management, as well as, achieving the general activity and stimulation they require. Finally, considering patients with MDD+, these are characterized by being more pragmatic, realistic, having an unstable self-image, and an erratic world-view (lower Self-transcendence from the TCI-R). Taking also into account that in previous studies a lower Self-transcendence is linked to worse general well-being and dropping-out SUD treatment, it may be suggested that interventions with MDD+ patients could benefit from therapeutic strategies that aim to increase creativity and spirituality, which are both associated with a higher Self-transcendence. With regards to the main relationships founded among personality and SUD and SMI clinical variables, we observed that such relationships are also influenced by the type of comorbid SMI. Results from the TCI-R indicate that higher scores in Novelty Seeking for patients with BD+ are related to a higher severity of addiction. Harm Avoidance is only linked to clinical variables for patients with SZ+, with a higher Harm Avoidance in patients having a greater presence of negative symptoms and general psychopathology. While Persistence did not show any clinical implications for none of the groups, Self- transcendence only showed clinical implications for the MDD+ group, in which a later age of SUD onset is associated with a lower Self-transcendence. Regarding results from the ZKPQ, we observed a positive relationship between Neuroticism-Anxiety and manic symptoms for patients with BD+, and the number of suicide attempts for patients with SZ+. Lastly, a higher Sociability is related to a later age of SUD onset for patients with SZ+, and to a later age of SMI onset for patients with MDD+. The study about coping strategies using the CSI in patients with SZ+, revealed that they are less likely to employ Engagement Strategies (Problem Solving and Social Support) and they have a lower self-perceived capacity to cope with treatment, compared with patients with SUD only. Among patients with SZ+, a major use of the Problem Solving strategy is related to a later age of SUD onset, and the self-perceived capacity to cope with treatment is negatively linked to severity of addiction and to positive symptoms. According to normative data, both groups (SUD and SZ+) use the Disengagement Strategy of Self-Criticism frequently; although the use of Self-Criticism was lower for patients with SZ+. Additionally, a higher use of Self-Criticism is related to a higher daily amount of medications for the SZ+ group. Hence, the presence of DD is associated with a lower use of active coping strategies and points to the need of training problem solving strategies, as well as, abilities to seek for social support during SUD treatment of patients with SZ+. Working on these two strategies could potentially improve treatment adherence and therapeutic outcomes. In conclusion, the findings of this thesis showed that patients with DD have different personality characteristics depending on their comorbid SMI diagnosis. Moreover, the relationship among personality and SUD and SMI clinical variables is also influenced by the type of SMI. Our findings extend to the DD field previous data about personality dimensions as potential endophenotypes for SZ (high Harm Avoidance) and BD (high impulsivity). Likewise, we observed the potential endophenotypes for developing an addiction (high Novelty Seeking and Impulsivity-Sensation Seeking, which are suggested especially for alcohol SUD) in polydrug users, regardless of the main SUD´s substance and adding nuances according to the comorbid SMI. On the other hand, a lower use of active coping strategies in relation to addiction treatment for patients with SZ+ extends to the DD field previous observations done in patients with SUD only and with SZ. Our data point to the potential usefulness of working different aspects, related to personality and coping, during DD treatment considering the comorbid SMI. However, future research is needed to advance in those lines of research, as well as, to overcome the limitations of our work. Additional studies should include a clinical, personality, and coping assessment, and longitudinal measures combined with objective data such as genetic polymorphisms and functional neuroimaging.<br>El concepto de Patología Dual (PD) hace referencia a la concurrencia de un Trastorno Mental (TM) y un Trastorno por Uso de Sustancias (TUS) en una misma persona. La prevalencia conjunta de estos dos diagnósticos es muy frecuente, siendo los tres TM severos comórbidos más prevalentes en pacientes con TUS la Esquizofrenia (SZ), el Trastorno Bipolar (TB) y el Trastorno Depresivo Mayor (TDM). La coexistencia del TUS y estos TMs conlleva una serie de características clínicas, de evolución y pronóstico, que dificultan la recuperación del paciente en ambos trastornos. Sin embargo, en la actualidad existe una necesidad evidente de realizar estudios que aporten tanto conocimiento teórico como trasladable al manejo clínico de los pacientes con PD. El presente trabajo se propuso, como primer objetivo, estudiar las características de personalidad en una muestra de pacientes con TUS atendiendo al diagnóstico de TM severo comórbido. Evaluamos una muestra de 104 pacientes hombres en tratamiento para el TUS, considerados en tres grupos según el diagnóstico de TM severo comórbido: Grupo SZ+ (TUS y SZ; N=37), Grupo TB+ (TUS y TB; N=32) y Grupo TDM+ (TUS y TDM; N=35). Se utilizaron dos instrumentos de medición de la personalidad, el Temperament and Character Inventory-Revised (TCI-R) de Cloninger y el Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), ambos basados en modelos psicobiológicos. Además, se exploró la influencia del TM en la relación entre personalidad y variables clínicas tanto del TUS como del TM. Nuestro segundo objetivo consistió en explorar la influencia de la PD en las estrategias de afrontamiento utilizadas en relación al tratamiento de la adicción. El tratamiento para el TUS representa un desafío para todos los pacientes, pero dadas las complicaciones clínicas de la PD se estudió el posible perfil diferencial de las estrategias de afrontamiento entre pacientes con SZ+ (diagnóstico más prevalente en nuestra muestra) y con sólo TUS. Para elucidar la influencia de la comorbilidad, se incluyó una muestra de 89 pacientes hombres en tratamiento para la adicción considerados en dos grupos: Grupo SZ+ (TUS y SZ; N=39) y Grupo TUS (N=43), a quienes se les aplicó el Coping Strategies Inventory (CSI) de Tobin junto con una exhaustiva evaluación clínica. Los principales resultados sobre personalidad indican que los pacientes con SZ+ destacan por una mayor ansiedad y temor a la incertidumbre (elevada Evitación del Riesgo del TCI-R), dificultad para perseverar ante la frustración y la fatiga (menor Persistencia del TCI-R) y preferencia por actividades en solitario o en grupos pequeños (menor Sociabilidad del ZKPQ). Nuestros hallazgos sugieren que los pacientes con SZ+ son quienes necesitarían especialmente de estrategias de manejo de expectativas negativas y ansiedad, de estrategias motivacionales y, siempre que sea posible, una incorporación paulatina a las sesiones grupales utilizadas durante el tratamiento para el TUS. Respecto a las características de personalidad de los pacientes con TB+, éstos destacan por la excitación frente a estímulos novedosos, ser más impulsivos, aburrirse fácilmente y poseer una necesidad de experimentar sensaciones fuertes por el mero hecho de vivirlas (elevadas Búsqueda de Novedad del TCI- R e Impulsividad-Búsqueda de Sensaciones del ZKPQ). Además, el diagnóstico de TB+ destaca por un mayor nivel de preocupaciones, miedos, tensión y malestar general (elevado Neuroticismo-Ansiedad del ZKPQ). Por tanto, serían especialmente los pacientes con TB+ quienes requieren de un énfasis terapéutico en el manejo de la impulsividad y en la búsqueda de la activación y estimulación que necesitan. Finalmente atendiendo a pacientes con TDM+, éstos se caracterizan por ser más pragmáticos, realistas, poseer una imagen más inestable de sí mismos y una visión más errática del mundo (menor Trascendencia del TCI-R). Considerando además que en estudios previos se ha relacionado una menor Trascendencia con peor bienestar general y con el abandono del tratamiento para el TUS, cabe sugerir que las intervenciones con estos pacientes se podrían beneficiar de incluir estrategias terapéuticas que incrementen la creatividad y la espiritualidad, ambas asociadas a una mayor Trascendencia. Respecto a las principales relaciones encontradas entre personalidad y variables clínicas del TUS y del TM, observamos que éstas también se hallan influenciadas por el tipo de TM severo comórbido. Los resultados del TCI-R indican que las puntuaciones superiores en Búsqueda de Novedad de los pacientes con TB+ se asocian a una mayor gravedad de la adicción. La Evitación del Riesgo sólo se relacionó con variables clínicas en pacientes con SZ+, siendo ésta más elevada cuanto mayor es la presencia de síntomas psicóticos negativos y de psicopatología general. Mientras que la Persistencia no mostró relaciones con variables clínicas en ningún grupo, la Trascendencia sólo mostró implicaciones clínicas en el grupo con TDM+, en el cual, una mayor edad de inicio del TUS se asoció a una menor Trascendencia. Respecto a los datos aportados por el ZKPQ, observamos una relación positiva entre el Neuroticismo-Ansiedad y la presencia de síntomas maníacos en pacientes con TB+, así como con la cantidad de intentos de suicidio en pacientes con SZ+. Finalmente, una mayor Sociabilidad se relaciona con una edad más tardía de inicio del TUS en pacientes con SZ+ y de inicio del TM en pacientes con TDM+. El estudio de estrategias de afrontamiento mediante el CSI en pacientes con SZ+ mostró que éstos utilizan con menor frecuencia estrategias de Manejo Adecuado del problema (Resolución de Problemas y Apoyo Social), y perciben que tienen menor capacidad para afrontar el tratamiento respecto a pacientes con sólo TUS. En pacientes con SZ+ un mayor uso de la estrategia de Resolución de Problemas se relaciona con una edad de inicio de TUS más tardía, y la capacidad para afrontar el tratamiento se asocia negativamente a la gravedad de la adicción y a los síntomas psicóticos positivos. Según baremos normativos ambos grupos (TUS y SZ+) recurrían muy frecuentemente a la estrategia de Manejo Inadecuado de Autocrítica, aunque su uso era menor en pacientes con SZ+. Además, una mayor Autocrítica se relaciona con más cantidad diaria de medicación en SZ+. Por tanto, la presencia de PD se vincula a un afrontamiento del tratamiento para la adicción menos activo y apunta a la necesidad de entrenar a los pacientes con SZ+ en el uso de estrategias de resolución de problemas y búsqueda de apoyo social durante su tratamiento para el TUS, pudiendo ello mejorar tanto la adherencia como la respuesta terapéutica. Como conclusión, los hallazgos de esta tesis muestran que los pacientes con PD difieren en las características de personalidad según su diagnóstico de TM severo comórbido. Además, la relación entre la personalidad y las variables clínicas del TUS y TM también se halla modulada por el tipo de TM. Nuestros resultados extienden al ámbito de la PD los datos previos sobre dimensiones de personalidad como posibles endofenotipos de la SZ (elevada Evitación del Riesgo) y del TB (elevada impulsividad). Así mismo, los posibles endofenotipos de personalidad para el desarrollo de la adicción (elevadas Búsqueda de Novedad e Impulsividad-Búsqueda de Sensaciones, que se sugieren especialmente para el TUS por alcohol) los observamos en pacientes policonsumidores, con independencia del tipo de sustancia principal del TUS, añadiendo matices según el TM severo comórbido. Por otra parte, el menor uso de estrategias de afrontamiento activas en relación al tratamiento de la adicción en pacientes con SZ+ extiende al ámbito de la PD observaciones previas realizadas en pacientes con TUS y con SZ. Los datos apuntan a la posible utilidad de trabajar aspectos diferenciales, relacionados con la personalidad y el afrontamiento, durante el tratamiento de la PD atendiendo al TM severo comórbido. Sin embargo, para poder progresar en esta área y superar las limitaciones de nuestros estudios, se requieren futuras investigaciones que, junto con la evaluación clínica, de personalidad y afrontamiento, incluyan registros longitudinales y medidas objetivas como polimorfismos genéticos y de neuroimagen funcional.

Past literature has showed that there have been several misdiagnosis of mental illness due to client’s delays in speech or introspection caused by an intellectual disability. It is believed that the intellectual disability is either interfering with the proper mental health diagnosis or a mental health diagnosis is unnecessarily being added to an intellectual disability. The study used a qualitative design that asked four psychiatrists on how they are treating their clients with an intellectual disability in addition to their mental illness. The interview guide asks about the difficulty in diagnosing individuals with a mental illness and a co-occurring intellectual disability. The proportion of clients also having an intellectual disability and co-occurring mental illness ranged from 5 to 20%. The problems that psychiatrists are running into are the fact that patients are not being correctly diagnosed before the age of 18 and are not able to get the resources that are needed, such as Inland Regional services.

AbstractThis case report presents the story of a young woman of Romani descent with a mixed dissociative (conversion) disorder within the contextual evidence-based and value-based medical framework. By painting the picture illustrating the course of her illness and the circumstances leading to the last clinical episode, compelling her most recent hospitalization, we delineate the contrast between common clinical phenomenology and the additional layers of the patient’s beliefs and values. Thus, we emphasize the importance of expanding the one-dimensional mainstream evidence-based approach, not only in cases of cross-cultural doctor-patient interactions but also in general medical practice, since the health attitudes and illness behaviors of every individual are influenced by their values and beliefs. In addition, the contemporary notion of medicine as a factual science requires a paradigm shift toward integrative multifaceted approaches if we as doctors are to treat human beings and not merely diseases.

1. Objectives: To assess the impact of the pregnancy on dual-diagnosed women. 2. Material and methods: Non-systematic review of the literature, through research on PubMed database with the keywords “dual diagnosis”, “pregnancy” and “mental illness”. 3. Results and conclusions: Dual diagnosis refers to the co-occurrence of a mental illness and substance abuse. The mean age of diagnosis for both mental illnesses and substance abuse on women is between 25 and 34 years old, which coincides with the period when women are most likely to be pregnant. One of the existent barriers on this topic is the lack of knowledge on the part of care providers as to the difficulties and treatment needs of the dual diagnosis client, with resultant anxiety and confusion about how to intervene, the efficacy of treatments, and especially how to balance the needs of the mother and fetus. The studies on this area show that patients with a substance abuse disorder or dual diagnosis had a high-risk pregnancy and less prenatal care than those with a mental illness alone, being schizophrenia the most frequent psychiatric diagnosis. For women who are dually diagnosed, the risks inherent in each disorder are combined with the potential for greater negative impact on pregnancy and the newborn.The risks of poor prenatal care, obstetric complications, and psychosocial difficulties increase and each disorder may exacerbate the other. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and postpartum with the concomitant risks to mother and baby.

This exploratory study was conducted to explore how people who have been diagnosed with mental disorders perceive their mental health condition, and their descriptions of lived experience of it. It also explored how their mental health condition might influence how they perceive themselves, their relationships, and how they engage the world around them through their activities. Sixteen participants (16) with a diagnosis of a mental disorder were the sample. The participants of the study were taking medication for the diagnosed mental disorder from a period of a minimum of six (06) months up to fortyseven (47) years. The data were collected at the Psychiatric Clinic, the General Hospital (Teaching), Kandy. The data were interpreted using Interpretative Phenomenological Analysis (IPA). It was identified that all the participants defined and understood mental health and mental illness through their lived experiences of mental illness. It was also identified that most of the participants experience some element of unhappiness or dissatisfaction because of their mental illness. However, the participants' positive self-esteem has played an important role in adjusting to the identity with the mental illness. The participants also valued the physical and psychological support they receive from their family members and others when they deal with their mental illness. Emotional support was highly valued by almost all the participants. It is expected that the generated knowledge of this research would help mental health professionals to work with families to construct an enabling view of the person with the illness and move away from treating them as helpless and irresponsible. Keywords: Self-Perception; Self-Identity; Self-esteem; Mental Health; Mental Illness

Introduction: Factitious disorders is a group of psychiatric pathologies in which a person acts as if he has an illness by deliberately producing or exaggerating symptoms on them, or sometimes they use a “victim” in order to catch the attention of the others. Usually, the real causes for this kind of behavior are emotional impairments and personality disorders. Munchausen syndrome and Munchausen by proxy syndrome are the most known of these disorders. Aim: The aim of this paper is to raise awareness for this kind of disorder because they are an extensive problem for the medical system and in many cases, they are hard to diagnose and manage. Method: We started by observing and documenting an unusual case of Munchausen syndrome at a patient from Infantile Neuropsychiatric Clinic of Psychiatry Institute “Socola”, Iasi and her mother with Munchausen by proxy syndrome. We compered this pair of cases with data reviews on the subject to see what are the challenges that are common for this kind of pathologies and how we can manage them. Conclusions: We concluded that factitious disorders are more common that is thought they are. Doctors tend to let this diagnose on the last place because the priority is to resolve the somatic symptoms of the patient. That is why we must acknowledge and understand how to manage this kind of mental disorder.

ICD-10 (The ICD-10 Classification of Mental and Behavioral Disorders. Clinical description and diagnostic guidelines) Introduction. Cotard syndrome is a neuropsychiatric pathology that is uncommon in medical practice but has a significant impact on public awareness of the importance of mental health. This mental disorder is also known as negation delirium, living dead syndrome, nihilistic delirium, or walking corpse syndrome. Objectives. A clinical case of a patient diagnosed with dementia due to late-onset Alzheimer's disease is presented; dementia also includes symptoms of Cotard's syndrome. Over time, the transmission of knowledge and data about Cotard Syndrome, despite its very low frequency, has become a pathology that intrigues and inspires curiosity among individuals. Consciousness of the existence of this delirious illness and the accurate definition of the symptoms of a dual diagnosis are required in a number of psychiatric pathologies. Method. This document was created using the "Elisabeta Doamna" psychiatry hospital Database from Galati, Romania, where patient data was acquired and admitted to the Psychiatry Clinic Section II. In addition, a variety of bibliographical references and diagnostic criteria were utilized, including the ICD-10 (the Classification of Mental and Behavioral Disorders, Clinical Description, and Diagnostic Guidelines), the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders), and the psychometric tests: the MMSE (the Mini Mental Status Test) and the GAFS (the Global Functioning Assessment Scale). Results and Conclusions Despite having no psychiatric history, the patient arrived at the psychiatric hospital after experiencing psychiatric symptoms caused by both Alzheimer's disease and Cotard's syndrome, symptoms that were ignored and gradually deteriorated, resulting in full-blown delirium, rapid dementia degradation, and a not-very-favorable outlook.

Of course, there are conditions for working with a patient. After the doctor has studied the approximate diagnosis of the patient's illness, personality, profession, social conditions, level, worldview, level of knowledge, external mental characteristics, it is necessary to prepare spiritually for communication with him. Communication between the patient and the doctor takes place in two frames. The first, in the outer circular chain, includes the steps in the physician’s preparation for communication with the patient, as described above. The second, the inner circle, is the chain of evidence that determines the identity of the patient, the causes of his illness.

Mental health is a state of an individual’s emotional and psychological wellbeing (Mental health basics,2018). People with mental illness. // Unresolved mental health problems can to a great extent affect the social, emotional, physical and educational development of teens and young adults, which in turn can have an enormous long-term negative effect on their adult life. (Fraser et al 2007). Studies [ show that young people that have positive mental health are much less likely to exhibit risk-taking behaviors such as addiction and even suicide (Reynold et al., 2013). According to the W.H.O. (2019),1 in 5 of the world's children and adolescents have a mental disorder with About 50% of mental health issues beginning before the age of 14. // Studies in Nigeria reveal that there is an existing high level of ignorance about mental illness with people tending to exhibit negative attitudes towards people who identify as having mental health illness. Also, the Rates of mental health workers vary from below 2 per 100,000 populations in low-income countries like Nigeria to 70 per 100,000 in high-income countries. // Presently openly discussing mental health issues is seen as a taboo in a Nigerian setting and people are scared of being stigmatized or labelled as being mad as madness is abhorred as a sign of a cursed bloodline. Research shows that 1/5th of suicide cases in Nigeria are of people aged 13-19, between January- June 2019,30% of suicide committed in Nigeria were students between the ages of 15-29 (Daily Trust,2019). These are worrying figures showing that young people are not able to access the help they need. // This project safe space project is an open-access web-based innovative inclusive system that makes mental health care accessible to teens and young adults in Nigeria who would have been excluded from accessing necessary education /information because they would be unable to afford to see mental health personnel or are so afraid of being stigmatized. In the website is contained age-appropriate carefully curated OER in the form of informative and easy to understand write-up on the different mental disorders, explainer videos, inspirational stories and a provision of a safe online hub connecting people sharing the same diagnosis. Here users can anonymously share their feelings with an understanding and supportive group. This presentation will be centered on the import of this particular project and giving a walkthrough of the project to demonstrate its design features and functionality.

The problem of making a correct diagnosis of a patient's disease is always is up to date. In this paper, we consider the problem classification of patients by type of mental illness based on analysis of EEG dendrograms of the brain. Shor O., Glik A., Yaniv-Rosenfeld A., Valevski A., Weizman A., Khrennikov A., Benninger F. proposed a method for analyzing dendrograms constructed from EEG for patients from several groups, previously divided into clusters according to the rendered medical verdict on the basis of p-adic quantum potential. In this study, it was decided to go the other way, and namely, to analyze dendrograms, which can be viewed as prefix codes. Analysis of the calculated parameters of prefix codes revealed the following feature: the average values of the mathematical expectation, entropy and variance for a group of patient dendrograms belonging to one mental cluster are unique. It is worth noting that the proposed method of EEG analysis can be used only as an auxiliary means indicating possible; type of disease. A correct diagnosis, through additional investigations, may put only by a specialist doctor.

Since the 1990s, the increase in work-related psychiatric complaints in Brazil, including in Paraíba-PB, highlights the relationship between work and illness. Data were collected on work-related mental disorders in Paraíba. This study aims to provide a comprehensive epidemiological analysis of work-related mental disorders in Paraíba, seeking to identify trends and risk factors. Using data from the IT Department of SUS-DATASUS (2015-2023), an ecological study was adopted to evaluate aspects such as age group, race, sex, occupation, diagnosis, evolution, issuance of Work Accident Report (CAT) and absence due to wear. The analysis reveals significant trends: the most affected age group is 40-60 years old (50.24%), with an increase among workers aged 20-39 years old (175.86%). Predominance of cases in mixed race (51.86%), with an increase of 1016.67%. Higher prevalence in women (77.87%), with 2.26 times more absences (69.37%). Neurotic and mood disorders were the most common (87%), progressing to temporary disability in 84% of cases. There was an increase in the issuance of CAT (215.38%), but 54.44% were not notified. Elementary school teachers were the most affected (27.97%). The increase in notifications among brown individuals may be associated with the growing recognition and acceptance of racial self-declaration. Female predominance reiterates the social overload of gender, resulting in physical and mental exhaustion. Furthermore, the prevalence of mood disorders in workers with multiple assignments and low pay suggests a possible relationship with continuous exposure to specific stressors. The urgency of interventions to promote the mental health of workers, especially women and mixed race, is highlighted. The lack of psychological support can lead to temporary or permanent disabilities. Multidisciplinary actions are essential to preserve mental health and improve the quality of life in the workplace in Paraíba.

Abstract: Multiple studies have found that psychiatric disorders, like mood disorders and substance use disorders, are highly comorbid among adults with either disorder. Integrated treatment refers to the treatment of two or more conditions and the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy. Integrated therapy for comorbidity per numerous studies has consistently been superior to the treatment of individual disorders separately. The purpose of this QI project was to identify the effectiveness of Cognitive Behavioral Therapy (CBT) instead of current treatment as usual for treating Substance Use Disorder (SUD) or mental health diagnosis independently. It is a retrospective chart review. The review examines CBT's efficacy for engaging individuals with co-occurring mood and substance u se disorders in treatment by enhancing adherence and preventing disengagement and relapse. Methods: Forty adults aged 26-55 with a DSM-IV diagnosis of a mood disorder of Major Depressive Disorder and/or anxiety and concurrent substance use disorder (at least weekly use in the past month). Participants received 12 sessions of individual integrated CBT treatment delivered with case management over a 12-week period. Results: The intervention was associated with significant improvements in mood disorder, substance use, and coping skills at 4, 8, and 12 weeks post-treatment. Conclusions: These results provide some evidence for the effectiveness of the integrated CBT intervention in individuals with co-occurring disorders. Of note, all psychotherapies are efficacious; however, it would be more advantageous to develop a standardized CBT that identifies variables that facilitate treatment outcomes specifically to comorbid disorders of substance use and mood disorders. It is concluded that there is potentially more to be gained from further studies using randomized controlled designs to determine its efficacy.

Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor. Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient urology office for an initial visit with a primary diagnosis of urinary incontinence. Charts were reviewed for documentation of individual or family risk factors for ACEs exposure, community risk factors for ACEs exposures, and records where no related documentation was included. Results: For the thirty-nine patients identified, no community risk factors were noted in the charts. Seventy-nine percent of patients had one or more individual or family risk factors documented. Implications for Nursing Practice This chart review indicates that a significant percentage of pediatric, school-aged patients presenting with urinary incontinence have exposure to ACEs. A formal assessment for ACEs at the time of initial presentation would be helpful to identify those at highest risk. References: Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–258 Hughes, K., Bellis, M.A., Hardcastle, K.A., Sethi, D., Butchart, D., Mikton, C., Jones, L., Dunne, M.P. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health, 2(8): e356–e366. Published online 2017 Jul 31.doi: 10.1016/S2468-2667(17)30118-4 Lai, H., Gardner, V., Vetter, J., &amp; Andriole, G. L. (2015). Correlation between psychological stress levels and the severity of overactive bladder symptoms. BMC urology, 15, 14. doi:10.1186/s12894-015-0009-6

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.

Around 1.25 million people in the UK suffer from eating disorders. These disorders can cause serious harm, both physically and emotionally, and they have the highest mortality rate of any mental illness. Early diagnosis, intervention and treatment is critical.