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This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and…
This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.
The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.
The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.
The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.
This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.
This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).
The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve…
The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve accuracy of diagnosis in the intellectual disability population. The paper aims to apply this system to a sample of a population with intellectual disability to further investigate its usefulness in the clinical setting.
A sample of 50 patients within an intellectual disability service was identified. Each individual was interviewed by a registrar in psychiatry of intellectual disability in the presence of their key worker or a carer that knew the individual well. Chart notes were extensively reviewed for clearly documented history of psychiatric symptoms and behavioural difficulties. The information gathered was applied as per the DC‐LD criteria to identify appropriate diagnoses. Previously documented diagnoses were also recorded for comparison purposes.
There was considerable discrepancy between the rates of psychiatric diagnoses after application of DC‐LD and rates of previously documented diagnoses within the sample. Use of DC‐LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. There were also discrepancies between rates of diagnosis of pervasive developmental disorders and Alzheimer's disease before and after use of DC‐LD.
This study adds to the evidence regarding the usefulness of DC‐LD in the intellectual disability population and also highlights the shortcomings of non‐systematic methods of diagnosis. It was agreed that DC‐LD criteria be applied to all service users in this population in the future.
This paper investigates the extent to which disability type contributes to differential evaluation of employees by managers. In particular, the authors examined managerial…
This paper investigates the extent to which disability type contributes to differential evaluation of employees by managers. In particular, the authors examined managerial prejudice against 3 disability diagnoses (i.e. psychiatric, physical disability and pending diagnosis) compared to a control group in a return-to-work scenario.
Working managers (N = 238) were randomly assigned to 1 of 3 scenarios containing medical documentation for a fictional employee that disclosed either the employee's psychiatric disability, physical disability, or a pending diagnosis. The authors also collected a separate sample (N = 42) as a control group that received a version of the medical documentation but contained no information about the disability diagnosis.
Compared with employees without stated disabilities, employees with a psychiatric disability were evaluated as more aggressive toward other employees, less trustworthy and less committed to the organization. Compared to employees with either physical disabilities or pending diagnoses, employees with psychiatric disabilities were rated as less committed to the organization. The authors discuss implications for future research and the trade-offs inherent in disability labeling and disclosure.
The current study extends prior research by examining a broader range of outcomes (i.e. perceived aggressiveness, trustworthiness and commitment) and moving beyond performance evaluations of employees with disabilities. The authors also assess the relative status of a “pending diagnosis” category—a type of disclosure often encountered by managers in many jurisdictions as part of accommodating employees returning to work from medical-related absence.
The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison…
The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.
Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning…
Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning disability, the less likely it is that the clinician can reliably confirm the diagnosis of a psychiatric disorder. Coordinated, multi‐modal interdisciplinary team assessment is the way forward, as it draws together the bio‐psychosocial model of interviewing and mental health care planning. In this article we go through the psychiatric assessment structure and highlight the differences in assessing people with learning disability compared with their peers in the general population. We give special consideration to mental health assessments in emergency settings, and to people with challenging behaviour.
Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness…
Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness, thereby creating the appearance of an emerging epidemic with increasing prevalence.
Method – I review the recent psychiatric and epidemiological research to reveal that the intellectual and scientific debates that occur in the psychological laboratory and in survey research are in fact falsely increasing the figures that show that an epidemic of bipolar is emerging.
Findings – For centuries, bipolar disorder was equated with severe psychosis and had a prevalence rate between 0.4% and 1.6%. As spectrum and subthreshold conceptions of bipolar disorder become established in official psychiatric diagnostic manuals, however, estimates of the prevalence of bipolar spectrum disorders have risen to almost 25%. I demonstrate that nearly all of this increase is a result of changes in the scientific and intellectual definition of bipolar disorders among psychiatric professionals, and that rates of symptoms are not in fact increasing.
Contribution to field – The arbitrariness of diagnostic thresholds naturally leads researchers to argue for lower thresholds. This allows more individuals who were previously considered psychiatrically normal to be reclassified as psychiatrically disordered. Lowering diagnostic thresholds increases the risk of confusing normal elation or sadness with disordered states, increasing the potential of false-positive diagnoses and the false impression of rising rates of disorder.
The purpose of this paper is to illustrate a lady with regression and disassociation with multiple psychiatric symptoms. This case highlights the limitations of…
The purpose of this paper is to illustrate a lady with regression and disassociation with multiple psychiatric symptoms. This case highlights the limitations of descriptive psychopathology and the usefulness of psychodynamic psychopathology in explaining and managing the mental phenomena.
Case report: the patient R is a 29-year-old lady. She has been known to the mental health institution since 14 years old. Over the next 15 years, she was admitted 27 times. She had been diagnosed with schizophrenia, bipolar disorder, depression, mental retardation, autism spectrum disorder and dissociative identity disorder. She has been subjected to long-standing abuse by her mother.
Discussion: labyrinthine diagnosis – placing a diagnosis on R proves to be challenging. When R presents with psychosis like and depressive symptoms, she is labelled as having a primary psychotic disorder and mood disorder, respectively. When R regresses to the P or the non-verbal individual persona, she is deemed to have mental retardation and autism spectrum disorder. Furthermore, R’s intelligence quotient was tested to be 65 at 14 years old. However, the intelligence quotient test was not consistent with her level of functioning during her non regressed state and therefore not considered reliable. Explosive and emotional outbursts and a positive family history of bipolar disorder rendered her to be diagnosed with the same. The multiple personas seem classical of dissociative personality disorder. However, the personas seem to exist on a continuum and are not independent of each other. Upon regression, R seems to be fixated at the oral stage. R also reported amnesia of events especially her emotional outbursts, while she was displaying her third persona. Dissociation could have rendered her unable to remember these events.
While the use of descriptive psychopathology is pragmatic and has the obvious advantage of being free from the burden of seeking explanation of the psychopathological phenomenon in a theoretical construct such as the psychodynamic framework, not all patients can be awarded a meaningful diagnosis using such an approach. This case report exemplifies that psychiatric presentation in some patients refuses to be neatly subjected to a useful psychiatric diagnosis using descriptive psychopathology as the diagnostic tool resulting in a confusing array of diagnoses, with each diagnosis representing an isolated facet of the psychological world of the patient while ignoring the rest. Explanatory models of psychopathology such as psychodynamic psychopathology still remain relevant in such cases for both understanding and explanation of the mental phenomena, and devising appropriate intervention strategies.
The authors review the call for cultural competence in psychiatric diagnosis and highlight the barrier of ‘monocultural ethnocentrism’ ‐ the tendency to presume that…
The authors review the call for cultural competence in psychiatric diagnosis and highlight the barrier of ‘monocultural ethnocentrism’ ‐ the tendency to presume that European‐American standards fit all cultural, racial and ethnic groups. They suggest that clinicians should: familiarise themselves with the history of racism in psychiatry; avoid stereotyping; appreciate the diversity within cultural, racial and ethnic groups; understand that individuals from various cultural, racial and ethnic groups may have had more traumatic experiences; and understand that individuals from the US and UK may have experiences with racism, some of which may cause mental illness. Finally the authors suggest strategies to increase cultural competence.
The paper reports on a review of assessment scales commonly used for assessment of psychiatric illnesses or behaviour problems in adults with learning disabilities…
The paper reports on a review of assessment scales commonly used for assessment of psychiatric illnesses or behaviour problems in adults with learning disabilities. Initially, a literature search was conducted to identify relevant peer‐reviewed journal publications pertaining to relevant scales. Those scales with more publications were reviewed with reference to the scale composition and psychometric properties. In total, eight behaviour scales, one psychiatric illness scale and three combined behaviour and psychiatric illness scales are reviewed.
We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent…
We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent processes with significant qualitative and quantitative differences, ultimately leading to better outcomes for developmentally disabled individuals.
Using secondary literature, we construct a sustained comparison of the two processes in terms of outcomes, timing, tempo, extent, funding, demographic composition, and investment in community services. We then reconstruct the strategies of de-stigmatization and framings of moral worth deployed in the two cases, analyzing their effects on deinstitutionalization in terms of conceptions of risk, rights, and care.
Deinstitutionalization began later for developmentally disabled individuals than for psychiatric patients, and was a more gradual, protracted process. It was not driven by fiscal conservatism, discharges, and the trans-institutionalization of the senile aged, as was deinstitutionalization for psychiatric patients, but primarily by the prevention of institutionalization of young children, and increased investment in infrastructure. Consequently, the deinstitutionalization of the developmentally disabled was far more thorough and successful. The process was shaped by the framing of the developmentally disabled as “forever children” by parents’ organizations that demanded a balance between autonomy, protection, and the provision of care. In contrast, the deinstitutionalization of psychiatric patients was shaped by their framing as autonomous citizens temporarily suffering from “mental health problems” that could be prevented, treated, and cured. This frame foregrounded the right to choose (and also refuse) treatment, while undervaluing the provision of care.