Aleksandar Janca

Assessment and diagnosis of personality disorders : the ICD-10 international personality disorder examination (IPDE)

Contributors Preface Armand W. Loranger, Aleksandar Janca and Norman Sartorius Acknowledgements Part I. Background and Field Trial Section 1. Background: 1. Problems in the field of personality disorder Alv A. Dahl and Antonio Andreoli 2. Review of diagnostic instruments for the assessment of personality disorders Armand W. Loranger 3. Epidemiology of DSM-III personality disorders in the community and in clinical populations James H. Reich and Giovanni de Girolamo 4. International personality disorder examination (IPDE) Armand W. Loranger 5. Experiences with the IPDE Alv A. Dahl and Antonio Andreoli Section 2. Field Trial: 6. Sampling, interviewers, interview procedures Werner Mombour 7. Description of centres participating in the IPDE field trial Aleksandar Janca and Charles Pull 8. Results Armand W. Loranger 9. Discussion and conclusions Armand W. Loranger Appendix Part II. International Personality Disorder Examination (IPDE) ICD-10 module Index.

Complementary and alternative medicine in the treatment of anxiety and depression.

Purpose of review There is well documented evidence for the increasing widespread use of complementary and alternative medicine in the treatment of physical and psychiatric symptoms and disorders within Western populations. Here we provide a review of the recent literature on evidence for using such interventions in the treatment of anxiety and depression. Recent findings With regard to herbal treatments, kava is effective in reducing anxiety symptoms and St Johns wort in treating mild to moderate depression. The association of kava with hepatotoxicity, however, is a significant concern. Promising data continue to emerge for the use of omega-3 fatty acids in managing depression. Evidence for the use of acupuncture in treating anxiety disorders is becoming stronger, although there is currently minimal empirical evidence for the use of aromatherapy or mindfulness-based meditation. Summary The evidence base for the efficacy of the majority of complementary and alternative interventions used to treat anxiety and depression remains poor. Recent systematic reviews all point to a significant lack of methodologically rigorous studies within the field. This lack of evidence does not diminish the popularity of such interventions within the general Western population.

Influence of psychological stress on immune-inflammatory variables in normal humans. Part II. Altered serum concentrations of natural anti-inflammatory agents and soluble membrane antigens of monocytes and T lymphocytes

The effects of academic examination stress on serum concentrations of interleukin (IL)-1 receptor (R) antagonist (A), soluble(s) IL-2R, sIL-6R, soluble glycoprotein 130 (sgp130), Clara cell protein (CC16), sCD8 and sCD14 were evaluated in 38 university students. The relationships among changes in the above immune-inflammatory variables, levels of serum cortisol, and scores on the Perceived Stress Scale (PSS) or the State-Trait Anxiety Inventory (STAI) were examined. Academic examination stress was associated with significant increases in PSS and STAI scores, and in serum sgp130 and sCD8 values. Academic examination stress was associated with significantly decreased serum sCD14 concentrations in students with high, but not low, stress perception. There were stress-induced differences in serum IL-1RA, sIL-6R and CC16 concentrations between students with high vs. low stress-induced anxiety. The stress-induced increase in serum sCD8 was significantly more pronounced in male students, whereas the increase in serum sgp130 was more pronounced in female students taking contraceptive drugs. These results suggest that: (1) psychological stress induces immune-inflammatory changes pointing toward complex regulatory responses in IL-6 signalling, a decreased anti-inflammatory capacity of the serum, and interactions with T cell and monocytic activation; and that (2) sex hormones may modify stress-induced immune-inflammatory responses.

The Aboriginal Concept of Time and its Mental Health Implications

Objective: To explore the Aboriginal concept of time and discuss its impact on the assessment and management of Indigenous mental health problems in Australia. Conclusions: The Aboriginal concept of time differs from the Judeo-Christian perception of time in that Aboriginal people do not perceive time as an exclusively ‘linear’ category (i.e. past-present-future) and often place events in a ‘circular’ pattern of time according to which an individual is in the centre of ‘time-circles’ and events are placed in time according to their relative importance for the individual and his or her respective community (i.e. the more important events are perceived as being ‘closer in time’). Such an important difference in perception of time contributes to the limited applicability of standard assessment procedures in psychiatry and creates numerous difficulties in providing culturally appropriate mental health services to Aboriginal people in Australia.

Assessment of somatoform disorders: a review of strategies and instruments

We provide an overview of methods and instruments developed for the assessment of somatoform disorders. Four diagnostic purposes have been identified: (i) classification according to a diagnostic system; (ii) screening for probable cases; (iii) dimensional measurement of syndrome severity; and (iv) assessment of associated clinical features. Existing instruments designed for each of these strategies are described, including specifications of their psychometric properties, particular features, advantages and disadvantages. A conclusion of this review is that the currently existing ‘family of assessment instruments’ in the field of somatoform disorders should be used to improve the comparability of scientific findings in different cultures and settings.

Can physical activity improve the mental health of older adults

The world population is aging rapidly. Whilst this dramatic demographic change is a desirable and welcome phenomenon, particularly in view of peoples increasing longevity, its social, financial and health consequences can not be ignored. In addition to an increase of many age related physical illnesses, this demographic change will also lead to an increase of a number of mental health problems in older adults and in particular of dementia and depression. Therefore, any health promotion approach that could facilitate introduction of effective primary, secondary and even tertiary prevention strategies in old age psychiatry would be of significant importance. This paper explores physical activity as one of possible health promotion strategies and evaluates the existing evidence that supports its positive effect on cognitive impairment and depression in later life.

Towards better understanding and management of somatoform disorders

Much research has recently been conducted on somatoform disorders demonstrating their clinical importance, associated health-service burden and economic cost. These conditions are often comorbid with other mental and physical disorders and particularly prevalent in primary care and general medical settings. Although culture-specific manifestations and variations of somatization occur—it is now accepted that medically unexplained somatic symptoms are a universal phenomenon. The management of somatoform disorders is generally a complex and lengthy process; however, a number of recent studies have demonstrated the effectiveness of short-term treatments such as cognitive behaviour therapy and educational interventions. Despite advances in their understanding and treatment, debate still surrounds the conceptualization and categorization of somatoform disorders, with a number of experts proposing a complete revaluation and reassignment of this diagnostic classification category. The following paper represents a review of recently published literature on frequency, characteristics, conceptualization, impact and management of somatoform disorders.

Mass hysteria revisited.

Purpose of review Instances of mass psychogenic response have occurred throughout history, and across population groups; however, the present-day threat of terrorism and biological warfare is expected to enhance societal vulnerability to epidemics of such events. This paper provides a brief review of the current state of knowledge regarding the conceptualization, diagnosis, and management of mass psychogenic response. Recent findings Various terms are nowadays used to denote mass hysteria, such as ‘mass psychogenic illness’ and ‘mass sociogenic illness’. Recent studies investigating personality types predisposed to mass hysteric reactions are inconclusive with a range of results found. Cognitive models of this condition have been effective in promoting empowerment and adaptation among vulnerable individuals. The actions of governments, medical communities, and the media are pivotal in the management of mass hysteria. Summary The diagnosis of mass hysteria remains contentious, and the mechanisms underlying its perpetuation are similarly ambiguous. The prevalence of ‘threat’ within the modern sociocultural climate is likely to increase the incidence of the condition, and this could result in serious implications for health services. A holistic approach entailing the collaboration of various public sectors performing a range of preventive activities will be required to contain future mass psychogenic reactions.

WHO/WFN Survey of neurological services: a worldwide perspective.

According to the findings obtained in the context of a Global Initiative on Neurology and Public Health carried out by the World Health Organization (WHO), there has been a lack of reliable and comparative data on services and other resources for neurological disorders in many parts of the world. In view of these findings and in collaboration with the World Federation of Neurology (WFN), WHO has recently organized an international Survey of Country Resources for Neurological Disorders, which involved 109 countries and covered over 90% of the worlds population. This large WHO/WFN collaborative endeavour collected expert information on a number of aspects of neurological care provision around the world including availability of neurological services in primary care; human resources for neurological disorders; sub-specialized neurological services; primary method of financing of neurological care; and disability benefits for patients with neurological disorders. The WHO/WFN Survey results clearly demonstrate that there are inadequate resources for patients with neurological disorders in most parts of the world, and highlight inequalities in the access to neurological care across different populations, and in particular in those living in low-income countries and in developing regions of the world. The key findings of the WHO/WFN Survey including their impact on delivery of neurological care around the world are presented and discussed in this paper. The entire set of WHO/WFN Survey results including numerous tables, graphs and accompanying commentaries can be found in the WHO/WFN Atlas of Country Resources for Neurological Disorders, which is available on request from WHO or at http://www.who.int/mental_health/neurology/ .

Role of psychological trauma in the cause and treatment of anxiety and depressive disorders.

Purpose of review The role of traumatic events in the development of post-traumatic stress disorder is well established but their importance in the other anxiety disorders and in depression is less clear. We have reviewed recent publications in the medical literature which add to current knowledge regarding the possible causative role of trauma and the efficacy of trauma-focused treatments in these disorders. Recent findings A number of recent studies add further support to the notion that traumatic events increase vulnerability to a range of psychiatric disorders. Furthermore, pretrauma risk factors are shared across different anxiety and depressive disorders. Patients with partial rather than full post-traumatic stress disorder often have their post-traumatic symptoms subsumed within another anxiety or depressive diagnosis. There is very little data relating to trauma-focused treatment of disorders other than post-traumatic stress disorder. Summary There is increasing evidence that clinicians should be cognizant of the possible role of traumatic experience in the cause of patients with diagnoses other than post-traumatic stress disorder. There is, however, a paucity of data for the efficacy of trauma-focused psychological interventions for disorders other than post-traumatic stress disorder and further research is therefore needed.