Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment

In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a system- atic formulation, and against ad hoc criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome. It pays attention to widely published consistent descriptions of the syndrome, and a new cluster analysis of post electrical injury patients. It formulates a proposal which could be incorporated into future editions of the American Psychiatric Association＇s Diagnostic and Statistical Manual （DSM）. The major neuropsycholog- ical consequences include neurocognitive dysfunction, and memory subgroup dysfunction, with ongoing consequences, and sometimes including progressive or delayed psychiatric, cognitive, and/or neurological symptoms. The proposed diagnostic criteria insist on a demonstrated context for the injury, both specifying the shock circumstance, and also physical consequences. It allows for a certain delay in onset of symptoms. It recognizes exclusory conditions. The outcome is a proposal for a DSM classification for the post electrical or lightning injury syndrome. This proposal is considered important for grounding patient treatment, and for further treatment trials. Options for treatment in electrical or lightning injury are summarised, and future trials are foreshadowed.

Operational definitions and measurement of externalizing behavior problems:An integrative review including research models and clinical diagnostic systems

Measurement of externalizing disorders such as antisocial disorders,attentiondeficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders.While the Diagnostic and Statistical Manual of Mental Disorders(DSM)and the International Classification of Diseases(ICD)have provided the diagnostic framework for decades,recent dimensional frameworks question the categorical approach of psychopathology,inherent in traditional nosotaxies.Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach,providing diagnostic labels.In contrast,dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum,but are less widely used in practice.Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks,revise the different measurement alternatives existing,and provide an integrative operational definition.First,an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology(HiTOP)model is carried out.Then,in order to analyze the coverage of operational definitions found,a description of measurement instruments among each conceptualization is provided.Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement.ICD and DSM versions have progressively introduced systematicity,providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development.However,it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders,and therefore their measurement.More recent theoretical approaches,such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems.Nevertheless,several issues concerning this model raise mesasurement challenges.A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments.Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed.The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

Diagnostic challenges in alcohol use disorder and alcoholic liver disease

Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by noninvasive methods.

The Response of Climatic Jump in Summer in North China to Global Warming

To reveal climatic variation over North China, the climatic jumps in summer in Beijing are analyzed using the data of precipitation of summer (June, July, August) during the period of 1841-1993, in which those missed before 1950 were reconstructed by the stepwise regression method with minimum forecast error. The climatic jumps at different scales are analyzed using different diagnostic methods with different decade (10-100 years) windows. Some new methods and ideas are proposed. The variance difference, the linear tendency difference, and the difference of power spectral distribution between the samples before and after the period at the moving point in the center of the series are compared with other methods (for example, Mann—Kendall test, t— test, and accumulative anomaly etc.). Considering the differences among the statistics above, a synthetic jump index is also proposed in order to get the definite jump points in the moving series. The results show that the climatic jumps in the area occurred in the 1890s, the 1910s and the 1920s, and mostly in the 1920s, which suggests that the local climatic jumps in North China have a simultaneous response to the global warming in the hundred-year scales. Key words Climatic jump - New diagnostic statistics - Synthetic jump index - Response to global warming This Study was supported by the “ National Key Programme for Developing Basic Sciences” G1998040901-1.

Connectivity differences between adult male and female patients with attention deficit hyperactivity disorder according to resting-state functional MRI

Attention deficit hyperactivity disorder（ADHD） is a pervasive psychiatric disorder that affects both children and adults. Adult male and female patients with ADHD are differentially affected, but few studies have explored the differences. The purpose of this study was to quantify differences between adult male and female patients with ADHD based on neuroimaging and connectivity analysis. Resting-state functional magnetic resonance imaging scans were obtained and preprocessed in 82 patients. Group-wise differences between male and female patients were quantified using degree centrality for different brain regions. The medial-, middle-, and inferior-frontal gyrus, superior parietal lobule, precuneus, supramarginal gyrus, superior- and middle-temporal gyrus, middle occipital gyrus, and cuneus were identified as regions with significant group-wise differences. The identified regions were correlated with clinical scores reflecting depression and anxiety and significant correlations were found. Adult ADHD patients exhibit different levels of depression and anxiety depending on sex, and our study provides insight into how changes in brain circuitry might differentially impact male and female ADHD patients.

Validity of Chinese Version of the Composite Internationa Diagnostic Interview-3.0 in Psychiatric Settings

Background： The Composite International Diagnostic Interview-3.0 （CIDI-3.0） is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings. Methods： We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders （SCID-I, gold standard） by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen＇s K. Results： Substantial to excellent CIDI to SCID concordance was found for any substance use disorder （area under the receiver operator characteristic curve [AUC] = 0.926）, any anxiety disorder （AUC = 0.807） and any mood disorder （AUC = 0.806）. The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders （AUC = 0.55） and anorexia nervosa （AUC = 0.50） was insufficient. Conclusions： Overall, the Chinese version of ClDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.