The 10 most-cited articles in The Journal of Nervous and Mental Disease, 2018

Prevalence rates are still lacking for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) diagnoses based on the new ICD-11 criteria. In a nationwide representative German sample (N = 2524; 14-99 years), exposure to traumatic events and symptoms of PTSD or CPTSD were assessed with the International Trauma Questionnaire. A clinical variant of CPTSD with a lower threshold for core PTSD symptoms was also calculated, in addition to conditional prevalence rates dependent on trauma type and differential predictors. One-month prevalence rates were as follows: PTSD, 1.5%; CPTSD, 0.5%; and CPTSD variant, 0.7%. For PTSD, the highest conditional prevalence was associated with kidnapping or rape, and the highest CPTSD rates were associated with sexual childhood abuse or rape. PTSD and CPTSD were best differentiated by sexual violence. Combined PTSD and CPTSD (ICD-11) rates were in the range of previously reported prevalences for unified PTSD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ICD-10). Evidence on differential predictors of PTSD and CPTSD is still…

Recent years have seen renewed interest and research about the use of hallucinogens as possible agents in the treatment of psychiatric disorders. However, we are unaware of studies assessing the current attitudes of American psychiatrists regarding hallucinogens. Therefore, we e-mailed surveys to 1000 members of the American Psychiatric Association-250 resident-fellows and 750 attending psychiatrists. The response rate was 32.4%. Respondents tended to perceive hallucinogens as potentially hazardous and appropriately illegal for recreational purposes. However, a large minority expressed optimism about the potential use of hallucinogens for psychiatric treatment. Male and trainee respondents, as compared with female and attending respondents, reported less concern about the risks of hallucinogens and greater optimism about their therapeutic potential. Younger psychiatrists also seemed more optimistic. Optimism among trainees and younger psychiatrists may possibly reflect greater exposure to recent positive publications about hallucinogens and less awareness of more negative past…

With over 10,000 mental health- and psychiatry-related smartphone apps available today and expanding, there is a need for reliable and valid evaluation of these digital tools. However, the updating and nonstatic nature of smartphone apps, expanding privacy concerns, varying degrees of usability, and evolving interoperability standards, among other factors, present serious challenges for app evaluation. In this article, we provide a narrative review of various schemes toward app evaluations, including commercial app store metrics, government initiatives, patient-centric approaches, point-based scoring, academic platforms, and expert review systems. We demonstrate that these different approaches toward app evaluation each offer unique benefits but often do not agree to each other and produce varied conclusions as to which apps are useful or not. Although there are no simple solutions, we briefly introduce a new initiative that aims to unify the current controversies in app elevation called CHART (Collaborative Health App Rating Teams), which will be further discussed in a second…

Posttraumatic stress disorder (PTSD) symptoms are positively related to suicide risk among firefighters. One mechanism that may account for this relationship is anxiety sensitivity (AS) cognitive concerns-the fear that cognitive symptoms of anxiety will have catastrophic consequences. We sought to replicate the mediating effect of AS cognitive concerns on the relationship between PTSD symptoms and suicide risk among 214 trauma-exposed male firefighters with non-zero suicide risk. Bootstrap mediation analyses tested AS cognitive concerns as a statistical mediator of PTSD symptoms (total and symptoms clusters scores) and suicide risk, controlling for depression symptoms and relevant demographic variables. AS cognitive concerns statistically mediated the relationship between PTSD symptoms (total score, as well as intrusion, avoidance, and arousal-reactivity symptoms clusters) and suicide risk; however, the reverse was also true. AS cognitive concerns may confer risk for suicide among trauma-exposed firefighters. Firefighters may benefit from AS-specific interventions, which are shown…

Weight bias issues are rarely discussed in Asian. Therefore, we examined the relationships between weight bias, perceived weight stigma (PWS), eating behavior, and psychological distress among Hong Kong people. Using cross-sectional design, 400 undergraduate students (175 men) completed questionnaires and were assigned into a self-reported overweight (n = 61) or nonoverweight group (n = 339) using body mass index, and a self-perceived overweight (n = 84) or nonoverweight group (n = 316) based on self-perception. For self-reported and self-perceived overweight groups, more weight bias was related to higher depression (β = -0.403; p = 0.004). Self-perceived group additionally showed that weight bias was related to PWS and inappropriate eating behaviors; PWS related to inappropriate eating behaviors. For self-reported and self-perceived nonoverweight groups, weight bias was related to PWS, inappropriate eating behaviors, anxiety, and depression (β = -0.228 to -0.148; p's < 0.05); PWS was associated with inappropriate eating behaviors, anxiety, and depression. Thus, weight bias issues…

Emotional Freedom Techniques (EFTs) combine elements of cognitive restructuring and exposure techniques with acupoint stimulation. Meta-analyses indicate large effect sizes for posttraumatic stress disorder, depression, and anxiety; however, treatment effects may be due to components EFT shares with other therapies. This analysis reviewed whether EFTs acupressure component was an active ingredient. Six studies of adults with diagnosed or self-identified psychological or physical symptoms were compared (n = 403), and three (n = 102) were identified. Pretest vs. posttest EFT treatment showed a large effect size, Cohen's d = 1.28 (95% confidence interval [CI], 0.56 to 2.00) and Hedges' g = 1.25 (95% CI, 0.54 to 1.96). Acupressure groups demonstrated moderately stronger outcomes than controls, with weighted posttreatment effect sizes of d = -0.47 (95% CI, -0.94 to 0.0) and g = -0.45 (95% CI, -0.91 to 0.0). Meta-analysis indicated that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or nonacupressure…

To quantify the effects of mind-body exercise on cognitive function in older adults with cognitive impairment, we systematically searched five databases. Findings were analyzed according to the mean change of global cognition, memory, and executive function. Subgroup analyses were conducted based on the level of cognitive impairment and types of exercise. Thirteen studies were included. Analyses revealed that mind-body exercise was effective in promoting global cognition in individuals with cognitive impairment (standardized mean difference [SMD] = 0.61; 95% confidence interval, 0.21-1.00; p = 0.003), as well as in individuals with mild cognitive impairment (SMD = 0.46; 95% confidence interval, 0.06-0.85; p = 0.02) or dementia; dance was effective in promoting global cognition (SMD = 0.84; 95% confidence interval, 0.23-1.46; p = 0.007) and memory (SMD = 0.27; 95% confidence interval, 0.02-0.52; p = 0.04) in individuals with cognitive impairment, but tai chi was not. Nevertheless, additional well-designed randomized clinical trials are further needed.

Metacognitive interpersonal therapy (MIT) is an integrative psychotherapeutic approach targeting personality disorders (PDs) featuring inhibition and avoidance. The current case series reports the outcome of a time-limited, 12-month MIT intervention for people with PDs featuring emotional inhibition. Seven participants were diagnosed with a PD on the basis of a structured clinical interview. The study followed a multiple baseline design, with baseline measures taken for 3 weeks before intervention. Participants underwent 12 months of weekly MIT sessions, with outcome measures taken every 3 months. Outcome variables were diagnostic recovery, symptom severity, and alexithymia. All participants improved over the course of the 12-month intervention across most measures. For six of the participants, the intervention was a likely driver of change. The current study contributes to a growing evidence base regarding the effectiveness of MIT for the treatment of PDs.

Despite low unemployment rates, individuals with mental health problems often struggle to gain reemployment. Many face the decision whether to disclose their mental illness to employers. This study therefore examined the role of disclosure attitudes for reemployment over time. Clinical and job search variables as well as attitudes toward disclosing a mental health issue to an employer were assessed among 301 unemployed individuals with mental health problems. Predictors of reemployment at 6-month follow-up were assessed using multiple regression, adjusted for sociodemographic variables, unemployment length, and depressive symptoms. Greater reluctance to disclose mental health problems at baseline predicted reemployment after 6 months. Reemployment was also associated with male sex, better education, lower disability levels, and more job offers at baseline. Therefore, a cautious approach toward disclosing a mental health problem may facilitate short-term reemployment. It is unclear whether this is a successful long-term strategy in employment settings.

Time-limited interventions may attenuate stigma and negative beliefs about borderline personality disorder (BPD) among mental health clinicians. This study examined whether a 1-day training in good psychiatric management (GPM) changed clinician attitudes and beliefs and whether those changes persisted over time. Fifty-two mental health clinicians attended a 1-day GPM training and completed a 13-item assessment of attitudes about BPD before and after the training and again 6 months later. One-way repeated-measures analysis of variances and dependent sample t-tests demonstrated significant changes for all items, 11 of which were in the direction of more positive attitudes about BPD. For six items, attitudes did not change immediately after training, but 6 months later had changed significantly. Findings indicate that brief training can foster enduring improvements in clinician attitudes and beliefs about BPD.