587 results found
Reed GM, First MB, Kogan CS, et al., 2019, Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders., World Psychiatry, Vol: 18, Pages: 3-19, ISSN: 1723-8617
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
Tyrer P, Mulder R, Kim Y-R, et al., 2019, The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics., Annu Rev Clin Psychol
The nomenclature of personality disorders in the 11th revision of the International Classification of Diseases and Related Health Problems represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined. Expected final online publication date for the Annual Review of Clinical Psychology Volume 15 is May 7, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Mulder R, Zarifeh J, Boden J, et al., 2019, An RCT of brief cognitive therapy versus treatment as usual in patients with non-cardiac chest pain, International Journal of Cardiology, ISSN: 0167-5273
© 2019 Elsevier B.V. Background: Non-cardiac chest pain (NCCP) is a common reason for presenting to an emergency department (ED). Many patients re-present with similar symptoms despite reassurance. Objective: To investigate the clinical value of a brief cognitive behavioural treatment (CBT) in reducing re-presentations of patients who present with NCCP. Method: A randomised controlled trial (RCT) comparing three or four sessions of NCCP directed CBT with treatment as usual (TAU). The primary outcome measure was reducing health service use measured as re-presentations to the ED and hospitalisations for NCCP over 12 months of follow-up. Secondary outcomes were chest pain, health anxiety, depression, anxiety, quality of life and social functioning. Results: 214 patients received CBT and 210 TAU. There was no difference in ED visits or hospitalisation at three months or 12 months follow-up. Those with prior ED presentations for NCCP were significantly less likely to present with NCCP at three months follow-up but not at 12 months. Health anxiety was less at three months in those who received CBT but this effect was not present at 12 months. No other differences in secondary outcome measures were present. Conclusions: A brief CBT intervention for NCCP failed to reduce representations or improve psychological health over 12 months. We do not recommend such an intervention to unselected patients with NCCP. Patients presenting with prior episodes of NCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile.
Tyrer P, 2019, Critical psychiatry is becoming Luddite, BJPsych Advances, Vol: 25, Pages: 55-56, ISSN: 2056-4678
<jats:title>SUMMARY</jats:title><jats:p>The critical psychiatry movement has a part to play in correcting some of the exaggerated claims sometimes made by inveterate optimists in our profession. But it has gone too far in creating increasingly destructive commentaries that add little to knowledge and only serve as a brake on progress.</jats:p><jats:sec id="S2056467818000610_sec_a1"><jats:title>DECLARATION OF INTEREST</jats:title><jats:p>None.</jats:p></jats:sec>
Mulder R, Tyrer P, 2018, Diagnosis and classification of personality disorders, Current Opinion in Psychiatry, Pages: 1-1, ISSN: 0951-7367
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial, AMERICAN JOURNAL OF PSYCHIATRY, Vol: 175, Pages: 756-764, ISSN: 0002-953X
Tyrer P, 2018, Recent Advances in the Understanding and Treatment of Health Anxiety, Current Psychiatry Reports, Vol: 20, ISSN: 1523-3812
Tyrer P, 2018, The Importance of Nidotherapy and Environmental Change in the Management of People with Complex Mental Disorders., Int J Environ Res Public Health, Vol: 15
Much has been done in the last 50 years to achieve a better understanding of the psychosocial causes and other factors influencing the manifestation of mental illness, but there has been a conspicuous omission. Although gross environmental deficiencies were exposed in old mental institutions, 70 years ago the more subtle maladaptive settings that reinforce chronicity in mental illness have often been forgotten. In this review, the potential of systematic environmental manipulation as a treatment (nidotherapy) and other similar forms of management, used many times in the past but now mainly in forensic settings, is examined. There is now accumulating evidence, reinforced by controlled trials, that planned environmental change, preferably carried out with the full cooperation of the patient, can be a major contributor to therapeutic benefit. It is also very cost-effective. All forms of the environment, physical, social and personal, can be addressed in making assessments, and once a planned way forward has been chosen, progress can be monitored by personnel with limited mental health experience. These interventions have applications in general mental health and occupational health services and deserve much wider use.
Tyrer P, Mulder R, 2018, Dissecting the elements of borderline personality disorder, Personality and Mental Health, Vol: 12, Pages: 91-92, ISSN: 1932-8621
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, Lamotrigine for people with borderline personality disorder: a RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Olajide K, Munjiza J, Moran P, et al., 2018, DEVELOPMENT AND PSYCHOMETRIC PROPERTIES OF THE STANDARDIZED ASSESSMENT OF SEVERITY OF PERSONALITY DISORDER (SASPD), JOURNAL OF PERSONALITY DISORDERS, Vol: 32, Pages: 44-56, ISSN: 0885-579X
Tyrer P, Tyrer H, 2018, Health anxiety: detection and treatment, BJPsych Advances, Vol: 24, Pages: 66-72, ISSN: 2056-4678
Tyrer P, 2017, Borderline hits the diagnostic buffers again, BIPOLAR DISORDERS, Vol: 19, Pages: 599-600, ISSN: 1398-5647
Tyrer P, Salkovskis P, Tyrer H, et al., 2017, Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278
Singh SP, Paul M, Parsons H, et al., 2017, A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?, BMC PSYCHIATRY, Vol: 17, ISSN: 1471-244X
Tyrer P, Tarabi SA, Bassett P, et al., 2017, Nidotherapy compared with enhanced care programme approach training for adults with aggressive challenging behaviour and intellectual disability (NIDABID): cluster-randomised controlled trial, Journal of Intellectual Disability Research, Vol: 61, Pages: 521-531, ISSN: 0964-2633
Tyrer P, Tyrer H, Morriss R, et al., 2017, Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial, OPEN HEART, Vol: 4, ISSN: 2053-3624
Sanatinia R, Wang D, Tyrer P, et al., 2016, Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety, BRITISH JOURNAL OF PSYCHIATRY, Vol: 209, Pages: 244-250, ISSN: 0007-1250
Olajide K, Tyrer P, Singh SP, et al., 2016, Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments, PERSONALITY AND MENTAL HEALTH, Vol: 10, Pages: 191-204, ISSN: 1932-8621
Tyrer P, Wang D, Tyrer H, et al., 2016, Dimensions of dependence and their influence on the outcome of cognitive behaviour therapy for health anxiety: randomized controlled trial, PERSONALITY AND MENTAL HEALTH, Vol: 10, Pages: 96-105, ISSN: 1932-8621
Kim Y-R, Tyrer P, Lee H-S, et al., 2016, Schedule for personality assessment from notes and documents (SPAN-DOC): Preliminary validation, links to the ICD-11 classification of personality disorder, and use in eating disorders, PERSONALITY AND MENTAL HEALTH, Vol: 10, Pages: 106-117, ISSN: 1932-8621
Tyrer P, Crawford M, Mulder R, et al., 2016, THE ADVANTAGES OF A SIMPLIFIED CLASSIFICATION OF PERSONALITY DISORDER IN INTERNATIONAL CLASSIFICATION OF DISEASES-11 REVISION, AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY, Vol: 50, Pages: 5-5, ISSN: 0004-8674
Tyrer P, Nagar J, Evans R, et al., 2016, The Problem Behaviour Checklist: short scale to assess challenging behaviours, BJPsych Open, Vol: 2, Pages: 45-49
Tyrer P, Tyrer H, Guo B, 2016, The General Neurotic Syndrome: A Re-Evaluation, Psychotherapy and Psychosomatics, Vol: 85, Pages: 193-197, ISSN: 0033-3190
Tyrer P, Tyrer H, Cooper S, et al., 2015, Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): a multicentre randomized controlled trial with economic evaluation., BMC Psychol, Vol: 3
BACKGROUND: Most patients with chest pain have nothing wrong with their cardiac function. Psychological forms of treatment for this condition are more likely to be successful than others. METHODS/DESIGN: A two-arm parallel controlled randomized trial of standard care versus a modified form of cognitive behaviour therapy for chest pain (CBT-CP) in patients who have attended emergency hospital services. Inclusion criteria include (i) emergency attendance more than once in the previous year with chest pain when no physical pathology has been found, (ii) aged between 16 and 75, (iii) signed consent to take part in the study. Exclusion criteria are (i) under current psychiatric care, (ii) those who have had new psychotropic drugs prescribed within the last two months, (iii) are receiving or about to receive a formal psychological treatment. Those satisfying these criteria will be randomized to 4-10 sessions of CBT-CP or to continue with standard care. Participants are randomized using a remote web-based system using permuted stacked blocks stratified by study centre. Assessment is carried out at baseline by researchers subsequently masked to allocation and at 6 months and 1 year after randomization. The primary outcome is the Health Anxiety Inventory score at 6 months, and secondary outcomes are generalised anxiety and depressive symptoms, the Lucock Health Anxiety Questionnaire adapted for chest pain, visual analogue scales for chest pain and discomfort (Inskip Scale), the Schedule for Evaluating Persistent Symptoms (SEPS), health related quality of life, social functioning and medical resource usage. Intention to treat analyses will be carried out with clinical and functioning data, and a cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D. The data will also be linked to another parallel study in New Zealand where 126 patients with the same inclusion criteria have been treated in a similar
Tyrer P, Tyrer H, 2015, Nidotherapy: The expansion of environmental treatment, Australian & New Zealand Journal of Psychiatry, Vol: 49, Pages: 934-934, ISSN: 0004-8674
Crawford MJ, Sanatinia R, Barrett B, et al., 2015, Lamotrigine versus inert placebo in the treatment of borderline personality disorder: study protocol for a randomized controlled trial and economic evaluation, TRIALS, Vol: 16, ISSN: 1745-6215
Newton-Howes G, Mulder R, Tyrer P, 2015, Diagnostic neglect: the potential impact of losing a separate axis for personality disorder, BRITISH JOURNAL OF PSYCHIATRY, Vol: 206, Pages: 355-356, ISSN: 0007-1250
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