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16 results

  • Chapter 2 - ICD-11 + DSM-5 = A Diagnostic Babel

  • Edited by Peter Tyrer, Emeritus, Imperial College London
  • Book:
    Making Sense of the ICD-11
    Published online:
    13 October 2023
    Print publication:
    26 October 2023, pp 17-24

  • Summary

    The ICD and DSM are both useful systems of psychiatric diagnosis, alike enough to be roughly comparable, but different enough to cause confusion and misuse. Both systems are in wide use around the world and are likely to remain so. Neither system is clearly better than the other – we would be much better off having either one, rather than both.

  • Fast Grain Mapping with Sub-Nanometer Resolution Using 4D-STEM with Grain Classification by Principal Component Analysis and Non-Negative Matrix Factorization

  • Frances I. Allen, Thomas C. Pekin, Arun Persaud, Steven J. Rozeveld, Gregory F. Meyers, Jim Ciston, Colin Ophus, Andrew M. Minor
  • Journal:
    Microscopy and Microanalysis / Volume 27 / Issue 4 / August 2021
    Published online by Cambridge University Press:
    25 June 2021, pp. 794-803
    Print publication:
    August 2021
    • Article
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      • Open access
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  • High-throughput grain mapping with sub-nanometer spatial resolution is demonstrated using scanning nanobeam electron diffraction (also known as 4D scanning transmission electron microscopy, or 4D-STEM) combined with high-speed direct-electron detection. An electron probe size down to 0.5 nm in diameter is used and the sample investigated is a gold–palladium nanoparticle catalyst. Computational analysis of the 4D-STEM data sets is performed using a disk registration algorithm to identify the diffraction peaks followed by feature learning to map the individual grains. Two unsupervised feature learning techniques are compared: principal component analysis (PCA) and non-negative matrix factorization (NNMF). The characteristics of the PCA versus NNMF output are compared and the potential of the 4D-STEM approach for statistical analysis of grain orientations at high spatial resolution is discussed.

  • Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

  • Katie L. Richards, Michaela Flynn, Amelia Austin, Katie Lang, Karina L. Allen, Ranjeet Bassi, Gabrielle Brady, Amy Brown, Frances Connan, Mary Franklin-Smith, Danielle Glennon, Nina Grant, William Rhys Jones, Kuda Kali, Antonia Koskina, Kate Mahony, Victoria A. Mountford, Nicole Nunes, Monique Schelhase, Lucy Serpell, Ulrike Schmidt
  • Journal:
    BJPsych Open / Volume 7 / Issue 3 / May 2021
    Published online by Cambridge University Press:
    07 May 2021, e98
    • Article
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      • Open access
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  • Background

    The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package.

    Aims

    This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study.

    Method

    Participants were 259 emerging adults (aged 16–25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined.

    Results

    There were significant increases (16–40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used.

    Conclusions

    This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.

  • Ten books

  • Allen Frances
  • Journal:
    The British Journal of Psychiatry / Volume 218 / Issue 5 / May 2021
    Published online by Cambridge University Press:
    28 April 2021, pp. 289-291
    Print publication:
    May 2021
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  • Comments

  • Ρ Pichot, Norman Sartorius, Allen Frances MD
  • Journal:
    European Psychiatry / Volume 8 / Issue 6 / 1993
    Published online by Cambridge University Press:
    16 April 2020, pp. 330-331
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  • ICD-11 should not repeat the mistakes made by DSM-5

  • Allen J. Frances, John M. Nardo
  • Journal:
    The British Journal of Psychiatry / Volume 203 / Issue 1 / July 2013
    Published online by Cambridge University Press:
    02 January 2018, pp. 1-2
    Print publication:
    July 2013
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  • Having two systems of psychiatric diagnosis creates unnecessary confusion therefore it would be desirable to achieve increased consistency between ICD-11 and DSM-5. Unfortunately, however, DSM-5 has included many controversial suggestions that have weak scientific support and insufficient risk–benefit analysis. As a result ICD-11 should learn from the DSM-5 mistakes rather than repeating them.

  • 16 - The role of the Royal Colleges in training and development

  • from SECTION 4 - TRAINING AND DEVELOPMENT
  • Edited by Sean Kehoe, James Neilson, University of Liverpool, Jane Norman, University of Edinburgh
  • Book:
    Maternal and Infant Deaths
    Published online:
    05 February 2014
    Print publication:
    01 June 2010, pp 241-254

  • Summary

    Royal College of Obstetricians and Gynaecologists (RCOG)

    Setting standards to improve women's health is the core philosophy ofthe Royal College of Obstetricians and Gynaecologists. This theme is central to our principal functions of training and standard setting in obstetrics and gynaecology. The organisation has almost 12000 Members and Fellows and just under 50% work outside the UK. Members work in 90 separate countries and the potential network of influence is considerable. This article will focus on issues of training and development delivered under the auspices of the RCOG but developed specifically for the under-resourced areas where Millennium Development Goals 4 and 5 present major challenges.

    UK-based training

    Historically, many postgraduate doctors came to the UK to work and train within the NHS. Such an experience was not time limited and often provided the trainee with a skewed experience of the discipline. Successful trainees would return home with new clinical and management skills and a postgraduate examination certificate. Membership of the RCOG would enable such doctors to develop a lifelong relationship with the facilities of the college.

    However, recently such opportunities have decreased owing to a rapid expansion of British medical graduates. Opportunities, coordinated by the RCOG, now allow a limited number of overseas doctors to work under supervision for up to 2 years. It is anticipated that shortly some more senior doctors will come to the UK for exposure to subspecialty and special interest work. Such experiences allow the trainers to become part of a competency-based training assessment process.

  • Whither DSM–V?

  • Allen Frances
  • Journal:
    The British Journal of Psychiatry / Volume 195 / Issue 5 / November 2009
    Published online by Cambridge University Press:
    02 January 2018, pp. 391-392
    Print publication:
    November 2009
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  • The DSM–V development process started with a grand ambition to provide a ‘paradigm shift’ in psychiatric diagnosis, based initially on the identification of biological markers. This is clearly unattainable, and so energy has now been diverted into developing other major changes, including the development of dimensional ratings and the formal diagnosis of prodromal and subthreshold disorders. It is argued that this process could lead to false positive ‘epidemics’ with harmful excessive treatments. The better, more modest, alternative is to reassess the text descriptions of the disorders and join with ICD–11 in creating a single nested system for both DSM–V and ICD–11.

  • Dysthymia in Clinical Practice

  • Hagop S. Akiskal, Jorge Alberto Costa e Silva, Allen Frances, Hugh L. Freeman, Martin B. Keller, Yvon D. Lapierre, Juan José Lopez Ibor, Jr, Eugene S. Paykel, Max Stabl, The WPA Dysthymia Working Group
  • Journal:
    The British Journal of Psychiatry / Volume 166 / Issue 2 / February 1995
    Published online by Cambridge University Press:
    02 January 2018, pp. 174-183
    Print publication:
    February 1995
  • Background

    Dysthymia has been reconceptualised in recent years from a personality disorder to a chronic affective disorder. It is incorporated into both the DSM and ICD diagnostic systems. Method. The members of the WPA Dysthymia Working Group combined the results of their manual literature searches with a search using Medline.

    Results

    Available data are summarised under the headings of classification, epidemiology, validity, comorbidity, course and outcome, pharmacotherapy and psychotherapy. The coexistence of major depressive disorder, constituting ‘double depression’ is of particular importance.

    Conclusions

    Improved knowledge of this disorder has led to a more positive approach to treatment, in which antidepressants can usefully be complemented by psychosocial measures. A high proportion of cases remain unrecognised in most populations, leading to prolonged morbidity and distress, much of which is now treatable.