Obsessive-compulsive and related disorders in ICD-11 Dan J. Stein, Leonardo F. Fontenelle, Geoffrey M. Reed Department of Psychiatry, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa. Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil. 4 School of Psychological Sciences, Monash University, Melbourne, Australia. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.

Introduction: Infliximab is frequently used in patients with ulcerative colitis who have failed to respond adequately to conventional therapies. We evaluated predictors of primary non-response and secondary loss of response in an ulcerative colitis population. Methods: Ulcerative colitis patients from a single-center database of inflammatory bowel disease were identified. Patient demographics, disease extent and severity, concomitant therapy at initiation of infliximab, and treatment outcomes were collected using the electronic medical record. Logistic regression was used to determine predictors of primary non-response to infliximab. Cox regression was used to analyze predictors of secondary loss of response. Results: Ninety-two patients with ulcerative colitis were included in the analysis. Forty-eight percent were female. Mean disease duration was 6.5 years. Fifty-nine percent had extensive colitis and the remainder had left-sided colitis or proctitis. At initiation of infliximab, 60% were on corticosteroids, 50% were on immunomodulators, and 43% were on aminosalicylates. Of the patients 22/92 (24%) had a primary non-response to infliximab. Eighteen initial responders (25%) developed a secondary loss of response to infliximab. Mean duration of infliximab use in responders was 29.5 months. Concomitant immunomodulator use increased 8-fold the odds of a primary response to infliximab induction (p=0.0008). Subjects with extensive colonic distribution had 0.18 times the odds of having a response (p=0.0083). Secondary loss of response was unaffected by initial disease severity, disease distribution, disease duration or concomitant immunomodulator therapy. Lower body mass index (BMI) at initiation was associated with increased risk of secondary loss of response (p= 0.013). A non-significant trend was seen towards an increase in secondary loss of response in patients with steroid use at initiation (p=0.064). Colectomy rates were 24% overall. Forty-five percent of primary non-responders underwent colectomy, compared with 17% of initial responders (p=0.007). Conclusion: In this retrospective analysis, extensive disease and lack of concomitant immunomodulator therapy were associated with an increased risk of primary non-response to infliximab in patients with ulcerative colitis. Colectomy rates were greater than 2-fold higher in primary non-responders. Secondary loss of response was associated with lower BMI at initiation but was not associated with initial disease severity, disease distribution, or concomitant immunomodulator therapy.

Obsessive-compulsive disorder (OCD) and substance use disorder share several aspects of phenomenology and may be underpinned by a common mechanism with compulsivity at the core. Despite this overlap, the two disorders show a variable pattern of comorbidity. Here, we review the current evidence for comorbidity across clinical and epidemiological studies, and propose a new heuristic for substance use comorbidity in OCD, based on a hypothetical threshold of OCD severity.

Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity.One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD.Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive.These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.

The results are consistent with those from previous studies, and reinforce the argument that comorbid substance use and mental disorders constitute a major public health burden.

With a high prevalence rate in South Africa, mental disorders and their associated psychosocial and physical disabilities contribute substantially to the burden of disease and to health costs. Inadequate public health resources and a chronically overburdened health system result in limited access to psychiatric care. Task-shifting psychosocial interventions from specialised to non-specialised health workers (NSHWs) to treat common mental disorders has been widely proposed as a strategy for expanding access to mental health care. While the research regarding task-shifting approaches to psychosocial interventions is increasing, no review of the data on task-shifted interventions to address mental disorders in South African public mental health setting has been conducted to date.The aim of this chapter is to review such data and consider this evidence in the context of a new mental health policy that seeks to make health services more equitably accessible.A thematic analysis was conducted on nine South African studies that reported on (i) NSHW-delivered psychosocial interventions; (ii) outcome data pertaining to intervention efficacy; and (iii) at least one outcome that addressed mental illness specifically. This was done by organising extracted data according to themes that might reflect emerging patterns in this area of research.Thus far, most South African task-shifting studies have focused on depression and substance-use problems. A particular interest in pregnant women as subjects was noted, with a striking absence of interventions aimed at children and adolescents. Across the studies, cadres of health workers were employed to deliver a variety of interventions, all of which had some previous evidence-based support and were manualised. The majority of studies provided evidence for the effectiveness of task-shifted interventions.Some efforts have been made to test task-shifted interventions, and the results provide preliminary support for the adaptation of manualised, evidence-based programmes to South African contexts. Greater emphasis is now needed on studies that establish the costs and sustainability of such interventions, as well as optimal upscaling and implementation methods.

Early work focused on the serotonin reuptake inhibitors; however, the majority of the trials have been negative. There is a small body of evidence focused on pharmacotherapy for TTM. In future, larger trials are required to expand on the preliminary evidence available for N-acetylcysteine, olanzapine and dronabinol in recent trials.

Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents' perceptions of their child's overweight highly influence the well-being of obese children and the way in which they perceive themselves. THE PRESENT REVIEW PAPER AIMS TO BROADEN THE SCOPE OF KNOWLEDGE OF CLINICIANS ABOUT SEVERAL IMPORTANT PSYCHOSOCIAL AND FAMILIAL DIMENSIONS OF CHILDHOOD OBESITY: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children's perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.

This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compulsive and related disorders category, as this is how most clinicians see these behaviors, and as this may optimize clinical utility. The descriptions of these disorders should largely mirror those in DSM-5, given the evidence from recent field surveys. The recommendations regarding ICD-11 and body-focused repetitive behavior disorders should promote the global identification and treatment of these conditions in primary care settings.

Individuals with social anxiety disorder (SAD) are characterized by fear or anxiety about social situations, but also by important alterations in self-referential processing. Given advances in our understanding of the neurocircuitry and neurochemistry of SAD, the question arises of the relationship between this research and an emergent literature on the psychobiology of self and self-consciousness. A number of investigations of SAD have highlighted altered activity in the medial prefrontal cortex (mPFC; involved in self-representation), insula (involved in interoceptive processing), and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors (SSRI) and self-focused reappraisal in normalizing such changes. Future studies to more closely investigate associations between psychobiological alterations and changes in self-related processing in SAD, may be useful in shedding additional light on both SAD and self-consciousness.

Mortaity at 28 days after the first AMI declinedin Norway between 2001 and 2009 in both men and women and in all age groups. All-cause mortality at 1 year also declined both in men and women due to decreases in CVD mortality rates, whilst non-CVD mortality rates increased amongst patients ≥65 years of age.