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Note: Content is not peer-reviewed, does not constitute medical advice, and is provided for educational/interest purposes only.
Note: Content is not peer-reviewed, does not constitute medical advice, and is provided for educational/interest purposes only.
1. Human Nature and Well-Being
1. Human Nature and Well-Being
Big 5, OCEAN
Life satisfaction correlates with low neuroticism, high extraversion, high consciousness - Link
Women are higher on agreeableness and N - Link
Life Satisfaction
Life events can change OCEAN: Review of N=196,256 individuals. Getting married lowers openness, new employment improves conscientiousness, and lowers neuroticism. The factors most correlating with life satisfaction are: new relationship, marriage, and new employment. Link.
2. Neurobiology
2. Neurobiology
3. Psychopathology
3. Psychopathology
4. Etiology
4. Etiology
Genetics
Heritability ≠ genetic causation: A trait can be genetically determined without heritability if there's no genetic variation for that trait (e.g., having two eyes).
Large study and missing heritability: n=347,630. It appears that a lot of the missing heritiability problems can be resolved by looking at the whole genome. However, interestingly, this large study found lower contribution of genetics for most mental-related traits. Neuroticism (18.5%), Education attainment (34.9%), Sleep (12.5%), Smoking (17.4%) (looking at the genetic contribution supplemental table 4). This is in contrast to height that showed 70.9% whole genome heritability. Link
A study of heritability of ADHD showed that teacher estimates indicated 69% heritability vs GWAS showing 5%. Link
“the measurable heritability of a trait does not tell us how 'genetically inheritable' that trait is.” Link
5. Assessment
5. Assessment
DSM quote on need for a thorough interview "The case formulation for any given individual should involve a careful clinical history and concise summary of the social, psychological, and biological factors that may have contributed to developing a given mental disorder. It is not sufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis. A thorough evaluation of these criteria may assure more reliable assessment”
DSM-II quote on not making too many diagnoses "The diagnostician, however, should not lose sight of the rule of parsimony and diagnose more conditions than are necessary to account for the clinical picture."
PHQ-9 up to ⅔ false positive - Link
In a study, researchers evaluated the widely used PHQ-9 scale. 153 individuals at a psychiatric clinic received the scale and clinicians interviews. Link. DOI: 10.1186/1471-244X-12-73
The consequence of psychiatric labels
The issue of ever increasing prevalence of mental illness in youth is already a concern. In a 2023 study of sixth grade students, 51.2% adopted mental health labels at some point. Furthermore, the study found that adopting such a label significantly correlated with lower self-esteem. DOI: 10.1177/00221465231175936. Link
"At Brown and Harvard, more than 20% of undergraduates are registered as disabled. At Amherst, that figure is 34%." Link
Problem with scales like PHQ-9, GAD-7, PCL-5, too many positives - link
PHQ-9: False positives among positives = 65%, PCL-5 False positives among positives = 55%. Despite a 2/3 false positive rate, 86.7% of patients testing positive for the PHQ-9 are prescribed antidepressants, 42.0% of those testing negative are also prescribed antidepressants, only 5-7% of those who tested positive got referred to psychiatry/psychology. Link. DOI:10.1136/bmj.b750
PHQ-9: •Kroenke et al. (2001) - DOI: 10.1046/j.1525-1497.2001.016009606.x
GAD-7 •Spitzer et al. (2006) DOI: 10.1001/archinte.166.10.1092
PCL-5 •Georgescu et al. 2024 DOI: 10.1080/20008066.2024.2333222
A more recent article with concerns for checklists for PTSD. 2025 - Comparing checklists to clinical interviews, only 21% of reported trauma was true positive, (79% was false positive). For symptoms, only 34% were true positive, (65.9% were false positive). Link. DOI: 10/1089/cap.2024.0126.
2025 - Only 11.7% of clinical interpret the PHQ correctly. Link. DOI: 10.1001/jamapsychiatry.2025.3796
Simple psych-ed (like an ADHD workshop) doubles self-perception of the disorder in healthy individuals (28% to 58%) - Link. DOI: 10.1017/S0033291725101979
Will consider adding "amafufunyana" to culture bound syndrome: Amafufunyana is a culture-bound syndrome recognized among Xhosa and Zulu communities in South Africa, traditionally interpreted as demonic or evil spirit possession. Sufferers may exhibit symptoms such as hearing voices emanating from the stomach, speaking in unfamiliar languages or altered tones, and agitation.
6. Diagnosis & Prognosis
6. Diagnosis & Prognosis
7. Risk Assessment
7. Risk Assessment
Suicide risk assessment
Many suicides happen rapidly. Studies show large numbers that unfold within minutes of the decision (Wyder, 2004). Rapid access to a loaded gun can turn a fleeting thought into a permanent outcome.
Wyder, 2004: 67% of attempters considered self-harm for under 30 minutes. 93% under 24 hours.
Deisenhammer et al., 2009: Nearly half (47.6%) thought about it for 10 minutes or less. Link. DOI: 10.4088/JCP.07m03904
2025 UK suicide guidelines - Link
• 1st recommendation “do not use risk assessment tools and scales to predict future suicide”
• 2nd recommendation “do not use risk assessment tools and scales to determine who should and should not be offered treatment or who should be discharged”
2025 US paper advocating for Zero Suicide and suicide risk assessments for all. Post. Link. DOI: 10.1001/jamanetworkopen.2025.3721
2025 Safety planning - 80% reduction in suicide in original study, 90% increase in replication study - Link. DOI: 10.1016/j.jad.2025.04.023
The mention of command auditory hallucination as a risk factor for suicide didn't have a reference "command auditory hallucinations may identify or even place psychotic individuals at greater risk for acute, suicidal behavior — these symptoms should be the target of immediate and aggressive characterization and treatment". Link. DOI: 10.1016/j.comppsych.2012.12.022
Suicide & Durkheim
For the next edition, we may do a segment on Durkheim's conceptualization of suicide
Social Regulation (Organization): Anomic Suicide: Lack of regulation; normlessness from social disruption (e.g., “I’m lost without clear societal norms”) vs Fatalistic Suicide: Excessive regulation; despair from oppressive control (e.g., “I’m trapped by society’s rigid rules”).
Social Integration (People): Egoistic Suicide: Low integration; isolation from social ties (e.g., “I feel disconnected from society” or “No one loves me”) vs Altruistic Suicide: High integration; self-sacrifice for the group (e.g., “I’m dying for others, self-sacrifice”).
It should be noted that Durkheim was interested in social construct and this would not cover individual psychological reason for suicide. However psychological concepts can be deduced from Durkheim. Social regulation can be viewed as individual regulation: are you disorganized and acting impulsively or are you very rational and considered all possibilities but nothing worked. Social integration can be viewed as how you feel connected/dependent/responsible for others
Violence and schizophrenia
For unconventional stranger homicide (this is a much narrower group than regular murder); severe mental illness is 43.3% versus 2.4% for conventional stranger homicide (though 43.6% of larger group were intoxicated) - Link. DOI: 10.1177/00258024241255779
Antipsychotics adherence lower risk of violence (not in the paper - this could be a confounder of adherence rather than the effect of antipsychotics) - link. DOI: 10.1016/S0140-6736(14)60379-2
Mental illness increase risk of being subject and perpetrator of violence. Schizophrenia specifically increased risk of being perpetrator but not subject (Figure 4 B). n=250,419 large Swedish study.- link. DOI: 10.1001/jamapsychiatry.2019.4275
2025 - Risk factors of violence in individuals with schizophrenia/psychosis (#1 Past crime, #2 drugs, #3 suicidality, rest wasn’t significant including symptoms of psychosis) - Link. DOI: 10.1192/bjp.2024.120
Predictors of violence (deliquency/substance use/conduct problems): Poverty didn't predict violence when controlling for "positive parenting, single mother status, divorce, or child to adult ratio". Other predictor "Higher peer deviance in later adolescence." Paper also show that while violence varies some with age, it is much more heterogenous among individuals. Link. DOI: 10.1017/S0954579414000789
Receiving money (universal basic income) doesn't reduce violence but increases drug use by 14% (the day of). Link. DOI: 10.1162/rest_a_00834
APA in 1982 in the Amicus Brief for Barefoot v. Estelle
Limitation of violence risk assessment as described by the APA in 1982 in the Amicus Brief for Barefoot v. Estelle Link
“even under the best of conditions, psychiatric predictions of long-term future dangerousness are wrong in at least two out of every three”
“medical knowledge has simply not advanced to the point where long-term predictions [ ] may be made with even reasonable accuracy”
“The unreliability of psychiatric predictions of long-term future dangerousness is by now an established fact”
psychiatry “permits the jury to avoid the difficult actuarial questions by seeking refuge in a medical diagnosis that provides a false aura of certainty”
This may also be relevant to assessment or diagnosis chapter
Medications and suicide
Lithium study of suicide in veterans that was stopped due to futility analysis. 519 veterans with depression and bipolar given medium dose of lithium (lvl: 0.5) followed about 310 days (slight difference between groups). There were 65 events in the lithium group and 62 in the placebo group so the study was stopped for futility. Severe blow to the idea that Lithium reduces suicide. Link. DOI: 10.1001/jamapsychiatry.2021.3170
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