DOCSLIB.ORG

Classification of Elective Mutism Torey L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Classification of Elective Mutism Torey L Classification of Elective Mutism Torey L. Hayden Abstract. In this study of 68 children displaying elective mutism, four types of mutism are distinguished: (a) symbiotic mutism, characterized by a symbiotic relationship with a caretaker and a submissive but manipulative relationship with others; (b) speech phobic mutism, characterized by fear of hearing one’s own voice and use of ritualistic behaviors; (c) reactive mutism, characterized by withdrawal and depression which apparently resulted from trauma and (d) passive-aggressive mutism, characterized by hostile use of silence as a weapon. The prevalence of physical and sexual child abuse in all four groups was high. The classification of elective mutism into subgroups is clinically relevant for a better understanding of the etiology and for devising appropriate intervention. Journal of the American Academy of Child Psychiatry, 19:118—133,1980 Elective mutism, a term first employed by Trainer (1934), has been used traditionally to describe those children who refuse to speak to all but a small number of intimates. This definition excludes all other nonpsychogenic forms of mutism, including hearing loss, aphasia, schizophrenia, and autism. Although the behavior is a perplexing problem to the families of preschool children, it becomes a seemingly insurmountable problem when the children enter the educational system. Consequently, the elective mutes become candidates for grade retention, special class placement, and frequently residential institutionalization, mounting failure on top of an already complex psychological problem. LITERATURE REVIEW Despite a considerable literature devoted to elective mutism since its identification in 1877 by Kussmaul, no large-scale studies of this specific problem have been undertaken. Hence etiology, dynamics, treatment, and even incidence rates remain uncertain. Several excellent exhaustive reviews of the literature currently exist, Browne et al. (1963), Elson et al. (1965), and Halpern et al. (1971) being among the best. However, detailed systematic observation of a number of cases is lacking. Parker et al. (1960) present the most comprehensive American study with 27 youngsters in the Tacoma school system. Wright (1968) studied 24 cases. Spieler (1941) reviewed 50 European cases described in the literature but did not see these children himself. The rest of the literature deals with a small number of cases, usually 6 or fewer, and very often only a single case. Elective mutism requires further attention because of the difficulty in creating a consistent profile of behavior (Chetnik, 1973; Misch, 1952; Reed, 1963; Waterink and Vedder, 1936; Weber, 1950); its resistance to treatment (Elson et al., 1965; Mora et al., 1962; Pustrom and Speers, 1964); the ungainly amount of time generally required (Chetnik, 1973; Mora et al., 1962; Nolan and Pence, 1970; Sines, 1967; Wassing, 1973); and the great amount of environmental restructuring necessary to produce change (Amman, 1958; Elson et al., 1965; Pangalila-Ratulangie, 1959; Reid et al., 1967; Sines, 1967; Wassing, 1973). The study reported here was undertaken to establish the parameters of elective mutism by investigating a large sample so that the underlying disturbance might be seen more clearly. METHODS Population Criteria for inclusion in the study were: (1) the child must have displayed normal speech and speech patterning in at least one previous circumstance for a period of 6 months or more; (2) the child must have displayed totally mute behavior in at least one major setting for a period of 8 weeks; (3) the child must have an IQ of 70 or more as substantiated by the WISC or Stanford-Binet; (4) the child must have been free of the diagnosis of psychosis, including autism. These criteria were arbitrarily set to assure inclusion of only those children who displayed elective, psychogenic mutism. Along with the 68 children accepted in the study, 270 were rejected for possible contaminating factors. Of these 270 children excluded from the study, 23 (all having speech impairment or retardation) displayed behaviors characteristic of the 68 identified elective mutes and responded to treatment in a manner equivalent to the 68, thus emphasizing the arbitrary nature of some of the inclusion criteria. Table I Demography of Sample Population Girls Boys* Age range 3—9 to 5—6 3 0 6—0 to 7—11 20 7 8—0 to 9—11 17 1 10—0 to 11—11 12 1 12—0 to 14—4 4 1 IQ range 70 to 84 9 3 85 to99 15 4 100 to114 10 2 115 to130 15 3 131+ 7 0 Race Black 2 1 Mexican-American 3 1 Native-American 3 2 White 48 8 Income ** high ($5,573 or more per person) 15 3 middle ($3,829) 23 6 low ($2,396 or less) 18 4 Location Kansas 4 0 Minnesota 36 8 Montana 3 1 Oregon 5 0 Washington 8 3 Community Size *** urban (over 50,000) 14 2 suburban / small town (2,500 to 50,000) 30 6 rural (less than 2,500) 11 4 * The ratio of girls to boys in this segment of the study was approximately 6:1. However, the continued study with 122 children showed it to be closer to two girls to one boy (2:1). ** As established by the Bureau of Labor Statistics, U.S. Dept. of Labor, 1976. *** As established by the U.S. Bureau of Census, 1976. Procedures Data on the children were compiled from direct observation, video-and audiotapes, written reports, questionnaires, and other pertinent written material such as school cumulative folders and psychological, psychiatric, and pediatric reports. The children, who were seen sequentially over a 7-year period, were all referred by school districts. Any later referrals were initiated by mental health clinics and psychiatric facilities; however, almost all observations and interactions were done in the school setting, since there the problem was most acute. Consequently, schools always remained intimately involved and were requested to activate an outside referral from parents or clinical settings by submitting their own referral. The districts also bore primary financial responsibility in 57 (84%) cases. I functioned at first as a special education teacher within the district, and later as a professional affiliated with local universities. I saw all the children directly. (The wide geographical distribution resulted from my frequent moves while pursuing graduate degrees and experience.) Parental permission was gained for access to records and video-and audiotaping privileges. Separate and/or joint conferences were held with parents, teacher, pediatrician, and other individuals who had been involved with the child and his or her problem. Usually included in the last group were psychologists, psychiatrists, speech therapists, school psychologists, social workers, child protection workers, and principals. During the conference questionnaires were filled out by the individuals present and most conferences were audiotaped. Occasionally questionnaires were sent to individuals who could not attend a conference. The return rate on the questionnaires was high since the majority were filled out at the time they were presented. Other questionnaires which were mailed were also usually returned since I followed up unreturned questionnaires with phone calls or in-person pickups. Parent questionnaires dealt with the mutism problem: when it started, how it was handled; the child’s home behavior; family practices: discipline, chores; family attitudes: how the child got along with sibs, how the mother handled misbehavior; child’s past developmental and physical history; perceived school behavior; and general information. Teacher questionnaires dealt with how the teacher saw and interacted with the child, his or her problem and family, and school behavior. Pediatrician questionnaires dealt primarily with developmental and medical history aspects and his or her involvement with the child’s mutism. The general professional questionnaires further covered how the professional perceived the child, his or her mutism, and the child’s interactions with the environment. During conferences the questionnaires generally served as jumping-off points for further discussion and elaboration. All required information was then tallied on a master list in an attempt to ascertain which were and were not salient characteristics of elective mutism. RESULTS Four types of elective mutism were observed: symbiotic mutism, speech phobic mutism, reactive mutism, and passive-aggressive mutism (see table 2). Forty-four characteristics appeared frequently enough in the population to merit mention. Some occurred predominantly in only one or two subgroups. Others occurred frequently in all four groups. These characteristics are summarized in tables 3, 4, 5, and 6. The identifying features of each classification are discussed under the separate subheadings. Table 2 Types of Elective Mutism Girls Boys Symbiotic (S) 24 7 Speech phobic (SP) 6 1 Reactive (R) 13 1 Passive - Aggressive (PA) 13 3 Because the study did not anticipate that four subgroups would be found, the analysis of data was complicated. Thus, results are reported in percentages, and the three control groups (normal, speech-delayed retarded, and neurotic) of 30 children each were dropped because three of the four subgroups became too small for reasonable statistical analysis. Moreover, the last control group, the neurotics, was difficult to compare because of the variety of neuroses, creating the need to subcategorize the control group itself. Symbiotic Mutism This classification embodies Salfield’s (1950) Kretschmerian “sensitives”. The most common type of elective mutism observed (N = 31), symbiotic mutism was characterized by four factors. First, all the children displayed a strong symbiotic relationship with a caretaker, most frequently (84%) the mother. The caretaker was a dominant, verbal individual who consistently met all the child’s needs and was often openly jealous of the child’s other relationships, especially outside the home. Second, the family constellation was always represented by one noticeably dominant, verbal parent and one noticeably passive, nonverbal or absent parent. In all but one instance (97%), the dominant parent was the mother. In no case where both parents were present was the father the dominant member.
Load more

Recommended publications
  • Psychogenic Voice Disorders Literature Review, Personal Ex
    ISSN: 2643-4059 Clarós et al. Int J Depress Anxiety 2019, 2:015 DOI: 10.23937/2643-4059/1710015 Volume 2 | Issue 2 International Journal of Open Access Depression and Anxiety REVIEW ARTICLE Psychogenic Voice Disorders Literature Review, Personal Ex- periences with Opera Singers and Case Report of Psychogenic Dysphonia in Opera Singer Pedro Clarós1*, Agata Karlikowska1,2, Astrid Clarós-Pujol1, Andrés Clarós1 and Carmen Pujol1 1Clarós Clinic Barcelona, Spain 2Scholarship Clarós Clinic, Cracow, Poland Check for *Corresponding author: Pedro Clarós, Clarós Clinic Barcelona, Spain, ORCID: 0000-0002-7567-0370 updates others do not perceive it as abnormal [2]. Abstract The point of this article is to make a diagnosis of psycho- Organic speech or voice disorder has structural or logical voice disorders easier by reviewing germane to the neurological components that cause the speech distur- subject literature. Current view on terminology, classifica- bance (e.g. vocal nodules, polyps, hematoma of vocal tion, clinical manifestation and underlying psychological folds, structural changes in the larynx due to aging, vo- background of this rare condition is given. Secondly our aim cal tremor, spasmodic dysphonia, or paralysis of vocal is to asses prevalence ratio of psychological voice disor- ders in a group of 1520 professional opera singers-people folds, among others). with the most challenging voice effort among professional On the contrary, a functional speech disorder is a voice users. Our findings contradict common belief of high occurrence rate of this disorder among opera singers. Cha- voice impairment that is caused by underlying psycho- racteristics of this professional group are discussed and a logical process with no organic pathology (or a non-se- short example case report is described.
    [Show full text]
  • DCF Pamphlet 155-2: Appendix 3
    DCF Pamphlet 155-2: Appendix 3 Appendix 3: The table below shows the ICD9 codes that are acceptable in the Substance Abuse and Mental Health Information System (SAMHIS). This replaces all previous versions of allowable ICD9 codes used in the Substance Abuse and Mental Health Information System. The following are the codes and their meaning. STATUS: 0 = Inactive, code is not usable, 1 = Active, this will show in SAMHIS. PROGRAM CODE: N = Not Active, M = Mental Health Code, S = Substance Abuse Code B = Behavioral Health (can be used for either a mental health or substance abuse diagnosis) NOTE: Codes with ‘N’ (Not Active) in the Program Code are for historical purposes only. ICD9 PROGRAM Code STATUS DESCRIPTION CODE 095.7 0 SYPHILIS OF TENDON/BURSA N 196.8 0 MAL NEO LYMPH NODE-MULT N 259.9 0 ENDOCRINE DISORDER NOS N 269.0 0 DEFICIENCY OF VITAMIN K N 289.9 0 BLOOD DISEASE NOS N 290 0 Senile and presenile organic psychotic conditions N 290.0 0 SENILE DEMENTIA UNCOMP N 290.1 0 Presenile dementia N 290.10 0 PRESENILE DEMENTIA N 290.11 0 PRESENILE DELIRIUM N 290.12 0 PRESENILE DELUSION M 290.13 0 PRESENILE DEPRESSION M 290.2 0 Senile dementia with delusional or depressive feat M 290.20 0 SENILE DELUSION M 290.21 0 SENILE DEPRESSIVE M 290.3 0 SENILE DELIRIUM N 290.4 0 Arteriosclerotic dementia N 290.40 0 ARTERIOSCLER DEMENT NOS N 290.41 0 ARTERIOSCLER DELIRIUM N 290.42 0 ARTERIOSCLER DELUSION M 290.43 0 ARTERIOSCLER DEPRESSIVE M 290.8 0 SENILE PSYCHOSIS NEC N 290.9 0 SENILE PSYCHOT COND NOS N 291 1 Alcohol psychoses S 291.0 1 DELIRIUM TREMENS
    [Show full text]
  • Pharmacological Treatment of Anxiety Disorders in Children and Adolescents
    Derlemeler/Reviews Ö. Yorbik, B. Birmaher Pharmacological Treatment of Anxiety Disorders in Children and Adolescents Özgür Yorbik1, Boris Birmaher2 ABSTRACT: Pharmacological treatment of anxiety disorders in children and adolescents Anxiety disorders are among the most common of childhood psychiatric disorders, which may be associated with low self-esteem, substance abuse, depression, social isolation, inadequate social skills, and academic difficulties. The aim of the presented article is to review the drug treatment of anxiety disorders. Selected papers and books regarding to drug treatment of anxiety disorders were reviewed. Currently the selective serotonin receptor inhibitors are the first choice for the short-term treatment of anxiety disorders in children and adolescent, because they have been shown to be effective and safe. It is recommended to begin the treatment with very low doses and increase gradually to avoid side effects and compromise the adherence to treatment. The medication should be administered at therapeutic dosages for least 6 weeks to decide effectiveness of the treatment. The studies on drug treatment of anxiety disorders in children and adolescent are scarce. More well designed, double blind, placebo controlled studies on drug treatment of anxiety disorder are required. Key words: anxiety disorders, drug therapy, children, adolescent Bull Clin Psychopharmacol 2003;13:133-141 INTRODUCTION psychosocial and pharmacological interventions. The psychosocial interventions include education of nxiety disorders are among parents and child about the anxiety the most common of disorder, consultation with school childhood psychiatric personnel and primary care physician, disorders, with a prevalence and cognitive-behavioral therapies rateA for any anxiety disorder ranging (CBT), and family therapies (25-30).
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]
  • A Case Study of an Electively Mute Child
    University of Northern Iowa UNI ScholarWorks Graduate Research Papers Student Work 1998 A case study of an electively mute child Robert Driscol University of Northern Iowa Let us know how access to this document benefits ouy Copyright ©1998 Robert Driscol Follow this and additional works at: https://scholarworks.uni.edu/grp Part of the Child Psychology Commons, Communication Sciences and Disorders Commons, and the Education Commons Recommended Citation Driscol, Robert, "A case study of an electively mute child" (1998). Graduate Research Papers. 566. https://scholarworks.uni.edu/grp/566 This Open Access Graduate Research Paper is brought to you for free and open access by the Student Work at UNI ScholarWorks. It has been accepted for inclusion in Graduate Research Papers by an authorized administrator of UNI ScholarWorks. For more information, please contact [email protected]. A case study of an electively mute child Abstract Selective mutism is characterized by the appropriate use of language in certain settings, with a consistent lack of language use elsewhere. The child is often viewed as shy, and it is assumed that the shyness is temporary and will be outgrown. The purpose of this paper is to explore the problem of selective mutism in school aged children for whom silence may extend for many months or even years. Selective mutism will be further defined, and frequency, duration, and a summary of treatment methods will be discussed. A case study that illustrates positive outcomes of a behavioral approach will also be described. This
    [Show full text]
  • Selective Mutism: the Child Silenced by Social Anxiety
    Selective Mutism: The Child Silenced by Social Anxiety. A Meta-Synthesis Item Type Thesis Authors Merrill, Kellie Publisher University of Alaska Southeast Download date 27/09/2021 21:54:35 Link to Item http://hdl.handle.net/11122/4661 THE CHILD SILENCED BY SOCIAL ANXIETY 1 Selective Mutism: The Child Silenced by Social Anxiety. A Meta-Synthesis Kellie Merrill Sub1nitted in partial fulfillment of the requirement ofthe Master of Education in Special Education degree at the University ofAlaska Southeast /­ Redacted for Privacy RECOMMENDED: Thomas Scott Duke, Ph.D., Academic Advisor Redacted for Privacy APPROVED: ~~--~-------------------------------------- Deborah Lo, Ph.D., Dean of School of Education Date Archives Thesis LC 4019 .M47 2012 LIBRARY UAS- ,JUNEAU THE CHILD SILENCED BY SOCIAL ANXIETY 2 Abstract This meta-synthesis explores the subject of selective tnutistn across 1nultiple age groups. Selective 1nutis1n is present in a very small percentage of students. Given the small number of students that have this disorder there is limited resources and professional collaboration options available for teachers. The low incident rate of selective mutism often leads to students being forgotten about in the classroo1n setting. Teachers do not know how to help them overcome their disorder and the students are not able to ask for the help they need. This exploration into selective mutism reviewed 30 articles on the topic and attempted to provide identifying characteristics of the disorder as well as interventions for educators to implement while working with students selective mutism. THE CHILD SILENCED BY SOCIAL ANXIETY 3 1. Introduction 1.1. Background We have all seen the child that hides behind his mama's legs when we try to engage the1n in a simple conversation.
    [Show full text]
  • When to Suspect When to Suspect Child Maltreatment
    When to suspect child maltreatment When to suspect child maltreatment National Collaborating Centre for Women’s and Children’s Health Other NICE guidelines produced by the National Collaborating Centre for Women’s and Children’s Health include: • Antenatal care: routine care for the healthy pregnant woman • Fertility: assessment and treatment for people with fertility problems • Caesarean section • Type 1 diabetes: diagnosis and management of type 1 diabetes in children and young people • Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception • Urinary incontinence: the management of urinary incontinence in women • Heavy menstrual bleeding • Feverish illness in children: assessment and initial management in children younger than 5 years • Urinary tract infection in children: diagnosis, treatment and long-term management • Intrapartum care: care of healthy women and their babies during childbirth • Atopic eczema in children: management of atopic eczema in children from When to suspect birth up to the age of 12 years • Surgical management of otitis media with effusion in children • Diabetes in pregnancy: management of diabetes and its commplications from preconception to the postnatal period child maltreatment • Induction of labour • Surgical site infection: prevention and treatment of surgical site infection • Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years Guidelines in production include: • Hypertensive disorders
    [Show full text]
  • Selective Mutism: a Three-Tiered Approach to Prevention and Intervention
    53 Selective Mutism: A Three-Tiered Approach to Prevention and Intervention R.T. Busse and Jenna Downey, Chapman University Selective mutism is a rare anxiety disorder that prevents a child from speaking at school or other community settings, and can be detrimental to a child’s social development. School psy- chologists can play an important role in the prevention and treatment of selective mutism. As an advocate for students, school psychologists can work with teachers, parent caregivers, speech pathologists, and other support staff toward helping children who may develop or have selec- tive mutism. The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the incidence and severity of selec- tive mutism. We present theories and research on the etiology and prevalence of the disorder, followed by a review of intervention methods and research at each tier. Based on the theoretical and research literature base, we conclude that early intervention may result in the prevention and amelioration of many occurrences of selective mutism. KEYWORDS: Selective Mutism, Childhood Anxiety Disorders, Social Phobia, Prevention, Treatment The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the prevalence and severity of selective mutism. Children with selective mutism (SM) experience a “consistent failure to speak in specific social situations (in which there is an expectation for
    [Show full text]
  • Definitions, Classifications, Neural Correlates and Clinical Profiles
    ISSN: 2640-8031 DOI: https://dx.doi.org/10.17352/apt MEDICAL GROUP Received: 18 December, 2020 Review Article Accepted: 29 December, 2020 Published: 31 December, 2020 *Corresponding author: Dr. Giulio Perrotta, Psycholo- Psychotic spectrum disorders: gist sp.ing in Strategic Psychotherapy, Forensic Crimi- nologist, Lawyer sp.ed SSPL, Researcher, Essayist, Italy, E-mail: Defi nitions, classifi cations, https://www.peertechz.com neural correlates and clinical profi les Giulio Perrotta* Psychologist sp.ing in Strategic Psychotherapy, Forensic Criminologist, Lawyer sp.ed SSPL, Researcher, Essayist, Italy Abstract The psychotic spectrum is the category that groups together a series of disorders linked to a symptomatology in which we witness the fragmentation of the plane of reality until it is completely broken. According to the DSM-V nosography, the disorders under examination are schizophrenia, delusional disorder, paranoid disorder, schizoid disorder, schizotypic disorder, schizoaffective disorder, brief psychotic disorder, psychotic break and catatonia. In this work, theoretical and practical profi les were analysed, paying attention to neurobiological content and therapeutic profi les, both psychotherapeutic and psychopharmacological. A note of disappointment has been made in the nosographic categorisation of dissociative disorders that currently would not be included in the psychotic spectrum disorders, although from the elements that emerged it would be interesting to revise them, precisely because of the clinical nature of the psychopathological category. Contents of the manuscript alterations in the fl ow of ideas, mental organisational inconsistency and alterations in the associative links (such as Defi nitions and general profi les paralogy, tangentiality, transverse responses and disconnected argumentative jumps); The term “psychosis”, offi cially introduced by Ernst von Feuchtersleben in 1845, refers to all those psychopathological d) attributable to disturbances of the “content of thought”, forms of psychopathology characterised by severe alteration i.e.
    [Show full text]
  • 100 Cases in Psychiatry, Second Edition
    100 Cases A 27-year-old man presents with a 6-month history of increasingly repetitive routines. He is now unable to Second edition leave the house without undertaking lengthy checking of locks, taps and switches. This is taking longer and 100 longer so that he is often late for work. He is worried about losing his job as other colleagues have been Cases made redundant. You have been asked to assess him... in Psychiatry 100 Cases in Psychiatry presents 100 scenarios involving mental health commonly seen by medical students and junior doctors in the hospital and community setting. A succinct sum- mary of the patient’s history, examination and any initial investigations in is followed by questions on the diagnosis and management of each case. The answer includes a detailed discussion on each topic, providing an essential revision aid as well as a practical guide for students and junior doctors. Making speedy and appropriate clinical decisions, and choosing the best course of Psychiatry action to take as a result, is one of the most important and challenging parts of training 100 to become a doctor. These true-to-life cases will teach students and junior doctors to recognize important psychiatric conditions, and to develop their diagnostic and Second edition management skills. Cases Key features: • Succinct case studies presented in an easy-to-read format, listing patient history, examination and investigations • Questions at the end of each case prompt readers to consider their options for diagnosis, investigation and management • Answer
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders
    The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines World Health Organization -1- Preface In the early 1960s, the Mental Health Programme of the World Health Organization (WHO) became actively engaged in a programme aiming to improve the diagnosis and classification of mental disorders. At that time, WHO convened a series of meetings to review knowledge, actively involving representatives of different disciplines, various schools of thought in psychiatry, and all parts of the world in the programme. It stimulated and conducted research on criteria for classification and for reliability of diagnosis, and produced and promulgated procedures for joint rating of videotaped interviews and other useful research methods. Numerous proposals to improve the classification of mental disorders resulted from the extensive consultation process, and these were used in drafting the Eighth Revision of the International Classification of Diseases (ICD-8). A glossary defining each category of mental disorder in ICD-8 was also developed. The programme activities also resulted in the establishment of a network of individuals and centres who continued to work on issues related to the improvement of psychiatric classification (1, 2). The 1970s saw further growth of interest in improving psychiatric classification worldwide. Expansion of international contacts, the undertaking of several international collaborative studies, and the availability of new treatments all contributed to this trend. Several national psychiatric bodies encouraged the development of specific criteria for classification in order to improve diagnostic reliability. In particular, the American Psychiatric Association developed and promulgated its Third Revision of the Diagnostic and Statistical Manual, which incorporated operational criteria into its classification system.
    [Show full text]
  • Mental Health in Primary Care Diagnostic and Treatment Guidelines
    SULTANATE OF OMAN MINISTRY OF HEALTH MANUAL FOR THE MANAGEMENT OF MENTAL ILLNESS IN PRIMARY HEALTH CARE SECOND EDITION-2011 DEPARTMENT OF NON COMMUNICABLE DISEASES SURVEILLANCE &CONTROL IBN-SINA HOSPITAL DEPARTMENT OF PRIMARY HEALTH CARE. MR - 414 PREFACE Health is “the complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organisation Constitution 1948). Thus mental health is an integral part of health and plays an important role in the overall health of individuals, families, communities and nations. Indeed, there is no health without mental health. It is therefore important to include mental health in preventive, curative and rehabilitative health care services in every stage of development in the human life cycle. Despite there being no doubt that mental health is as important as physical health to overall well being of individuals, societies and countries, only a small minority of the 450 million people in the world suffering from a mental or behavioural disorder are receiving treatment, and this is also true of Oman as well as other countries . Prevention of all illnesses and disabilities is the policy of the Ministry of Health in Sultanate of Oman. There is a need to provide easily accessible, effective and early recognition of mental disabilities because delay produces adverse effects not only on the patients and their families but also on the whole economy and overall well being of society. Early recognition leads to early intervention resulting in better prognosis. Given the prevalence of mental disorders , and the desire to achieve equitable population access to mental health promotion, prevention, and treatment, it is essential , as in other countries, to integrate mental health into primary health care.
    [Show full text]