Status of Psychotic Disorders in ICD-11

The World Health Organization (WHO) is currently revising the ICD-10, which was approved in 1990, making the current period the longest in the history of the ICD without a major revision. [1] WHO is a global public health agency of the United Nations, whose constitutional responsibilities include the development and maintenance of international classification systems for health. [2] WHO’s Member States have agreed by international treaty to use the ICD as a basis for reporting health information that is usable and comparable across countries.

Within the context of the overall ICD revision process, the WHO Department of Mental Health and Substance Abuse has been assigned responsibility for managing the technical work of developing the chapter on mental and behavioral disorders. In developing the ICD-11 classification of mental and behavioral disorders, the Department has specified that substantial changes to existing mental disorder categories and definitions should be made through a transparent, international, multidisciplinary, and multilingual process that involves the direct participation of a broad range of stakeholders and is as free as possible from conflicts of interests. To assist the Department in all phases of the mental and behavioral disorders revision process, the WHO has appointed an International Advisory Group, chaired by Steven E. Hyman, which has in turn appointed a series of Working Groups in specific areas. [3] The Working Group on the Classification of Psychotic Disorders (WGPD), of which the first author is chair, has been charged with reviewing the evidence and developing proposals for schizophrenia spectrum and other primary psychotic disorders. The editorial is intended to provide an overview of the WGPD’s progress, and it follows a similar editorial on the classification of psychotic disorders in DSM-5. [4]

–Wolfgang Gaebel, Schizophrenia Bulletin

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More Evidence Early Intervention in Autism Gets Results

An early behavioral intervention may not only improve behaviors in young children with autism but it could also lead to “striking” brain changes, according to new imaging research.

A small case series study showed that after receiving a pivotal response treatment (PRT) intervention, the participating children with autism spectrum disorders (ASD), who were only 5 years of age, showed significant improvements in adaptive behavior as well as in communication. They also had increased activation in brain regions that support social perception, as shown by functional magnetic resonance imaging (fMRI) scans.

“I think this is the first time fMRI has been used to identify neural correlates of response to a treatment such as this. And parents really like it,” co-investigator Fred R. Volkmar, MD, director of the Child Study Center at the Yale University School of Medicine in New Haven, Connecticut, and chief of child psychiatry at the Children’s Hospital at Yale–New Haven, told Medscape Medical News.

The study was published online October 27 in the Journal of Autism and Developmental Disorders.

Remarkable Changes

The PRT intervention includes parental training and uses motivational play activities in its methods. Although this initial analysis focused only on 2 children, Dr. Volkmar reported that the results have led to a new full-scale study that includes 60 children.

–Deborah Brauser,

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Community Action Guide: Supporting Kids and Families Impacted by Caregiver Mental Health Problems, Substance Abuse and Trauma

This new guide from the Substance Abuse and Mental Health Services Administration (SAMHSA) presents resources that service providers, advocates, and practitioners can use to better understand and respond to young children whose caregivers are negatively affected by mental disorders, substance abuse, and/or trauma. The guide offers information, resources, and tips useful for engaging the wider community to come together for children and families in need of support.

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GrandFacts: Resources for Grandparents Raising Children

Click here for GrandFacts, state and local benefits for grandparents raising kids, and more

Across the United States, almost 7.8 million children are living in homes where grandparents or other relatives are the householders, with more than 5.8 million children living in grandparents’ homes and nearly 2 million children living in other relatives’ homes. These families are often called “grandfamilies.”

More than 2.5 million grandparents are taking on the responsibility for these children. Many other relatives also take on this responsibility, although data are not available on other relatives. Often they assume this responsibility with neither of the children’s parents present in the home. In fact, nearly 1 million children are living in homes where the grandparent is the householder and neither parent is present in the home (comparable data are not available for children living in homes where another relative is the householder and neither parent is present.)

These grandparent and other relative caregivers and the children they are raising are often isolated. They lack information about the range of support services, resources, programs, benefits, laws and policies available to help them successfully fulfill their caregiving role. In addition, to better serve children, families and older adults, educators and program practitioners need access to information about these key resources. Policy makers also seek information and education about the issues facing these “grandfamilies.” Therefore, in a unique national partnership, AARPBrookdale Foundation GroupCasey Family ProgramsChild Welfare League of AmericaChildren’s Defense Fundand Generations United have created the GrandFacts: State Fact Sheets for Grandparents and Other Relatives Raising Children.

GrandFacts State Fact Sheets for Grandparents and Other Relatives Raising Children are funded in part by AARP Foundation and  Verizon Thinkfinity.

Caregiver Resources: 13 Tools to Reduce Stress This Holiday Season

By Rebecca Klein, Huffington Post

For Tory Zellick, the holiday season used to mean a table full of savory turkey, ham and stuffing, and a delighted mother who gladly prepared each dish from scratch. However, at the age of 18, Tory’s mother was diagnosed with breast cancer, and Tory had to take on holiday preparation duties.

“My mom normally made a million foods during the holidays, but when she got sick, suddenly I had to do that,” said Zellick, author of The Medical Day Planner. “But my mom also wanted to help where she still could. So she would back-seat drive: She would sit at the table and lecture me about what makes a good turkey, a good stuffing. It became stressful to say the least.”

The holiday season can be stressful for anyone, but for the more than 34 million unpaid caregivers in America, there are added pressures.

For Dr. Bruce Margolis, Medical Director for Genworth Financial’s Long-Term Care Insurance Division, the main pressure is keeping his 95-year-old mother-in-law in high spirits. “It is a difficult time of year for my mother-in-law who lives with us because it reminds her of her late husband. This causes her to she reflect more on her life, which can get her down,” said Margolis. “What we’ve tried to do is have more family around, bring out old pictures and movie reels and have some fun with that.”

Fortunately, there are a plethora of resources that can help with holiday caregiving stress. For example, at the website, users can find extra help with the eldercare locator; hire house keepers or errand runners through the senior care directory; or talk for free to a counselor.

Since November is National Family Caregivers Month, Huff/Post50 has rounded up a range of tools and services to help make the holidays a little less stressful for those caring for loved ones. Link: check out the full article and slideshow

The Early 20’s is a High-Risk Time for Emerging Adults. Here’s What Concerned Parents Can Do

Raising kids is stressful when children are young, and again when they go through the teen years. But by their early 20s, parents should be able to take a deep breath and congratulate themselves on a job well done. Ideally by this time, your children have embarked on a career path and are ready to stand on their own as full-fledged adults.

However, the reality is that in many families, it’s not quite so simple. These so-called “emerging adult” years are a time of heightened risk in a variety of ways. Consider: Substance use and abuse peaks at age 21 to 22, including binge drinking, marijuana use and other drug use; serious mental health disorders such as schizophrenia and bipolar disorder typically appear for the first time in the late teens or early twenties; a host of other mental health disorders increase sharply from adolescence to emerging adulthood, most notably major depression and anxiety disorders; eating disorders are highest among young women in their 20s.

by Jeffrey Jensen Arnett and Elizabeth Fishel, AARP

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Race/Ethnicity and Self-Reported Levels of Discrimination and Psychological Distress

Reports of racial discrimination differed significantly among racial groups. Self-reported discrimination was independently associated with psychological distress after adjusting for race/ethnicity, age, sex, education level, employment status, general health status, nativity and citizenship status, English use and proficiency, ability to understand the doctor at last visit, and geographic location. The relationship between discrimination and psychological distress was modified by the interaction between discrimination and race/ethnicity; the effect of discrimination on distress was weaker for minority groups (ie, blacks and people of other races/ethnicities) than for whites.

–Center for Disease Control and Prevention (CDC)

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10 Tips to Boost Resilience in Service Members

Resilience is the ability to withstand, recover and grow in the face of stressors and changing demands. It’s a skill that can be learned and sharpened with practice. Building flexible strength is a hallmark of resilience and necessary for recovering peak performance after stressful events.

Service members face unique stressors, which, without the flexibility to recover and adjust, may challenge their fitness for duty and ability to manage home and family life post-deployment. Here are 10 tips experts at Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury shared that if practiced may help service members better adapt and manage stressful situations:

  • Communicate regularly and effectively. Express what you think, feel or believe in a way that will help you solve problems and receive the outcome you desire.
  • Maintain positive and personal connections. When you’re challenged or stressed, sometimes it’s easier to respond successfully with the support of family and friends.
  • Avoid seeing a crisis as unconquerable. Even if you can’t change a stressful situation, you can change your reaction to it.
  • Be accepting of change. Accepting the things you cannot change allows you to focus on the things you do have control over.
  • Move toward your goals. Focus on goals you can achieve in the near future instead of focusing solely on distant goals.
  • Take positive, decisive actions. Don’t view problems as permanent. Explore actions you can take that will give you more control over a situation.
  • Look for opportunities for self-discovery. We can often learn valuable life lessons as a result of a traumatic event.
  • Nurture a positive view of yourself. Develop confidence in your ability to solve problems and learn to trust your instincts.
  • Keep things in perspective. Focus on the broader context and keep a long-term outlook.
  • Look to a hopeful future. Visualize what you want your life to be, rather than fearful of what it could be.

Becoming resilient doesn’t happen overnight. But with practice, these tips can help you take positive steps toward improving your ability to handle and overcome life’s challenges.

–Diana Moon, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Become a Red Cross Disaster Mental Health Volunteer–Train and Prepare for the Next Disaster


What is the Red Cross doing and what does it need? 

The Red Cross has been providing shelter, feeding, health and mental health support to millions of people affected by Hurricane Sandy (5.9 million meals and snacks have been served through 11/15/12).  We have deployed 265 volunteer disaster mental health (DMH) professionals across state lines to assist with operations.  25,986 mental health contacts have been logged in New York and New Jersey. With the approach of the Thanksgiving holidays, many more DMH workers are needed to support clients and responders who will spend their holiday in shelters and impacted communities, struggling to cope with significant losses.  Please consider becoming a Red Cross DMH volunteer and deploying to support these disaster relief efforts.

As you read the DMH recruitment information below, keep in mind that disaster relief operations are fluid and staff needs change daily.  At the time that prospective volunteers read this message, the needs may have changed.  Additionally, our chapters are currently very busy processing large numbers of questions and offers to help.  Those interested in enrolling in the Red Cross DMH program should be prepared for a waiting period before you will be able to enroll and deploy as a DMH volunteer and thank you for your help!

Opportunities for Mental Health Professionals to Become Red Cross Disaster Mental Health Volunteers

Are you eligible? 

Red Cross DMH Volunteers must be:

  • Independently-licensed, master’s level (or higher) mental health professionals (psychiatrists, psychologists, social workers, professional counselors),
  • State-licensed or state-certified school counselors and school psychologists, or
  • RNs with a certification for psychiatric and mental health nursing to include RN-BC, PMHNP-BC or PMHCNS-BC.
  • Licensed in the state in which you live

If you are not eligible, don’t worry. There are many volunteer opportunities within Red Cross that are equally important and rewarding.  Please contact your chapter to explore activities such as Client Casework or Mass Care. You chapter may recommend a good volunteer fit for you.

Steps to Become a Red Cross Disaster Mental Health Volunteer:

  • All volunteer work with the American Red Cross begins at the local chapter
  • Enter your zip code under “Find your local Red Cross” at to find the chapter closest to you.
  • Register as a volunteer with the chapter.
    • Fill out a health status record
    • Complete a background check
    • Take Foundations of Disaster Mental Health training* and Disaster Services: An Overview
    • Fulfill any other training or paperwork that your chapter may require
    • While you are waiting for a course or to be approved to deploy, any support you can provide to your local community and Red Cross chapter will be of great value.
  • Psychological First Aid is also a required course for DMH volunteers. You may be able to take it after you have registered as a volunteer. Discuss this possibility with your chapter.

Why does it take so long to get deployed?  Why is there so much paperwork?

  • Essential information and background checks are needed to ensure the safety and welfare of Red Cross clients, volunteers and partners.  Preparing disaster relief workers to respond in the aftermath of disaster can be extremely challenging. Chapter staff is often overworked and are often volunteers themselves.
  • The Red Cross places high value in getting the right people, to the right place, doing the right thing, at the right time.  Sometimes that means taking more time before deployment in order to save time moving people later.
  • Local Red Cross chapters are managing large amounts of requests from the community and from prospective volunteers.

What is different about volunteering with the Red Cross?

  • Be patient and flexible.  Situations in disaster change rapidly and service delivery needs are fluid.  You may be asked to work at one site providing one type of service and then be switched to another site within a short period of time.
  • Our co-workers are also our clients.  90% of Red Cross staff are volunteers just like you.  They need your support.
  • You won’t have an office.  Most mental health work done in disaster is done in non-traditional settings, like shelters and service centers.  You may be providing support as you’re going for a walk or sitting under a tree.
  • Provide non-traditional mental health services.
    • Psychological first aid, triage, crisis intervention, assessment and basic support
    • Early intervention is primarily focused on assisting disaster survivors and response workers in meeting their most basic needs.
      • Helping people feel safe and secure
      • Obtaining food and water
      • Addressing physical health needs (e.g., first aid, medications)
      • Connecting to family, friends, and other social support networks.
    • Psychotherapy is not appropriate.
  • The work is very rewarding …. And very frustrating.  You’re working with people who have immediate needs for emotional support, food, shelter and other basics.  The most crucial need is information, which often you don’t have because the situation is constantly changing.  We do the best we can with the limited resources we have.

What if I’m already a trauma specialist – why do I need special training? 

  • The Red Cross has a specific role in disaster response which is different from the regular work of most mental health professionals.  Training is needed to understand that role.
  • In order to minimize frustration, you need to understand the disaster response system and organization of the Red Cross.
  • Most trauma interventions are not appropriate in the early aftermath of disaster, but your specialized training can be helpful in identifying those who are at risk for longer-term complications.

Assertive Community Treatment (ACT) Saved My Marriage

I thank all the Gods and all Heaven’s Most Powerful Beings for ACT (Assertive Community Treatment).  They saved my marriage by enabling my spouse and life-partner, Sandy to receive her medications compliantly, so she could become better able to take the meds on her own.  If the guy in [a] video…wants to call them “Nazi Storm-troopers” well, worse names have been hurled at family members by psychotic loved ones when all they wanted to do was assist these loved ones in getting into appropriate treatment.

Are there abuses of rights and mistreatment of the mentally ill in our Nation’s Corrections system?  I will be the first to admit it.  And I am doing what I can by writing a novel about such tragedies and the light at the end of such tunnels.

But I will never cease to be grateful to our psychiatrists and pharmacology researchers for doing their jobs.

–Larry Ackerman

Office & Programs Coordinator at NAMI Michigan

“Michigan’s Voice on Mental Illness”