OBJECTIVE:The authors of this review aimed to examine the characteristics of published research on the clinical diagnosis of malingering and to critically assess the reporting of data on housing, race-ethnicity, and co-occurring psychiatric disorders. METHODS:Five databases (Embase, MEDLINE, ProQuest Dissertations and Theses Global, PsycInfo, and Web of Science) were searched from database inception to June 17, 2025. Results were independently screened by two researchers to identify studies of patients given a diagnosis of malingering in a clinical setting. PRISMA guidelines were followed. RESULTS:Of 3,150 records screened, 21 articles were included. Methods of identifying malingering used by these studies included the nonmutually exclusive categories of chart review (N=17 studies, 81%), ICD codes (N=7, 33%), and DSM criteria (N=3, 14%). Only five (24%) articles reported the housing status of individuals given a diagnosis of malingering. The racial-ethnic characteristics of people determined to be malingering were seldom reported (N=6, 29%). Although nine (43%) articles reported the prevalence of co-occurring psychiatric disorders among people determined to be malingering, the focus of reporting was overwhelmingly on personality, mood, psychotic, and substance use-related disorders, with limited coverage of cognitive disorders and anxiety- and trauma-related disorders. Only three (14%) articles reported data on longitudinal mental health outcomes such as overdose and suicide. CONCLUSIONS:Limited data are available with regard to how diagnostic decisions about malingering take into consideration patients' housing status and mental health history. Potential racial-ethnic disparities in malingering diagnoses are poorly characterized.

OBJECTIVES:This paper outlines the experience developing Addiction Medicine Practice-Based Research Network (AMNet), which promotes the adoption of patient-reported outcome measures (PROMs) and measurement-based care in outpatient addiction treatment practices and creates a platform for quality improvement and research. METHODS:From August 2019 to July 2023, the AMNet team selected patient-reported outcome measures for implementation in the American Psychiatric Association's clinical data registry (PsychPRO), recruited addiction medicine providers, and collected PROMs data. RESULTS:AMNet selected 12 PROMs for implementation in PsychPRO. Through July 2023, 1565 providers expressed interest, of whom 216 of the 929 eligible providers (23%) attended an onboarding call/webinar. Two hundred six providers (95%) from 54 practices returned Participation Agreements. Subsequently, 65 providers (32%) from 39 practices withdrew, resulting in 141 (68%) providers from 15 practices. From November 2020 to July 2023, 38 providers submitted PROMs data using 1 of 3 PsychPRO patient portals. Sixteen of the 53 providers (30%) who signed up for the initial portal collected data from 468 patients. As of July 2023, 83 of the 141 providers (59%) opted to submit PROMs data from their own portal or electronic health record. CONCLUSIONS:Next steps will include continued recruitment of providers, addressing barriers to data transfer and integrating data from providers' portals into the registry to create a platform for future research.

Use of patient-reported outcomes measures (PROMs) may improve addiction treatment outcomes. This qualitative study investigated barriers and facilitators for PROMs implementation among prescribers of medications for opioid use disorder (MOUD) participating in AMNet, an addiction medicine practice-based research network. Semi-structured interviews were conducted with seven qualitative research participants of 57 AMNet providers. Interview data were analyzed thematically and coded using ATLAS.ti. Barriers included lack of electronic health record (EHR) integration; user interface issues; insufficient administrative support; challenges with patient engagement; and lack of fit with clinical practice. Facilitators included perceptions that PROMs use would improve outcomes and increase accountability while advancing addiction medicine. Patient-reported outcomes measures implementation is feasible in small outpatient MOUD practices, although resource constraints and technological barriers may reduce potential reach.

The DSM-5 text revision (DSM-5-TR) is the first published revision of the DSM-5 since its publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of the DSM-5-TR is to comprehensively update the descriptive text accompanying each DSM disorder on the basis of reviews of the literature over the past 10 years. In contrast to the DSM-IV-TR, in which updates were confined almost exclusively to the text, the DSM-5-TR includes many other changes and enhancements of interest to practicing clinicians, such as the addition of diagnostic categories (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, unspecified mood disorder, and a category to indicate the absence of a diagnosis); the provision of ICD-10-CM symptom codes for reporting suicidal and nonsuicidal self-injurious behavior; modifications, mostly for clarity, of the diagnostic criteria for more than 70 disorders; and updates in terminology (e.g., replacing "neuroleptic medications" with "antipsychotic medications or other dopamine receptor blocking agents" throughout the text and replacing "desired gender" with "experienced gender" in the text for gender dysphoria). Finally, the entire text was reviewed by an Ethnoracial Equity and Inclusion Work Group to ensure appropriate attention to risk factors such as the experience of racism and discrimination, as well as the use of nonstigmatizing language.

OBJECTIVE The authors investigated adaptations to outpatient care delivery and changes in treatment demand and engagement among patients receiving medications for opioid use disorder (MOUD) in the months after the declaration of the COVID-19 public health emergency in 2020. METHODS Data were collected through an online survey (June-November 2020) of outpatient MOUD prescribers. The survey obtained information on outpatient practices' adaptations to MOUD treatment and urine drug screening (UDS) and elicited provider views on the effects of the COVID-19 pandemic on patient demand for, and engagement in, treatment. Multivariable regression analyses were used to examine associations among practice characteristics, patient engagement, and service adaptations. RESULTS Of 516 respondents, 74% reported adaptations to MOUD delivery during the pandemic. Most respondents implemented virtual visits for initial (67%) and follow-up (77%) contacts. Prescribers of buprenorphine were more likely than those who did not prescribe the medication to report MOUD adaptations. Among respondents reporting any MOUD adaptation, 77% made adaptations to their UDS practices. Among 513 respondents who answered COVID-19-related questions, 89% reported that the pandemic had affected the treatment and engagement of their patients. Of these respondents, 30% reported increased difficulty with patient engagement, and 45% reported that their patients preferred virtual visits during this period, whereas 18% endorsed patient preference for in-person visits. CONCLUSIONS Telehealth and federal regulatory easements in response to the COVID-19 pandemic enabled providers to continue treating patients for opioid use disorder in 2020. The results suggest that care adaptations and changes in patient demand and engagement were common in the practices surveyed.

The DSM-5 Text Revision (DSM-5-TR)1 is the first published revision of DSM-5 since its original publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of DSM-5-TR is to comprehensively update the descriptive text that is provided for each DSM disorder based on reviews of the literature since the release of the prior version. However, in contrast to DSM-IV-TR, in which updates were confined almost exclusively to the text2, there are a number of significant changes and improvements in DSM-5-TR that are of interest to practicing clinicians and researchers. These changes include the addition of diagnostic entities, and modifications and updated terminology in diagnostic criteria and specifier definitions. The updates to the diagnostic criteria and text in DSM-5-TR are the product of two separate but concurrent processes: the iterative revision process that allows the addition or deletion of disorders and specifiers as well as changes in diagnostic criteria to be made on an ongoing basis3, which commenced soon after the publication of DSM-5, and a complementary text revision process which began in 2019. While most of the changes instituted since publication of DSM-5 and included in this text revision involve relatively minor changes and serve to correct errors, clarify ambiguities, or resolve inconsistencies between the diagnostic criteria and text, some are significant enough to have an impact on clinical practice4. Here we outline the main changes in DSM-5-TR, subdivided into four categories: addition of diagnostic entities and symptom codes; changes in diagnostic criteria or specifier definitions; updated terminology; and comprehensive text updates. Diagnostic entities added to DSM-5-TR include Prolonged Grief Disorder, Unspecified Mood Disorder, and Stimulant-Induced Mild Neurocognitive Disorder. Prolonged Grief Disorder is characterized by the continued presence, for at least 12 months after the death of a loved one, of intense yearning for the deceased and/or persistent preoccupation with thoughts of the deceased, along with other grief-related symptoms such as emotional numbness, intense emotional pain and avoidance of reminders that the person is deceased, that are sufficiently severe to cause impairment in functioning5, 6. Unspecified Mood Disorder is a residual category for presentations of mood symptoms which do not meet the full criteria for any of the disorders in either the bipolar or the depressive disorders diagnostic classes, and for which it is difficult to choose between Unspecified Bipolar and Related Disorder and Unspecified Depressive Disorder (e.g., acute agitation). Stimulant-Induced Mild Neurocognitive Disorder has been added to the existing types of substance-induced mild neurocognitive disorders (alcohol, inhalants, and sedative, hypnotics or anxiolytic substances), in recognition of the fact that neurocognitive symptoms, such as difficulties with learning and memory and executive function, can be associated with stimulant use7. Free-standing symptom codes have been added to the chapter Other Conditions that May Be a Focus of Clinical Attention, to indicate the presence (or history of) suicidal behavior (“potentially self-injurious behavior with at least some intent to die”) and nonsuicidal self-injury (“intentional self-inflicted damage to the body likely to induce bleeding, bruising, or pain in the absence of suicidal intent”)1. These codes will allow the clinician to record these clinically important behaviors independent of any particular psychiatric diagnosis. Changes in diagnostic criteria or specifier definitions have been implemented for more than 70 disorders. While most of these changes are relatively minor, a number are more significant, and address identified problems that could lead to misdiagnosis. Diagnostic criteria sets or specifier definitions with more significant changes include those to criterion A for Autism Spectrum Disorder; changes in severity specifiers for Manic Episode; addition of course specifiers to Adjustment Disorder; and changes to criterion A for Delirium. Autism Spectrum Disorder is defined by persistent difficulties in the social use of verbal and nonverbal communication (criterion A) along with restricted repetitive patterns of behavior (criterion B). While the minimum threshold for the restricted repetitive behavior component was straightforward (at least two of four), the minimum required number of types of deficits in social communication was ambiguous. Specifically, the criterion A phrase “as manifested by the following” could be interpreted to mean “any of the following” (one of three) or “all of the following” (three of three). Since the intention of the DSM-5 Work Group was always to maintain a high diagnostic threshold by requiring all three, criterion A was revised to be clearer: “as manifested by all of the following”. The “mild” severity specifier for Manic Episode (few, if any, symptoms in excess of required threshold; distressing but manageable symptoms, and the symptoms result in minor impairment in social or occupational functioning) was inconsistent with Manic Episode criterion C, which requires that the mood disturbance be sufficiently severe to cause marked impairment in social or occupational functioning, necessitate hospitalization, or include psychotic features. The severity specifiers from DSM-IV have now been adopted: “mild” if only minimum symptom criteria are met; “moderate” if there is a very significant increase in activity or impairment in judgment, and “severe” if almost continual supervision is required. Specifiers indicating the duration of symptoms in Adjustment Disorder were inadvertently left out of DSM-5 and have now been reinstated: “acute” if symptoms have persisted for less than 6 months, and “persistent” if symptoms have persisted for 6 months or longer after the termination of the stressor or its consequences. The essential cognitive features in Delirium are disturbances of attention and awareness of the environment. While the nature of the attentional disturbance – characterized in criterion A as a reduced ability to direct, focus, sustain, and shift attention – is clear, the characterization of the awareness component as “reduced orientation to the environment” is confusing, given that “disorientation” already appears as one of the “additional disturbances in cognition” listed in criterion C. Consequently, criterion A has been reformulated to avoid using “orientation”, so that it now reads “A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment”. DSM-5 terminology has been updated to conform to current preferred usage, and includes replacing “neuroleptic medications”, which emphasize side effects, with “antipsychotic medications or other dopamine receptor blocking agents”; replacing “intellectual disability” with “intellectual developmental disorder”; and changing “conversion disorder” to “functional neurological syndrome”. Reflecting the evolving terminology in the area of gender dysphoria, “desired gender” is replaced with “experienced gender”; “natal male/natal female” with “individual assigned male at birth” or “individual assigned female at birth”; and “cross-sex treatment regimen” with “gender-affirming treatment regimen”. The updates to the text were the result of a three-year process involving over 200 experts, most of whom had participated in the development of DSM-5. There were 20 Review Groups to cover the Section II chapters, each headed by a Section Editor. Experts were asked to review the text to identify material that was out-of-date. This was supplemented by literature reviews that covered the period of the prior 10 years. Three cross-cutting Review Groups (Sex and Gender, Culture, Suicide) reviewed every chapter, focusing on material involving their specific expertise. Revisions to the text also underwent a forensic review. Finally, an Ethnoracial Equity and Inclusion Work Group reviewed the entire text to ensure among other things that explanations of ethno-racial and cultural differences in symptomatic presentations and prevalence took into consideration the impact of experiences such as racism and discrimination. Most disorder texts had at least some revisions, with the overwhelming majority having significant revisions. Text sections most extensively updated were Prevalence, Risk and Prognostic Factors, Culture-Related Diagnostic Features, Sex- and Gender-Related Diagnostic Features, Association with Suicidal Thoughts and Behaviors, and Comorbidity. The text sections with the fewest updates were Diagnostic Features and Differential Diagnosis. The American Psychiatric Association continues to welcome empirically-grounded proposals for change. Guidelines for submitting such proposals can be found at www.dsm5.org.

Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.

Objective: Posttraumatic stress disorder (PTSD) is prevalent and sometimes severely disabling. Providing effective treatment for PTSD and addressing its social consequences require accurate diagnosis. PTSD criteria have changed in all editions of the American Diagnostic Criteria since introduction of the diagnosis in DSM-III in 1980. The DSM-5 Field Trials demonstrated very good inter-rater reliability for PTSD, but a crosswalk study comparing DSM-IV and DSM-5 criteria has potential to identify diagnostic differences generated by changed criteria. Methods: A DSM-IV to DSM-5 PTSD crosswalk study was conducted in real-world adult clinical treatment settings in two DSM-5 Field Trials sites, the Dallas (N = 93) and Houston (N = 48) Veterans Affairs medical centers. The crosswalk assessment was conducted by trained clinicians who interviewed the patients and rated both sets of criteria on a combined checklist. Results: PTSD prevalence differed insubstantially between criteria sets (42% vs. 45% and 55% vs. 52% in the Dallas and Houston sites, respectively), with moderate to excellent diagnostic agreement (reliability indicated, respectively, by κ = .53 and .93); however, substantial proportions of individuals diagnosed in one criteria set did not meet criteria in the other. Differences in cross-criteria diagnostic reliability were largely a function of differing definitions of criterion A trauma. Conclusions: Reliability across the two criteria sets was generally good to excellent, and diagnostic discrepancy predominantly reflected the elimination of criterion A2 in DSM-5 with a smaller contribution from changes to the avoidance and numbing criteria.

Research on climate change and mental health is a new but rapidly growing field. To summarise key advances and gaps in the current state of climate change and mental health studies, we conducted a scoping review that comprehensively examined research methodologies using large-scale datasets. We identified 56 eligible articles published in Embase, PubMed, PsycInfo, and Web of Science between Jan 1, 2000, and Aug 9, 2020. The primary data collection method used was surveys, which focused on self-reported mental health effects due to acute and subacute climate events. Other approaches used administrative health records to study the effect of environmental temperature on hospital admissions for mental health conditions, and national vital statistics to assess the relationship between environmental temperature and suicide rates with regression analyses. Our work highlights the need to link population-based mental health outcome databases to weather data for causal inference. Collaborations between mental health providers and data scientists can guide the formation of clinically relevant research questions on climate change.

Background Individuals with severe and persistent mental illness (SPMI) have a higher risk of contracting COVID‐19 than individuals without SPMI. In combination with physical distancing, hygiene protocols, and vaccines, quarantine and self‐isolation are primary means of viral containment. However, individuals with SPMI may experience more difficulties with mandated quarantine or self‐isolation because of their illness(es), stigma, and marginalization. To date, there is a lack of consensus on strategies that could aid such individuals in completing isolation. Aim This review aimed to synthesize evidence for interventions to support self‐isolation and mandated quarantine for COVID‐19 among individuals with SPMIs. Methods We followed the PRISMA guidelines, searching 19 electronic databases (9 published literature registries and 10 gray literature sources). We looked for relevant randomized controlled trials, quasi‐experimental studies, and program evaluations of the effectiveness of relevant psychosocial, pharmacological, harm reduction, and addiction management strategies to support isolation settings or quarantine requirements for individuals with any SPMI (e.g., any mental disorder, substance use disorder, or their combination). Findings Of 10,298 total records that were located, 5582 were duplicate citations. Upon screening the remaining 4716 unique records by title and abstract, we excluded a further 3562 records. Only one original article met our inclusion criteria after reviewing the full texts of the remaining 1154 citations. To support individuals experiencing homelessness during the COVID‐19 pandemic, San Francisco developed an isolation hotel that reduced COVID‐19 hospital strain for 1009 participants (25% had a mental health disorder and 26% had a substance use disorder). While 81% completed their hotel stay, 48 patients had behavioral health needs that exceeded the hotel's capabilities. No other studies met our review's eligibility criteria. Most articles located by the search simply proposed solutions or discussed the challenges brought by COVID‐19 for people with SPMIs. While some documents went a step further (e.g., shelter guidance documents to support individuals experiencing homelessness), these rarely addressed individuals with SPMIs directly. Conclusions This systematic review evaluated evidence from published and gray literature on interventions to support self‐isolation and mandated COVID‐19 quarantine for individuals with SPMIs. Only one study met our inclusion criteria. This study found a beneficial effect of a dedicated isolation hotel for individuals experiencing homelessness and COVID‐19—where approximately 25%–50% of the study sample had a mental or substance use disorder. While there has been an abundance of COVID‐19 protocols in general, information for SPMIs is lacking. As the pandemic continues and we better prepare for future pandemics, developing protocols for supporting SPMIs in this context is imperative.

Introduction:The need for innovative approaches to address the opioid epidemic in the United States is widely recognized.Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments.Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice.To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes.This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies.Methods: A key step in the development of AMNet was the selection of substance usespecific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association's mental health patient registry, PsychPRO.A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD).Results: Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants.These tools were further categorized as core and optional.Conclusion: By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD.Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.

Objective: Right Direction (RD) was a component of a universal employee wellness program implemented in 2014 at Kent State University (KSU) to increase employees' awareness of depression, reduce mental health stigma, and encourage help-seeking behaviors to promote mental health. We explored changes in mental health care utilization before and after implementation of RD. Methods: KSU Human Resources census and service use data were used to identify the study cohort and examine the study objectives. A pre-post design was used to explore changes in mental health utilization among KSU employees before and after RD. Three post-intervention periods were examined. A generalized linear mixed model approach was used for logistic regression analysis between each outcome of interest and intervention period, adjusted by age and sex. Logit differences were calculated for post-intervention periods compared to the pre-intervention period. Results: Compared to the pre-intervention period, the predicted proportion of employees seeking treatment for depression and anxiety increased in the first post-intervention period (OR = 2.14, 95% Confidence Interval [CI] = 1.37–3.34), then declined. Outpatient psychiatric treatment utilization increased significantly in the first two post-intervention periods (OR =1.89, 95% CI = 1.23–2.89; OR = 1.75, 95% CI = 1.11–2.76). No difference was noted in inpatient psychiatric treatment utilization across post-intervention periods. Unlike prescription for anxiolytic prescriptions, receipt of antidepressant prescriptions increased in the second (OR = 2.25, 95% CI = 1.56–3.27) and third (OR = 2.16, 95% CI = 1.46–3.20) post-intervention periods. Conclusions: Effects of RD may be realized over the long-term with follow-up enhancements such as workshops/informational sessions on mindfulness, stress management, resiliency training, and self-acceptance.