2024-07-24 MBH CRG Meeting
Mental and Behavioural Health CRG
Date
27 July 2024
Piper Ranallo PhD
Elaine Wooler
Jane Millar
Former user (Deleted)
Laura Fochtmann
Andrew Wilson
Irina
Ramsey Davis\
Rebecca Berman (Unlicensed)
Attendees
Jan Ivar Ernø
Recording (GoogleDrive)
Discussion items
Item | Description | Owner | Notes | Action |
|---|---|---|---|---|
1 | 25467004 |Hyperaffectivity (finding)| Clarify meaning and position in hierarchy. Definition of affectivity (APA Dictionary): APA dictionary of psychology have a definition of affectivity: the degree of a person’s response or susceptibility to pleasure, pain, and other emotional stimuli. Evaluation of affectivity is an important component of a psychological examination; the therapist or clinician may look for evidence of such reactions as blunted affect, inappropriate affect, loss of affect, ambivalence, depersonalization, elation, depression, or anxiety. https://dictionary.apa.org/affectivity Consider
Discussion
Rebecca/ Andrew - SYN
| Piper Ranallo PhD
|
| Elaine Wooler - will look at translations, see if used in other countries/languages
Need: Clear rubric for how we make decisions about concepts and terms Methods:
|
2 | 198288003 |Anxiety state (finding)| Clarify meaning and position in hierarchy. Used extensively in the UK. APA dictionary defines it as an older concept related to anxiety neurosis: https://dictionary.apa.org/anxiety-state ICD-10 representation https://icd.who.int/browse10/2019/en#/F41.1 looks to be an index term for GAD along with anxiety neurosis and anxiety reaction. Consider:
| Elaine Wooler Piper Ranallo PhD |
| |
3 | 102498003 |Agony (finding)| Clarify meaning and position in hierarchy. Currently modeled as a subtype of Finding relating to grief and dying (finding) Merriam Webster has the following definitions of agony: 1a: intense pain of mind or spirit : extreme distress : anguish <the agony of being found wanting and exposed to the disapproval of others — Margaret Mead> 1b often capitalized : the sufferings of Jesus in the garden of Gethsemane <and being in an agony he prayed more earnestly — Luke 22:44 (Authorized Version)> 2a: intense pain of body : extreme torment : torture <left arm twisted upward behind him … in slow, deliberate agony — Kay Boyle> 2b: the throes of death : death struggle <his final agony> 3: a violent struggle, conflict, or contest <the world is convulsed by the agonies of great nations — T. B. Macaulay> 4: a strong sudden and often uncontrollable display (as of joy or delight) : outburst <my cousin … in an agony of mirth — Edith Wharton> Consider:
| Piper Ranallo PhD |
| |
4 | Leaden paralysis (finding) is a Symptoms of depression (finding) Clarify position in hierarchy ICD-11 MMS MB24.D Leaden paralysis - A feeling that one's arms or legs are as heavy as lead, associated with a form of depression that also commonly includes overeating and oversleeping - parent = symptoms or signs involving mood or affect. https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1189315647 Consider:
Discussion: Guidance around 'symptom' concepts. | Piper Ranallo PhD |
| |
4 | Disturbance in intuition (finding) and lack of intuition (finding) Clarify meaning and position in hierarchy.
| Piper Ranallo PhD |
| |
5 | Finding of individual style of dress (finding) Clarify clinical utility and unambiguity Consider: Items prefaced with "?" may not meet URU criteria (URU = useful, reproducible, understandable across healthcare workforce) Concepts Wears a turban (finding) |
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6 | Emotion v. Emotion State AND Mental phenomenon v Mental State Clarify meaning and position in hierarchy.
| Piper Ranallo PhD Former user (Deleted) |
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Meeting Files
Previous Meetings
Comments
Hi Ed,
Thanks for posting. We can discuss in more detail on the call today, but briefly:
Item 2 (Anxiety state): Based on the assumption that the FSN is the source of truth for meaning of a term, it originally appeared to be either a duplicate of 'anxiety' or more specific subtype (a point in time feeling of anxiety). However, after further research we learned the term 'anxiety state' was used extensively in the UK to describe a distinct phenomena more akin a mix of what is now called GAD and what used to be called 'free floating anxiety'.
Item 3 (Agony): Yes, agree!
Item 4 (Leaden paralysis): I believe there is another candidate parent concept - something related to feeling of heaviness in limbs, but let's discuss.
a. interesting - I think this requires further discussion. Note - we have many observable and clinical finding concepts that describe the same phenomena (e.g., level of consciousness) but that appear twice - once in a hierarchy for neurological observable /finding and once in a hierarchy for mental observable / finding.
b. Yes, agree re: seems inconsistent with SI policy. Note similar concept "psychotic symptom".
Item 5 (finding of individual style of dress): These concepts are used in the MSE to describe "appearance". We previously reviewed and inactivated other concepts that we thought were either offensive, subjective, ambiguous, or not clinically relevant (e.g., ugly appearance, beautiful appearance, colorful appearance)
Piper
Symptoms: Some but not all symptom concepts are under <<418799008 |Finding reported by subject or history provider (finding)| based on a definition of symptom as subjective evidence of disease or physical disturbance observed by the patient. We asked Content Managers AG about this content and whether the reporter should be better captured by the information model, but did not get any feedback.
On item 2 (Anxiety state):
I don't understand the line of reasoning that necessarily replaces 'anxiety state' with 'generalised anxiety disorder' (as opposed to other plausible candidate targets such as 'anxiety' or 'anxiety disorder').
On item 5 (Finding of individual style of dress):
Curious to know why these have been highlighted for consideration by this group - has it come from translation work?
SI has recently modified one of these anyway ('Wears left and right shoes from two different pairs of shoes' was, until 2023, simply 'Wears odd shoes'). I can see how the polysemic 'odd' may be problematic for translation purposes, but IMHO that doesn't make the phrases 'wears odd shoes' and 'wears odd socks' unsuitable for inclusion a terminology.
As you know I'd favour an approach more tolerant of less-than-perfect 'URU' performance for many mental and behavioural terms (and preservation of such terms to support NLP-based term matching). I'd always thought that many of the terms listed (and the ideas they represent) were useful proxies for disorganised, confused or neglectful behaviour and thus of clinical value.
That said, 'wears turban' seems to be a bit of an outlier. Bit of a stretch but perhaps it is of value in relation to workplace safety in certain jurisdictions?
On item 4 (Leaden paralysis):
Defer to greater wisdom but the move to 'motor retardation' seems reasonable. However, looking at this area:
a. is there a material difference between 'motor retardation' and 'psychomotor retardation'? The phrases were split up in 2021 making the former strictly neurological and the latter mental/behavioural - was this reasonable?
b. (for info) 'symptoms of depression' (and its friend 'symptoms of stress') are atypical for SNOMED CT - where are all the other 'symptoms of...' codes? It's tempting to start thinking about removing them, but I note that 'symptoms of depression' has not inconsiderable UK primary care usage so it should probably stay.
On item 3 (Agony):
In the spirit of my second point, delighted that we are not proposing to remove 'agony' despite its slippery semantics. I can understand the motivation to move from 'finding relating to grief and dying' (though note the current synonym 'pangs of death'); a move to 'distress' is probably OK so long as we don't think too hard about the meaning of the word 'distress' - found in notions ranging from 'spiritual/moral distress' to 'Fetal distress due to augmentation of labour with oxytocin'.
Ed