Background: Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM-IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods: Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results: The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions: Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety.

Syftet med studien har varit att undersöka varför, hur och med vilket resultat en del sörjande söker professionellt samtalsstöd efter en närståendes död. Som forskningsdesign valdes en kvalitativ deskriptiv studie omfattande halvstrukturerade intervjuer med fem sörjande. Datamaterialet analyserades enligt Tema Analys. Studiens resultat pekar på att deltagarna har upplevt att deras sorg och behov av en längre sjukskrivning i sorgearbetet inte tagits på allvar av varken läkare, försäkringskassan eller arbetsgivare, vilket har orsakat dem onödig stress som försämrat sorgearbetet. Samtalsstödet inom den offentliga vården hos sjukhus, akutmottagning och vårdcentral har upplevts som icke tillfredställande p.g.a. personalens bristande förmåga att bemöta, informera och stödja sörjande.  Man har också upplevt att behandlingsmetoderna inte anpassas efter patienters specifika behov av hjälp utan utifrån politiska krav på lönsamhet och effektivitet. Den KBT-behandling som erbjuds upplevs inte vara lämplig för att kunna bearbeta en komplicerad sorg. Sörjande efterfrågar i stället psykodynamisk kris-/sorgterapi individuellt och/eller i grupp, som de upplevt positivt från privata vårdgivare, men som anses för dyrt. Svenska kyrkans kostnadsfria sorggrupper har också upplevts positivt, men icke troende och de som har en annan tro tvekar inför att söka sig dit. Det finns ett starkt behov av förbättringar inom professionellt samtalsstöd som idag erbjuds sörjande i Sverige. Det vore önskvärt att fler läkare utbildas till psykoterapeuter så att sörjande skulle kunna få både medicinsk och psykoterapeutisk behandling av en och samma person. Detta skulle bidra till ökad trygghet som är positivt i sorgearbete. Införande av den diskuterade diagnosen förlängt sorgesyndrom i det kommande DSM-V och ICD11, skulle förmodligen underlätta för sörjande att få rätt till sjukskrivning och ge enklare tillgång till lämplig och subventionerad samtalsbehandling. Detta skulle kunna bidra till bättre hälsa och snabbare återgång till arbetslivet, vilket är positivt både ur mänskligt såväl som samhällsmässigt perspektiv.

[pt] Esta tese analisa o apagamento do sujeito na clínica contemporânea, tomando como exemplo a construção do campo discursivo da psiquiatria biológica. Investiga a construção deste campo como resultado da luta pelo monopólio da autoridade científica. Problematiza o predomínio da abordagem fisicalista acerca do sofrimento subjetivo e a medicalização do mal-estar. Ao longo dos capítulos, a tese discute a constituição de valores individualista e a noção de sujeito do inconsciente. Descreve a trajetória intelectual da psiquiatria para revelar a tensão entre as abordagens física e mental. Examina o projeto psiquiátrico de reduzir a subjetividade ao funcionamento cerebral. Analisa criticamente a classificação dos transtornos mentais, associando-a à inflação diagnóstica. A tese identifica que a psiquiatria biológica tem se deparado com limites clínicos para a imposição da leitura fisicalista. Estes limites relacionam-se à ausência de evidências que confirmem a premissa segundo a qual os transtornos mentais são transtornos cerebrais. Do ponto de vista da psicanálise, o limite está dado pelo fato de que o sujeito é efeito de linguagem e que, portanto, não é possível tomá-lo como duplo do cérebro nem reduzi-lo a categorias diagnósticas universalizantes. / [en] This thesis analyses the effacement of the subject in the contemporary clinic, taking as example the construction of the discursive field of biological psychiatry. It inquires the construction of the field as a result of the battle for monopoly of scientific authority and qualification. It questions the predominance of physicalism regarding subject suffering and the medicalization of uneasiness. Throughout its chapters, the thesis discusses the development of individualistic values and the notion of the unconscious subject. It describes the intellectual path of psychiatry in order to unveil the tension between the physical and mental approaches. Examines the psychiatric project to reduce subjectivity in brain functioning. It analyzes critically the classification of mental disorders in order to associate it to a diagnostic inflation. The thesis shows that the biological psychiatry has faced scientific limits for the imposition of the physicalistic reading. These limits refer to the lack of evidences that confirm the premise according to which mental disorders are brain disorders. From the psychoanalytical point of view, the limit is given by the fact that the subject is a result of language and that, therefore, it is not possible to consider it as a double of the brain, or reduce it to universalizing diagnostic categories.

Cette thèse propose une méthodologie de pilotage d'organisations complexes, ens'intéressant à de nouvelles méthodes de planification collaborative et d'optimisation d'interventions en environnements soumis à des rayonnements ionisants. En nous basant sur l'étude d'installations scientifiques et technologiques complexes tels que celles du CERN à Genève (Suisse) et de la GSI à Darmstadt (Allemagne), nous y analysons les besoins et contraintes de planification imposés par les environnements à risques en général, et par lesrayonnements ionisants en particulier. Les implications liées à la collaboration sont ensuite détaillées, et un modèle ontologique d'intervention est proposé afin de sélectionner les méthodes les plus adaptées au problème étudié. La méthode proposée dans cette thèse repose sur des techniques éprouvées en planification de projets ainsi qu'en conception de produits comme la Design Structure Matrix (DSM). Elle introduit en revanche dans ces domaines des méthodes habituellement rencontrées en intelligence artificielle : les algèbres temporelles qualitatives et la propagation des contraintes temporelles, ainsi que la recherche de compromis en cas de conflit. Cette « DSM Collaborative » a été implémentée dans une application prototype testée sur des cas pratiques au CERN et à la GSI, dont le premier est décrit dans l'ultime chapitre de cette thèse. C'est une approche qui place la ressource(essentiellement humaine) et les contraintes temporelles au coeur du processus de planification. Elle met l'accent sur la collaboration entre les différents participants, ainsi que sur la simulation et la comparaison multicritère de multiples scenarii plutôt que sur la recherche d'un unique optimum souvent irréalisable sur le plan pratique. / This work proposes a methodology to handle complexity in organizations byfocusing on innovative and collaborative planning and scheduling methods dedicated to the optimization of interventions in environments emitting ionizing radiations. By taking as work environment highly complex and technological scientific facilities such as the ones of CERN in Geneva (Switzerland) and GSI in Darmstadt (Germany), we analyze the needs and requirements induced in intervention planning and scheduling by hazardous environments in general, and then more specifically by ionizing radiations. The implications of collaborative work are then scrutinized, and an ontological model for interventions is designed in order to select the methods best suited to our problem. The framework we present in this work relies on methods sucessfully used in project planning and scheduling and innovative product design like the Design Structure Matrix (DSM). It also introduces in these fields methods borrowed to artificial intelligence planning and scheduling such as the temporal qualitative algebras, constraint propagation, and the search of compromises in case of conflicts. This so called “Collaborative DSM” has been implemented in a prototype software application tested at CERN and GSI on practical applications. The very first one and its results are presented in the final chapter of this thesis. This framework aims at placing resources (mostly human resources) and temporal constraints at the heart of the planning and scheduling process. It focuses on collaboration between the different actors involved, from coordinators to technicians, and on simulation and multiple-criteria comparison of several scenarios, rather than searching for a unique optimum, which often tends to be non-practical, should one even be found.

Abstract Background: Autism spectrum disorders (ASDs), defined as pervasive developmental disorders (PDDs) in DSM-IV and ICD-10, become manifest in childhood, ranging from a severe form, autism, to milder forms, Asperger syndrome (AS) and pervasive developmental disorder not otherwise specified (PDD-NOS)/atypical autism. AS is also specified in criteria by Gillberg and by Szatmari et al. Different diagnostic criteria sets, overlaps, inaccuracies and exclusion criteria of many comorbid psychiatric disorders in PDDs have caused confusion. In DSM-5, PDDs were replaced by one diagnosis called ASD. Aims and methods: This is an epidemiological study of 8-year-old children and a clinical study of 9- to 16-year-old high-functioning outpatients with AS/autism (HFA). The epidemiological target population (n = 4,422) was rated via the Autism Spectrum Screening Questionnaire (ASSQ) by parents and/or teachers and a screened sample was examined in order to estimate the prevalence of ASDs, to discover deficits in the diagnostic criteria of ASDs, to evaluate DSM-5 draft criteria for ASD, and to assess cut-off scores for the Finnish ASSQ. Comorbid psychiatric disorders were identified and overall level of functioning rated in 50 subjects with AS/HFA. Results: The prevalence of AS according to DSM-IV was 2.5, to ICD-10 2.9, to Gillberg 2.7, and to Szatmari et al. 1.6 per 1,000. The prevalence of autism was 4.1 and that of ASDs 8.4 per 1,000 (DSM-IV). DSM-5 draft criteria were less sensitive in detecting AS/HFA. For 7- to 12-year-old children (IQ ≥ 50), the optimal cut-off scores were 30 in clinical settings and 28 in total population screening using summed parent-rated and teacher-rated ASSQ scores. Comorbid psychiatric disorders were common (prevalence 74%) and often multiple; behavioral disorders in 44%, anxiety disorders in 42%, and tic disorders in 26%. Oppositional defiant disorder, depressive disorder and anxiety disorders as comorbidities indicated significantly lower levels of functioning. Conclusions: Our results indicate the need to standardize the diagnostic criteria. The ICD-11 criteria should be uniform and harmonize with DSM-5. Determining cut-off scores for ASD screening instruments in different languages and cultures is of utmost importance. Clinicians are reminded to investigate psychiatric comorbidity in ASDs in order to target treatment and rehabilitation precisely. / Tiivistelmä Lähtökohdat: Autismikirjon häiriöt, ICD-10:ssä ja DSM-IV:ssä nimellä laaja-alaiset kehityshäiriöt, ilmenevät lapsuudessa. Niihin luetaan autismi, Aspergerin oireyhtymä (AS) ja tarkemmin määrittelemätön laaja-alainen kehityshäiriö/epätyypillinen autismi. Gillberg sekä Szatmari työtovereineen ovat myös määritelleet AS:n kriteerit. Useat diagnostiset kriteerit, päällekkäisyydet, epätarkkuudet ja monien psykiatristen liitännäishäiriöiden poissulkeminen laaja-alaisissa kehityshäiriöissä ovat aiheuttaneet sekaannuksia. DSM-5:ssä laaja-alaiset kehityshäiriöt korvattiin yhdellä diagnoosilla: autismikirjon häiriö. Menelmät ja tavoitteet: Väitöstyö muodostui 8-vuotiaita lapsia koskeneesta epidemiologisesta tutkimuksesta sekä 9–16-vuotiaita AS- ja autistisia (HFA) lapsia ja nuoria koskeneesta kliinisestä tutkimuksesta. Vanhemmat ja/tai opettajat täyttivät epidemiologisen kohderyhmän lapsista (n = 4 422) suomennetun autismikirjon seulontalomakkeen (ASSQ), ja seuloutuneille tehtiin diagnostiset tutkimukset. Tämän jälkeen määritettiin autismikirjon esiintyvyys, kartoitettiin diagnostisten kriteerien puutteita, arvioitiin DSM-5-luonnoskriteerit autismikirjon häiriölle ja määritettiin ASSQ:n seulontarajat. Psykiatrinen komorbiditeetti ja sen merkitys toiminnalliseen tasoon tutkittiin AS-/HFA-lapsilla ja -nuorilla (n = 50). Tulokset: AS:n esiintyvyys oli 2,5/1000 DSM-IV:n, 2,9/1000 ICD-10:n, 2,7/1000 Gillbergin ja 1,6/1000 Szatmarin mukaan. Autismin esiintyvyys oli 4,1/1000 ja koko autismikirjon 8,4/1000 (DSM-IV). DSM-5-luonnoskriteerit olivat epäherkät tunnistamaan AS:ää ja HFA:ta. Parhaiten soveltuviksi ASSQ:n seulontarajoiksi alakouluikäisille (ÄO ≥ 50) osoittautuivat 30 kliinisiä tilanteita ja 28 väestöseulontoja varten laskemalla yhteen vanhempien arvioinnin ja opettajan arvioinnin pisteet. Psykiatrisia liitännäishäiriöitä oli 74 %:lla, ja monilla oli useita. Käytöshäiriöitä oli 44 %:lla, ahdistuneisuushäiriöitä 42 %:lla ja tic-häiriöitä 26 %:lla. Uhmakkuus- ja masennushäiriö sekä ahdistuneisuushäiriöt alensivat merkitsevästi toiminnallista tasoa. Päätelmät: Tulokset osoittivat diagnostisten kriteereiden yhtenäistämistarpeen. ICD-11:een on syytä laatia yhdenmukaiset kriteerit DSM-5:n kanssa. Autismikirjon seulontalomakkeille on tarpeen määrittää eri kieliin ja kulttuureihin soveltuvat pisterajat. Psykiatrisen komorbiditeetin selvittäminen autismikirjon häiriöissä on tärkeää, jotta hoito ja kuntoutus voidaan kohdentaa oikein.

The diploma thesis deals with foundations of a new learning and research center of the Charles University. Goal is economical and secure design of geotechnical structures. In this thesis, has been used less known technology of deep foundations. The author points to the diversity of utilization, such as sealing wall, anchored and unanchored sheeting, columns designed to influence tension and pressure. For the static calculation have been used programs Scia Engineer and Geo5 v19. Part of this thesis the technological process of technology of the soil improvement by DSM.

Despite a wealth of studies on differences regarding the biobehavioral and social–psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the “current rules of game” used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems.

The energy transition is accompanied by massive electrification of uses and sectors such as transport. As a result, the pressure on the electricity grid is increasing, and the time to connect to the power system is lengthening. Deploying new infrastructure is a laborious and expensive process but there are alternatives to exploit the flexibility of the power grid. The deployment of smart meters opens the door to many applications related to flexibility on the consumer side, to reduce peak loads that threaten grid capacity. Targeting the right consumers for Demand-Side Management (DSM) is a prerequisite to maximizing the chances of success of such programs. This degree project replicates and adapts the method developed in [14] to segment residential customers. It consists of encoding Daily Load Curves (DLC) using a dictionary of Typical Load Profiles (TLP) and grouping consumers according to the distribution of their TLP. A temporal analysis of the main TLP reveals different consumption behaviors. Customers are segmented into groups that reflect the degree of volatility of their consumption. This enables a classification based on the potential for Energy Efficiency (EE) or Demand Response (D/R) programs. We address the issue of attribute detection using the distribution of TLP of customers. In particular, several classification algorithms are compared to detect TLP characteristic of Electric Vehicle (EV). The obtained load shapes show consumption peaks at night, which may correspond to the charging time of EV. The method is discussed, especially the choice of the number of load profiles to be included in the dictionary of TLP. It proves to be useful to group consumers with similar consumption profiles and opens the door to applications such as individual household consumption forecasting. / Energiomställningen kräver en massiv elektrifiering av användningsområden och sektorer som t.ex. transportsektorn. Detta leder till att trycket på elnätet ökar och att tiden för att ansluta sig till elnätet blir allt längre. Att bygga ut ny infrastruktur är en mödosam och dyr process, men det finns alternativ för att utnyttja elnätets flexibilitet. Utplaceringen av smarta mätare öppnar dörren för många tillämpningar som rör flexibilitet på konsumentsidan, för att minska toppbelastningar som hotar nätkapaciteten. Att rikta in sig på rätt konsumenter för DSM är en förutsättning för att maximera chanserna att lyckas med sådana program. I detta examensarbete replikeras och anpassas den metod som utvecklats i [14] för att segmentera hushållskunder. Den består av att koda DLC med hjälp av ett lexikon av TLP och gruppera konsumenter enligt fördelningen av deras TLP. En tidsmässig analys av de viktigaste TLP avslöjar olika konsumtionsbeteenden. Kunderna delas in i grupper som återspeglar graden av volatilitet i deras konsumtion. Detta möjliggör en klassificering baserad på potentialen för EE eller D/R-program. Vi tar upp frågan om attributdetektering med hjälp av fördelningen av TLP hos kunderna. I synnerhet jämförs flera klassificeringsalgoritmer för att upptäcka TLP som är karakteristiska för EV. De erhållna belastningsformerna visar konsumtionstoppar på natten, vilket kan motsvara laddningstiden för EV. Metoden diskuteras, särskilt valet av antalet belastningsprofiler som ska ingå i ordlistan för TLP. Metoden visar sig vara användbar för att gruppera konsumenter med liknande förbrukningsprofiler och öppnar dörren för tillämpningar som prognostisering av enskilda hushålls förbrukning.

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Discussion surrounds the question as to whether criteria for generalized anxiety disorder (GAD) should change, particularly in youth. This study examines the effects of possible criteria changes on GAD prevalence and clinical correlates. DSM-IV GAD was assessed using the M-CIDI in a community sample of adolescents and young adults. Diagnostic thresholds were modified in two age spans (9–20 and 21–34 years) using a person-by-year data file (N = 38,534 cases). Relaxing the duration or excessiveness criteria led to the most pronounced changes in GAD prevalence, while relaxing frequency, uncontrollability, or associated-symptom criteria had smaller effects. A lower duration requirement increased rates more in older than younger age spans. Opposite effects occurred for changes in associated-symptoms or clinical-significance criteria. Broader GAD definitions identified cases in both age spans that appeared mostly milder than DSM-IV cases but that still differed from non-GAD cases in various clinical factors and validators. Developmental aspects require stronger consideration in future diagnostic systems.