Mental health clinicians have previously been reported to express reservations regarding the utility and accuracy of the psychiatric classification systems. In this study we aimed to examine clinicians’ experiences with instances of perceived inaccuracy of a schizophrenia diagnosis. Mental health clinicians (N = 175) participated in an online survey assessing prevalence and perceived reasons for inaccuracies of a schizophrenia diagnosis. Respondents included psychiatric ward directors (13.1%), senior psychiatrists and psychologists (40.5%), and psychiatry and clinical psychology residents (36%). Fifty-three percent of respondents reported encountering instances where a schizophrenia diagnosis was assigned even though clinical presentation did not match diagnostic criteria. Seventy-three percent of senior psychiatrists in a position to determine a diagnosis declared assigning schizophrenia even when controversial among clinical staff, and 15% of them declared doing so frequently. The likelihood of frequently assigning a schizophrenia diagnosis even when clearly controversial was predicted by the perception that an inaccurate diagnosis is assigned due to the presence of negative symptoms (OR 2.20, 95% CI 1.04–4.66, p = 0.039) and due to patient-related factors, such as the need to facilitate rehabilitation (OR 1.77, 95% CI 1.07–2.90, p = 0.024). Although a schizophrenia diagnosis is considered relatively stable and clear, our study indicates that, in clinical practice, the assignment of this diagnosis is frequently controversial. These controversies are associated with the perception that an inaccurate diagnosis is assigned due to diagnostic considerations, or due to the possibility that patients might benefit from such a diagnosis. Implications and limitations for psychiatric practice and discourse are discussed.

Introduction: In recent years, several studies were conducted to explore the potential augmenting effect of oxytocin for the treatment of individuals with severe mental illness. Nonetheless, studies exploring its effects in routine inpatient settings using high-quality randomized controlled trials are scarce. The current study assessed the effect of oxytocin administration on treatment process and outcome among psychiatric inpatients, while employing a rigorous experimental methodology. Methods: A double-blind, placebo-controlled, randomized trial was conducted at a public psychiatric hospital in Israel. Patients (N = 87, 71.3% female participants) were administered intranasal oxytocin/placebo twice daily for 4 weeks, as add-on to usual care. Patients were assessed for severity of anxiety and depression symptoms and their working alliance with their therapist after each therapy session, and treatment outcome was assessed weekly. Multilevel modeling was performed to assess the linear change from pre- to post-treatment. Results: Patients receiving OT demonstrated significantly larger symptomatic improvements (B = −0.01, t [437] = −2.36, p = 0.01). Larger gains were also observed for depression (B = −0.14, p < 0.001 in the OT group, B = −0.06, p = 0.02 in the placebo group) and general distress (B = −0.57, p < 0.001 in the OT group, B = −0.29, p = 0.02 in the placebo group). No significant effect was observed for anxiety, the working alliance, or attachment. Discussion: Oxytocin has the potential to improve treatment outcome among inpatients. Nonetheless, additional controlled research is needed to further assess its effects on therapy process, as well as to account for therapeutic, pharmacological, and neuronal intervening factors.

Background: Morally injurious events (MIEs), encompassing personal transgressions, witnessing others commit transgressions, or experiencing betrayal by leaders, can conflict with one's moral/ethical principles, evoking outrage and profound mistrust. Although MIEs are associated with depression, PTSD, and anxiety, the mechanisms linking MIEs to psychiatric symptomatology remain unclear, especially among civilians in times of collective trauma.Objective: This study explored one potential mechanism: stigma toward mental-health treatment, which can deter help-seeking and exacerbate guilt, shame, and mistrust.Method: We focused on civilians (N = 1,052) exposed to MIEs in conflict zones in southern and northern Israel following the 7 October 2023 attack. Participants were recruited using an online platform and assessed for depression, PTSD, and anxiety symptoms. We hypothesised that stigma toward treatment would mediate relationships between MIE exposure levels and depression, PTSD, and anxiety symptoms.Results: Results showed high MIE exposure levels and symptomatology among civilians in conflict zones. Moreover, we found significant indirect effects of stigma toward treatment on all three symptom types.Conclusions: Our findings suggest that while MIEs directly link to symptoms, stigma toward treatment plays a significant role in understanding this link. These findings emphasise the importance of addressing stigma toward treatment for individuals experiencing MIEs and underscore the need for targeted interventions in conflict zones.

Objective: The present study aimed to examine the association between patient–therapist micro-level congruence/incongruence ratio and psychotherapeutic outcome. Method: Nine good- and nine poor-outcome psychodynamic treatments (segregated by comparing pre- and post-treatment BDI-II) were analyzed (N = 18) moment by moment using the MATRIX (total number of MATRIX codes analyzed = 11,125). MATRIX congruence was defined as similar adjacent MATRIX codes. Results: the congruence/incongruence ratio tended to increase as the treatment progressed only in good-outcome treatments. Conclusion: Progression of MATRIX codes’ congruence/incongruence ratio is associated with good outcome of psychotherapy.