Education in Psychopathology in Europe: Results from a Survey in 32 Countries.

OBJECTIVES: The aim of the present paper is to assess the current status of training on psychopathology in Europe and to identify the unmet needs of training on psychopathology. METHODS: An online survey was carried out during the period July-December 2013. Forty-one representatives of early career psychiatrists of their national associations were invited to participate. Each respondent was asked to provide the collective feedback of the association rather than that of any of its individual officer or member. RESULTS: Thirty-two associations returned the questionnaire out of the 41 contacted (response rate, 78%). All respondents recognized psychopathology as a core component of training in psychiatry. According to respondents, the primary aims of psychopathology are (a) to assess psychiatric symptoms (47%), (b) to understand patients' abnormal experiences (33%), and (c) to make nosographical diagnosis (20%). A formal training course in psychopathology is available in 29 out of the 32 surveyed countries. In most countries, (a) there is not a defined number of hours dedicated to psychopathology, (b) teaching is mainly theoretical, and (c) a structured training on psychometric tools is missing. At the end of the training, about half of trainees is not satisfied with received training in psychopathology. CONCLUSIONS: According to European early career psychiatrists, there is the need to rethink training in psychopathology, which should be at the heart of training in psychiatry and the key element of psychiatric practice. Education in psychopathology is affected by several unmet needs, such as lack of appropriate training in the use of psychometric instruments, lack of supervision, and lack of practical skills.

The perception of the fetus in mothers with liver transplantation. Brief communication.

BACKGROUND: In this brief note we present the preliminary findings of a study of 16 women who underwent liver transplants before becoming pregnant and giving birth. The aim of the study was to show the similarities and differences between ways women experience the transplanted organ (liver) and the fetus. METHODS: To explore bodily experiences, a semi-structured ad hoc interview was done on a sample of 16 transplanted women who had completed a pregnancy. The interview was designed to explore the possible similarities between their perception of the transplanted organ (liver) and of the fetus. RESULTS: The main findings that emerge from our study are the following: a) in the post-transplant, pre-pregnancy phase, these women develop a polarized attention on the transplanted organ; b) during pregnancy this attention shifts towards the fetus; c) after childbirth the hyper-attention on the transplanted organ disappears and the subject resumes a normal relationship with her body. CONCLUSIONS: Therefore, pregnancy and childbirth are experiences that can normalize relations between a person who has undergone a transplant and their transplanted organ.

Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations / Interpretación, reacción emocional e implicaciones en la vida diaria de experiencias de tipo alucinatorias en población clínica y no clínica

BACKGROUND: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. METHOD: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. RESULTS: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the nonclinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. CONCLUSIONS: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them

ANTECEDENTES: la investigación en Experiencias de Tipo Alucinatorias (HLEs en inglés) aún no ha explorado si las personas sin psicosis que las experimentan les atribuyen el mismo significado, si estas provocan las mismas reacciones emocionales o si ocurren en los mismos contextos que en la psicosis. El objetivo de este estudio fue comparar las características de estas experiencias entre un grupo no clínico y un grupo clínico de pacientes con esquizofrenia y trastornos del espectro esquizofrénico. MÉTODO: ambos grupos fueron evaluados para determinar la prevalencia de las HLEs, después de lo cual fueron entrevistados sobre las características de estas experiencias. RESULTADOS: ambos grupos buscan activamente eliminar estas experiencias; pueden identificar la presencia de un factor desencadenante, y poco control percibido. Sin embargo, las HLEs provocaron más ansiedad, malestar e interferencia en la vida diaria en el grupo clínico que en el grupo no clínico. Además, el grupo clínico definió sus HLEs como más negativas y experimentadas bajo situaciones estresantes. CONCLUSIONES: estos resultados sugieren que las experiencias de ambos grupos no son completamente equivalentes, especialmente cuando se toman en cuenta las reacciones emocionales producidas por estas experiencias y el significado que las personas les atribuyen

Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations.

BACKGROUND: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. METHOD: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. RESULTS: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the non-clinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. CONCLUSIONS: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them.

Is feeling extraneous from one's own body a core vulnerability feature in eating disorders?

OBJECTIVE: To identify core vulnerability features capable of discriminating subjects who are more prone to develop eating disorders. SAMPLING AND METHODS: A nonclinical group composed of 253 university students was studied by means of the Identity and Eating Disorders questionnaire (IDEA), exploring abnormal attitudes toward one's own body and difficulties in the definition of one's own identity, the Body Uneasiness Test (BUT) and different self-reported questionnaires evaluating the specific and general psychopathology of eating disorders. The results were compared with those of a clinical eating disorder group. RESULTS: In the student sample, a group composed of 35 subjects with abnormal eating patterns and a group (218 subjects) without such features were identified. The IDEA total and subscale scores were found to be significantly higher in subjects with abnormal eating patterns than in subjects without them (all p < 0.001). Positive correlations between the IDEA total and subscale scores and the BUT global score were observed in both groups (all p < 0.01). The comparison of the scores on the IDEA between the clinical group (patients with full-blown eating disorders) and the subjects with abnormal over-threshold eating patterns yields a significant difference in the 'feeling extraneous from one's own body' subscale of the IDEA. CONCLUSIONS: The IDEA resulted in being a valid instrument to identify a vulnerability to eating disorders in subjects with abnormal eating patterns in the general population and to recognize the presence of a significant discomfort related to the body. Feeling extraneous from one's own body is the experience that discriminates most between clinical and nonclinical subjects.

Promotion of mental health in children of parents with a mental disorder.

Mental disorders are associated with many difficulties in the activities of daily living, work, relationships and family, and they determine high social and economic costs that represent an important public health problem. The literature has shown that children of parents with mental disorders grow up in environments that are potentially harmful to their mental health and are at risk of neglect and maltreatment. Interventions to prevent mental disorders and psychological symptoms of children of parents with mental disorders are effective but supporting these families is a complex task which requires both cooperation between departments and an interdisciplinary knowledge. A greater knowledge of the responses provided to assist families with dependent children and a mentally ill parent, could stimulate reflections on critical issues and government actions aimed at promoting and protecting the mental health of children.

Myths of motherhood. The role of culture in the development of postpartum depression.

OBJECTIVES: This paper intends to offer a theoretical insight into the myths of motherhood and how these myths can bear on the pathogenesis of postpartum depression. METHODS: From a man's view motherhood is conceptualized as a necessary stage in the progress towards the attainment of femininity. This view is impersonal and external to the experience of motherhood. From a female perspective, motherhood presents itself as a conflicting situation. We will then focus on the necessity to construct a discourse on motherhood by using a code which belongs to women rather than men. The analysis of a blog and a comedy show will provide evidence concerning the evolution of the female discourse on motherhood thus contributing to the debunking of the myths of motherhood. The final section discusses ways in which myths of motherhood can bear on the pathogenesis of postpartum. CONCLUSIONS: Among "melancholic type" women, who tend to abide by social norms, play established social roles and hide their inner conflicts, myths of motherhood contribute to suppress the contradiction which is intrinsic to motherhood itself making this contradiction uncontrollable and potentially devastating.

Quality of hallucinatory experiences: differences between a clinical and a non-clinical sample.

In this study, we asked people from two samples (a clinical one, consisting of patients with schizophrenia, and a non-clinical one, including university students) to complete the Revised Hallucination Scale (RHS) as a self-questionnaire. When the participants responded positively to an item, they were encouraged to provide further detailed descriptions (i.e., examples of their own experiences) concerning that item. We found that the kinds of descriptions provided by the two groups were very different. We suggest that it is not advisable to explore the presence of hallucinations in non-clinical samples using research protocols based exclusively on yes-or-no answers to questionnaires like the RHS. Hallucinatory or hallucinatory-like experiences cannot be reliably and validly assessed without a precise characterization of the phenomenal quality of the experience.

Early perinatal diagnosis of mothers at risk of developing post-partum depression--a concise guide for obstetricians, midwives, neonatologists and paediatricians.

OBJECTIVE: In this article, we tried to provide all those involved in perinatal medicine with a concise guide to detect mothers at risk of developing post-partum depression. Motherhood is a critical situation characterized by role conflicts because conflicts among the role of mother, worker and wife are the norm in the post-partum period and may jeopardize the mother's existence. METHODS: We have described a kind of personality that is at great risk of developing post-partum depression because of the incapacity to creatively manage situations of role conflict. This personality structure is called typus melancholicus, and we operationally defined its main features: orderliness, conscientiousness, hypernomia/heteronomia and intolerance of ambiguity. RESULTS: We have shown how these mothers may typically behave during pregnancy and early motherhood: they cannot avoid behaving with feverish perfectionism, developing an exaggerated preoccupation towards the unborn child and hostility towards persons and events that are experienced as an obstacle to their search for perfection. They ultra-carefully follow all the steps concerning paediatric check-ups and feel all the responsibility relating to the care of the child, without being able to delegate to someone else or share their feelings. CONCLUSION: We hope to provide those clinicians who are engaged in the care of pregnant women and their children with a valuable and user-friendly instrument for understanding and making a timely diagnoses of at-risk psychopathological phenomena.

El Typus melancholicus de Tellenbach en la actualidad: una revisión sobre la personalidad premórbida vulnerable a la melancolía / Typus melancholicus from tellenbach up to the present day: a review about the premorbid personality vulnerable to melancholia

El concepto de Typus Melancholicus (TM) fue desarrollado por Tellenbach para describir la personalidad pre-mórbida e inter-mórbida vulnerable a la depresión endógena. En la primera parte de este artículo se propone describir los principios básicos de la teoría de Tellenbach – el método, el concepto de endon, de rítmico, de situación, de remanencia, de includencia y de desesperación. Posteriormente se presenta una descripción sistemática de los rasgos de la personalidad pre-mórbida-ordenalidad, concieciosidad, hiper/heteronomía e intolerancia a la ambigüedad. Para destacar la forma típica como se enlaza la condición pre-mórbida con la melancolía, se presentan dos casos clínicos, uno de Tellenbachy otro de nuestra práctica clínica. Además, se propone una revisión de la literatura científica del trabajo de Tellenbach en la actualidad. Finalmente se discute la importancia clínica del constructo del TM (AU)

The concept of Typus Melancholicus (TM) was shaped by Tellenbach to describe the premorbid and intermorbid personality vulnerable to endogenous depression. The first part of this paper aims to point out the basic principles of Tellenbach’s theory – the method, the concept of endon, of rhythmic, of situation, of rimanence, of includence and of despair. Then, we present a systematic description of the premorbid personality features -orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity. Furthermore, we present two clinical cases, one from Tellenbach and the other from our clinical practice to underline the typical way which links the premorbid condition to melancholia. Also, we propose a review of the scientific literature from Tellenbach’s work to the present day. Finally, we discuss the clinical importance of the TM construct (AU)

[Typus melancholicus from tellenbach up to the present day: a review about the premorbid personality vulnerable to melancholia]. / El Typus melancholicus de Tellenbachen la actualidad: una revisiónsobre la personalidad premórbidavulnerable a la melancolía.

The concept of Typus Melancholicus (TM) was shaped by Tellenbach to describe the premorbid and intermorbid personality vulnerable to endogenous depression. The first part of this paper aims to point out the basic principles of Tellenbach's theory ­ the method, the concept of endon, of rhythmic, of situation, of rimanence, of includence and of despair. Then, we present a systematic description of the premorbid personality features - orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity. Furthermore, we present two clinical cases, one from Tellenbach and the other from our clinical practice to underline the typical way which links the premorbid condition to melancholia. Also, we propose a review of the scientific literature from Tellenbach's work to the present day. Finally, we discuss the clinical importance of the TM construct.