Emotional Dysregulation in Adults from 10 World Societies: An Epidemiological Latent Class Analysis of the Adult-Self-Report

AbstractBackground/Objective: Emotional dysregulation (ED) is a dimensional psychological domain, previously operationalized by instruments of the Achenbach System of Empirically Based Assessment (ASEBA) for children and adolescents; however, its cross-cultural and bottom-up characteristics among adult populations are still unknown. Method: We examined scores obtained on the Adult Self-Report (ASR) by 9,238 18- to 59-year-olds from 10 societies that differed in social, economic, geographic, and other characteristics. A Latent Class Analysis was performed on the data from each society. Results: In each society, a dysregulated class (DYS) was identified, which was characterized by elevated scores on most ASR syndromes. The mean prevalence of DYS was 9.2% (6.1-12.7%). The best models ranged from three to five latent classes in the different societies. Conclusions: Although the number of identified classes and the prevalence of ED varied across societies, a DYS class was found in each society, suggesting the need to adopt a dimensional view of psychopathology and a cross cultural perspective also in adult populations.

ReportResumenAntecedentes/Objetivo: La desregulación emocional (DE) es un ámbito dimensional en Psicología, previamente operacionalizado por los instrumentos del Achenbach System of Empirically Based Assessment (ASEBA) para niños y adolescentes; sin embargo, aún se desconocen sus características interculturales y su enfoque ascendente en su aplicación a la población adulta. Método: Examinamos las puntuaciones obtenidas en el Adult Self-Report (ASR) por 9.238 personas de 18 a 59 años pertenecientes a diez sociedades que diferían en cuanto a sus características sociales, económicas, geográficas y de otro tipo. Se realizó un análisis de clases latentes con los datos de cada sociedad. Resultados: En cada sociedad se identificó una clase desregulada (DES), que se caracterizaba por pun-tuaciones elevadas en la mayoría de los síndromes ASR. La prevalencia media de DES fue del 9,2% (6,1-12,7%). Los mejores modelos oscilaron entre tres y cinco clases latentes en las diferentes sociedades. Conclusiones: Aunque el número de clases identificadas y la prevalencia de DE variaron entre las diversas sociedades, se encontró una clase DES en cada sociedad, lo que sugiere la necesidad de adoptar una visión dimensional de la psi-copatología y una perspectiva intercultural también en las poblaciones adultas.

Neurobiology and the Hierarchical Taxonomy of Psychopathology: progress toward ontogenetically informed and clinically useful nosology
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The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical structural model of psychological symptoms formulated to improve the reliability and validity of clinical assessment. Neurobiology can inform assessments of early risk and intervention strategies, and the HiTOP model has greater potential to interface with neurobiological measures than traditional categorical diagnoses given its enhanced reliability. However, one complication is that observed biological correlates of clinical symptoms can reflect various factors, ranging from dispositional risk to consequences of psychopathology. In this paper, we argue that the HiTOP model provides an optimized framework for conducting research on the biological correlates of psychopathology from an ontogenetic perspective that distinguishes among indicators of liability, current symptoms, and consequences of illness. Through this approach, neurobiological research can contribute more effectively to identifying individuals at high dispositional risk, indexing treatment-related gains, and monitoring the consequences of mental illness, consistent with the aims of the HiTOP framework.
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La taxonomía jerárquica de la psicopatología (TJP) es un modelo estructural empírico de síntomas psicológicos propuesto para mejorar la confiabilidad y la validez de la evaluación clínica. La neurobiología puede dar cuenta de las evaluaciones de riesgo precoz y estrategias de intervención, y el modelo de TJP tiene un mayor potencial para interactuar con las mediciones neurobiológicas que los diagnósticos categoriales tradicionales dada su mayor confiabilidad. Sin embargo, una complicación es que los correlatos biológicos observados de los síntomas clínicos pueden reflejar varios factores, que van desde el riesgo de la disposición hasta las consecuencias de la psicopatología. En este artículo, se argumenta que el modelo TJP proporciona un marco optimizado para realizar investigaciones sobre los correlatos biológicos de la psicopatología desde una perspectiva ontogenética que distingue entre indicadores de responsabilidad, síntomas actuales y consecuencias de la enfermedad. A través de este enfoque, la investigación neurobiológica puede contribuir de manera más efectiva con la identificación de individuos con un alto riesgo de disposición, el registro de los beneficios del tratamiento y el monitoreo de las consecuencias de la enfermedad mental, de acuerdo con los objetivos del marco de referencia de la TJP.

La taxonomie hiérarchique de la psychopathologie (HiTOP, Hierarchical Taxonomy of Psychopathology) est un modèle empirique et structuré de symptômes psychologiques visant à améliorer la fiabilité et la validité de l'évaluation clinique. L'évaluation sur le risque précoce et les stratégies thérapeutiques peuvent bénéficier des apports de la neurobiologie ; le modèle HiTOP interagit mieux avec les mesures neurobiologiques que les diagnostics catégoriels classiques, en raison de sa plus grande fiabilité. Néanmoins, le fait que les corrélats biologiques observés des symptômes cliniques peuvent refléter différents facteurs qui vont du risque lié à la prédisposition aux conséquences de la pathologie, complique les choses. Dans cet article, nous soutenons que le cadre du modèle HiTOP est optimal pour la recherche sur les corrélats biologiques de la psychopathologie d'un point de vue ontogénétique qui distingue les indicateurs de responsabilité, les symptômes actuels et les conséquences de la maladie. Par cette approche, la recherche neurobiologique permet de mieux identifier les personnes à risque de prédisposition élevé, de mieux répertorier les bénéfices liés au traitement et de surveiller les conséquences de la maladie mentale, selon les objectifs du cadre de l'HiTOP.

[Introduction to symptom networks in psychopathology]. / Introduction aux réseaux de symptômes en psychopathologie.

In this article, we present the main methodological principles of symptom networks in psychopathology. It is a topological approach linking entities from different scales of analysis of an individual (from genetics to behavior, via cerebral connectivity). They are an alternative to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and Research Domain Criteria (RDoC), but they do not exclude them. Symptom networks exceed or circumvent some limits of these classifications. Furthermore, they contribute to the stratification and organization of these nosologies. Behind the originality of its methodology, this program proposes a redefinition of mental illness which modifies the conception of psychiatry. But their future is still uncertain: they must take on an epistemological and methodological challenge. At the same time, they have to convince the community of mental health researchers and clinicians of their utility and value.

TITLE: Introduction aux réseaux de symptômes en psychopathologie. ABSTRACT: Nous présentons dans cet article les grands principes méthodologiques des réseaux de symptômes en psychopathologie. Ceux-ci pourraient constituer une approche alternative au manuel diagnostique et statistique des troubles mentaux (DSM) et aux Research Domain Criteria (RDoC), sans les exclure pour autant. Les réseaux de symptômes dépassent ou contournent certaines limites de ces classifications, mais leur avenir est encore incertain : ils devront relever des défis épistémologiques et méthodologiques, tout en parvenant à convaincre la communauté de chercheurs et de cliniciens en santé mentale de leur utilité et de leur qualité.

Transtorno de acumulação: uma revisão / Hoarding disorder: a review

O transtorno de acumulação (TA) pode ser definido como uma dificuldade persistente de desfazer-se de itens devido ao sofrimento associado com o descarte ou uma necessidade percebida de guardar posses a despeito de seu valor real. Tal comportamento pode resultar no acúmulo de objetos, o que compromete significativamente o uso da moradia, causando sofrimento e/ou prejuízo funcional. Os itens acumulados mais frequentemente são objetos e animais. A prevalência do transtorno é de 1,5 a 2,1% na população em geral, podendo ser maior que 6% em idosos. O TA causa riscos à saúde e à segurança dos indivíduos, especialmente dos idosos, gerando um custo relevante para a sociedade. O diagnóstico de TA é clínico e só deve ser feito após a exclusão de condições médicas gerais e outros transtornos mentais que podem levar ao acúmulo de objetos. O TA parece ser um transtorno de curso crônico e progressivo, comumente associado a comorbidades psiquiátricas. Estudos indicam a participação de fatores genéticos, familiares, cognitivos e de experiências traumáticas na etiologia do TA. A abordagem terapêutica mais estudada até o momento foram as psicoterapias, mas os resultados mostram efeito pequeno. Os estudos farmacológicos existentes são muito incipientes, não permitindo conclusões de eficácia.

Hoarding disorder can be defined as a persistent difficulty in discarding items, due to distress associated with such disposal or a perceived need to save items regardless of their actual value. Such behavior must result in the accumulation of clutter, which significantly compromises living conditions, causing distress and/or functional impairment. The most frequently hoarded items are objects and animals. The point prevalence of clinically significant hoarding was estimated to be 1.5 to 2.1% in the general population, and may exceed 6% in the elderly. HD poses a range of health and safety hazards to individuals, especially older adults, generating significant costs to society. The diagnosis of HD is clinical, and should only be established after general medical conditions and other mental disorders that can lead to accumulating behavior have been ruled out. HD appears to follow a chronic, progressive course, and is commonly associated with psychiatric comorbidities. Studies indicate that genetic, familial, cognitive, and traumatic factors are implicated in the etiology of HD. To date, psychotherapies have been the most widely studied therapeutic approaches, but the results of these studies show small effects. Research into pharmacological approaches to HD is still incipient, precluding any conclusions of efficacy

Exploring the underlying structure of mental disorders: cross-diagnostic differences and similarities from a network perspective using both a top-down and a bottom-up approach.

BACKGROUND: It has been suggested that the structure of psychopathology is best described as a complex network of components that interact in dynamic ways. The goal of the present paper was to examine the concept of psychopathology from a network perspective, combining complementary top-down and bottom-up approaches using momentary assessment techniques. METHOD: A pooled Experience Sampling Method (ESM) dataset of three groups (individuals with a diagnosis of depression, psychotic disorder or no diagnosis) was used (pooled N = 599). The top-down approach explored the network structure of mental states across different diagnostic categories. For this purpose, networks of five momentary mental states ('cheerful', 'content', 'down', 'insecure' and 'suspicious') were compared between the three groups. The complementary bottom-up approach used principal component analysis to explore whether empirically derived network structures yield meaningful higher order clusters. RESULTS: Individuals with a clinical diagnosis had more strongly connected moment-to-moment network structures, especially the depressed group. This group also showed more interconnections specifically between positive and negative mental states than the psychotic group. In the bottom-up approach, all possible connections between mental states were clustered into seven main components that together captured the main characteristics of the network dynamics. CONCLUSIONS: Our combination of (i) comparing network structure of mental states across three diagnostically different groups and (ii) searching for trans-diagnostic network components across all pooled individuals showed that these two approaches yield different, complementary perspectives in the field of psychopathology. The network paradigm therefore may be useful to map transdiagnostic processes.

Editorial: The shape of the nosology to come in developmental psychopathology.

The field has embarked on an effort to better integrate neurobiological and psychological dimensions of functioning with putative psychopathological syndromes. If successful, this effort aims to be a turning point as impactful as the change, a century ago, away from the study of symptom dimensions and toward the study of psychopathological syndromes. New statistical and neurobiological methods and findings hold considerable promise in this regard, and several papers in the present issue underscore these ongoing and important new directions. For this proposed direction to succeed, however, three guiding principles are necessary. First, the syndromal approach must continue to be viewed as provisional, and not reified. Second, in contrast, individual dimensions of neurobiology, psychology, personality, or symptoms should not be decontextualized but considered in relation to other traits and dimensions, syndromal configurations. Major clinical syndromes cannot be ignored. Third, following the Kraepelian insights of a century ago in addition to the more recent insights of developmental psychopathlogy, trait and dimension aspects of psychopathology need to be understood in their developmental context. Whether an integrated dimensional-categorical-developmental understanding of psychopathology can be extended to the entire nosology or only parts of it remains to be seen.

Modelo estrutural de internalização e externalização: emergência, validade e utilidade clínica / Internalizing and externalizing structural model: emergency, validity and clinical utility / El modelo estructural de internalización y externalización: emergencia, validez y utilidad clínica

Os sistemas oficiais de classificação e diagnóstico em psicopatologia apresentam limitações relacionadas à extensa heterogeneidade clínica e ao significado dos padrões de comorbidade diagnóstica. A fim de superá-las, pesquisadores têm defendido uma estrutura dimensional para as psicopatologias mais prevalentes baseada em dois fatores latentes de internalização e externalização. O presente artigo visa avaliar a validade do Modelo Estrutural de Internalização e Externalização, tendo como norte a superação das referidas limitações e sua utilidade clínica. Revisão não sistemática da literatura nas bases Scielo e PubMed. Foram selecionados artigos empíricos e teóricos que avaliavam a pertinência do modelo. Foram excluídos estudos de replicação ou que avaliam o modelo em amostras infantis. A busca de literatura resultou em um total de 536 artigos, dos quais foram mantidos 44. Esse conteúdo foi organizado em três linhas de pesquisa: estudos epidemiológicos-estruturais, psicobiológicos e psicométricos. O Modelo Estrutural de Internalização e Externalização apresenta indicadores que dão sustentabilidade aos seus pressupostos teóricos. O modelo é capaz explicar a comorbidade diagnóstica e, parcialmente, heterogeneidade clínica. Entretanto, não apresenta instrumental clínico normatizado para a operacionalização dos construtos e não há estudos com amostras clínicas graves.

The official systems of classification and diagnosis of psychopathology have limitations related to the extensive clinical heterogeneity and the meaning of patterns of diagnostic comorbidity. To overcome them, researchers have argued for a dimensional structure to the most prevalent psychopathology based on two latent factors of internalizing and externalizing vulnerability. The current study aimed to evaluate the validity of the Internalizing/Externalizing Structural Model, having as a standard its ability to overcome the aforementioned limitations and its clinical utility. A non-systematic review was performed in PubMed and SciELO databases. Theoretical and empirical articles were retrieved based and evaluated on basis of its relevance to the model. Replications and studies based on samples of children were excluded. Bibliographic search yielded a total of 536 articles, of which 44 were retrieved. The content of the articles were organized into three lines of research: structural-epidemiological, psychobiological, and psychometric. The Internalizing/Externalizing Structural Model presents indicators that support its theoretical assumptions. The model is able to explain the diagnostic comorbidity and, partially, clinical heterogeneity. However, there is no standardized clinical instrument for the operationalization of internalizing/externalizing constructs and no validation studies with inpatient samples.

Los sistemas oficiales de clasificación y diagnóstico de la psicopatología tienen limitaciones relacionadas con la amplia heterogeneidad clínica y el significado de los patrones de comorbilidad diagnóstica. Para superarlas, los investigadores han argumentado a favor de una estructura tridimensional de la psicopatología más frecuente en base a dos factores latentes de internalización y externalización vulnerabilidad. El presente estudio tuvo como objetivo evaluar la validez del modelo estructural internalización/externalización tener patrones de utilidad, la heterogeneidad y la comorbilidad clínicas como parámetros. Una revisión no sistemática fue realizada en bases de datos PubMed y SciELO. Artículos teóricos y empíricos se recuperaron basa y evaluado en función de su relevancia para el modelo. Se excluyeron réplicas y estudios basados en muestras de niños. Búsqueda bibliográfica arrojó un total de 536 artículos, de los cuales 44 fueron recuperados. El contenido de los artículos que se han organizado en tres líneas de investigación: estructural-epidemiológicos, psicobiológicos y psicométricos. El modelo estructural de internalización/externalización presenta indicadores que apoyan sus hipótesis teóricas. El modelo es capaz de explicar la comorbilidad de diagnóstico y, en parte, la heterogeneidad clínica. Sin embargo, no existe un instrumento clínico estandarizado para avaluación de internalización e externalización, ni estudios de validación con muestras de pacientes hospitalizados.

Externalizing and internalizing subtypes of posttraumatic psychopathology and anger expression.

Subtypes of posttraumatic psychopathology were replicated and extended in 254 female veterans with posttraumatic stress disorder (PTSD). Cluster analyses on Minnesota Multiphasic Personality Inventory-2 and Personality Psychopathology Five scales (Harkness, McNulty, & Ben-Porath, ) yielded internalizing and externalizing psychopathology dimensions, with a third low psychopathology group (simple PTSD). Externalizers were higher than the internalizers and the simple PTSD groups on the antisocial, substance, and aggression scales; internalizers were higher on depression and anxiety scales. Further validation included an independent measure of psychopathology to examine anger (Buss-Durkee Hostility Inventory, [BDHI]; Buss & Durkee, ). Externalizers were higher on extreme behavioral anger scales (assault and verbal hostility); and externalizers and internalizers were higher than the simple PTSD subjects on other anger scales. Positive correlations between the BDHI scales and the PTSD symptom of "irritability and anger outbursts" were found across scales in the total sample (range: r = .19-.36), on the assault scale in externalizers (r = .59), and the verbal hostility scale in both internalizers (r = .30) and simple PTSD (r = .37) groups, suggesting the broad utility of the symptom in the diagnosis. The results demonstrate the generalizability of the internalizing/externalizing typology to the female veteran population and highlight clinically relevant distinctions in anger expression within PTSD.

Association of treatment satisfaction and psychopathological sub-syndromes among involuntary patients with psychotic disorders.

PURPOSE: Previous research has shown a link between treatment satisfaction and global psychopathology in different groups of psychiatric patients. However, neither the relationship between treatment satisfaction and the sub-syndromes of global psychopathology nor their temporal ordering have been explored. METHODS: Participants admitted involuntarily to psychiatric wards in the UK and diagnosed with psychotic disorders (N = 232) were included. Treatment satisfaction and psychopathological sub-syndromes (i.e., manic excitement, anxiety-depression, negative symptoms, positive symptoms) were measured within 1 week and at 1 month after admission. RESULTS: Repeated measures ANOVAs showed that higher treatment satisfaction is associated with lower scores on the manic excitement, anxiety-depression and positive symptom sub-syndromes, while no significant association was found for negative symptoms. However, cross-lagged panel analyses showed that treatment satisfaction predicted change only in positive symptoms while none of the paths from the relevant sub-syndromes to treatment satisfaction was significant. CONCLUSION: Treatment satisfaction can be regarded as an antecedent of changes in positive symptoms only. These results underline the importance of examining psychopathological sub-syndromes separately as they may relate differentially to other important correlates of psychoses.

Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology.

Personality trait dimensions are related to a wide variety of important life outcomes, such as mortality, physical and mental health, and interpersonal relationships. Nevertheless, the diagnostic system with arguably the most influence in mental health settings (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. [DSM-IV]) formally includes personality primarily in the form of 10 putatively categorical personality disorders. We advocate a more complete and extensive integration of personality in future DSMs, via the explicit inclusion of an empirically based, dimensional personality trait model. To justify this position, we provide a broad review of the ways in which personality traits have proven useful in the description and conceptualization of personality disorders and other mental disorders, as well as in the prediction of key clinical phenomena. We also discuss the importance of constructing a comprehensive quantitative model of psychopathology based on data, an endeavor that is motivated and informed by the close conceptual and empirical parallels between personality and psychopathology.

Commentary on "Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology".

This article develops the larger theme that the fundamental quantitatively developed architecture of personality provides a sound base for classifying all areas of psychopathology and, more specifically, should underlie the current effort to revise the classification of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). My commentary is organized around what I perceive to be four significant problems with the proposed change to a trait-based system: (1) unfamiliarity to clinicians (and possibly unfeasibility), (2) lack of clinical utility, (3) the preliminary quality of the science upon which the proposed change is based, and (4) harmful effects on the diagnosis of borderline personality disorder (BPD).

Commentary on Krueger and Eaton's "Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology": real-world considerations in implementing an empirically based dimensional model of personality in DSM-5.

In their article, Krueger and Eaton (pp. 97-118, this issue) advocate for a "more complete and extensive integration of personality traits in future DSMs [Diagnostic and Statistical Manuals of Mental Disorders], via the explicit inclusion of an empirically based, dimensional personality trait model" (p. 97) and review the "diverse ways in which the inclusion of an empirically based personality trait model could constitute a critical innovation in the transition from DSM-IV to DSM-5" (p. 113). Krueger and Eaton's proposal that (DSM-5) adopt a dimensional personality trait approach exemplifies the difficulties of devising a classification scheme that satisfies the needs of the both the clinical and research communities. In this instance, the challenge is adapting a complex dimensional trait scheme developed and utilized almost exclusively by the research community, for clinical use.

Bridging the gap with the five-factor model.

Comments on the original article Personality traits and the classification of mental Disorders: Toward a more complete integration in DSM-5 and an empirical model of psychopathology by Robert F. Krueger and Nicholas R. Eaton (see record 2010-13810-003). Some researchers had hoped the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) would ask psychiatrists (and the clinical psychologists and researchers who are also tied to the DSM) to leap the gap and embrace a trait-based taxonomy of personality pathology (Widiger & Trull, 2007). Krueger and Eaton (pp. 97-118, this issue) take a more pragmatic stance: They hope to coax psychiatrists across by introducing personality dimensions as an adjunct to familiar PD types; they envision that DSM-5 might serve "as a bridge" (p. 110, this issue) to a fully dimensional Diagnostic and Statistical Manual of Mental Disorders, Sixth Edition (DSM-6). We acknowledge the wisdom of this strategy and suggest ways to strengthen it.

Quantitative methods in psychiatric classification: the path forward is clear but complex: commentary on Krueger and Eaton (2010).

Comments on the original article Personality traits and the classification of mental Disorders: Toward a more complete integration in DSM-5 and an empirical model of psychopathology by Robert F. Krueger and Nicholas R. Eaton (see record 2010-13810-003). Krueger and Eaton (pp. 97-118, this issue) have provided a trenchant argument for greater use of dimensional approaches in the classification of personality disorders (PDs) in future iterations of the psychiatric nomenclature, and their explication of the importance of personality constructs in models of psychopathology more generally is commendably lucid. We agree that the division of PDs in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) into 10 categorical diagnoses with arbitrary thresholds does not match existing data and requires significant retooling, and we view the inclusion of dimensional traits as an important component of the provisional Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) proposal.

A personality trait model for the Diagnostic and Statistical Manual of Mental Disorders (DSM): the challenges ahead.

We were sincerely flattered to discover that John Gunderson, Michael First, Paul Costa, Robert McCrae, Michael Hallquist, and Paul Pilkonis provided commentaries on our target article. In this brief response, we cannot hope to discuss the myriad points raised by this august group. Such a task would be particularly daunting given the diversity of the commentaries. Indeed, the diversity of the commentaries provides a kind of "metacommentary" on the state of personality and psychopathology research. That is, the intellectual diversity contained in the commentaries underlines the substantial challenges that lie ahead of us, in terms of articulating a model of personality and psychopathology with both scientific validity and clinical applicability.

Stability of the factor structure of Barrat’s Impulsivity Scales for children across cultures: a comparison of Spain and Colombia / Estabilidad de la estructura factorial de la escala de impulsividad para niños de Barratt a través de culturas: una comparación entre España y Colombia

Despite the great importance of impulsivity in many childhood and adolescence disorders, there are few self-reports on child impulsivity. Recently, a modified version of Barratt’s BIS-11 questionnaire adapted for children has been developed, which may be useful in assessing this personality dimension. The present study reports an adaptation of this questionnaire in a different culture (Colombia) and assesses the degree of convergence between the factor structures of both adaptations using consensus oblimin rotation. The results indicate not only that the factor structure of the test remains stable across both adaptations, and that two of the three scales in the Colombian version show acceptable reliabilities, but also that cultural and linguistic issues are important in test adaptation even when the same language is used (AU)

A pesar de la gran importancia de la impulsividad en múltiples patologías de la infancia y la juventud, existen pocos cuestionarios de impulsividad para niños. Recientemente se ha desarrollado una versión modificada del cuestionario BIS-11 de Barratt adaptado para niños que puede ser útil en la evaluación de esta dimensión de personalidad. Este estudio presenta una adaptación de este cuestionario a una cultura distinta (colombina) y evalúa el grado de convergencia entre las soluciones factoriales de ambas versiones del test utilizando el método de rotación consensos oblimin. Los resultados indican una elevada estabilidad de la solución factorial a través de las versiones y una fiabilidad satisfactoria para dos de las tres escalas en la adaptación colombiana. Por otra parte se pone de manifiesto la importancia de los aspectos culturales y lingüísticos en la adaptación de un test incluso cuando se trata de la misma lengua (AU)

The road to DSM-V. Bipolar disorder episode and course specifiers.

There is general agreement that DSM-IV and ICD-10 require major improvements in format and content to make them more valid, evidence-based and clinically useful. DSM-IV-TR currently includes a series of clinical features that provide potentially useful information on cross-sectional and longitudinal courses of bipolar disorder. This conceptual and data-driven review proposes changes in the current classification by removing, modifying and adding bipolar episode and course specifiers in DSM-V. Specifiers to be maintained would be 'with catatonic features', 'with melancholic features', 'with atypical features' and 'with rapid cycling'. The 'seasonal pattern' modifier should be amended to allow manic, hypomanic and mixed episodes to be included in the description. Some specifiers should likely be substantially reconceptualized ('severity/psychosis/remission') or removed ('with post-partum onset'). Age at onset (early, intermediate or late onset) and predominant polarity (manic, depressive) should be added for their relevance for course and outcome.