Personalized Models of Psychopathology.

The personalized approach to psychopathology conceptualizes mental disorder as a complex system of contextualized dynamic processes that is nontrivially specific to each individual, and it seeks to develop formal idiographic statistical models to represent these individual processes. Although the personalized approach draws on long-standing influences in clinical psychology, there has been an explosion of research in recent years following the development of intensive longitudinal data capture and statistical techniques that facilitate modeling of the dynamic processes of each individual's pathology. Advances are also making idiographic analyses scalable and generalizable. We review emerging research using the personalized approach in descriptive psychopathology, precision assessment, and treatment selection and tailoring, and we identify future challenges and areas in need of additional research. The personalized approach to psychopathology holds promise to resolve thorny diagnostic issues, generate novel insights, and improve the timing and efficacy of interventions.

Assessment of Personality and Psychopathology in Healthcare Settings: Introduction to the Special Section.

Healthcare in the United States has increasingly benefited from the adoption of multidisciplinary providers. Many multidisciplinary teams include psychologists who often conduct psychological and personality assessments in their practice. This special section highlights areas of personality and psychological assessment in applied healthcare contexts. Nghiem and colleagues review the psychometric performance of various personality and psychopathology instruments and provide recommendations for the assessment of solid organ transplant evaluations. Gottschling and colleagues present a culturally adapted screener for anxiety-related symptoms in geriatric adults that can easily be administered in various healthcare settings. Perry and colleagues provide a rationale and method for including a brief personality assessment for patients with cancer. McCord presents a broadband screener, the Multidimensional Behavioral Health Screen (MBHS), that assesses 9 components of psychopathology. Mitchell and colleagues provide evidence for using the MBHS in primary care clinics as an alternative to the Patient Health Questionnaire-9. This special section provides evidence-based information regarding personality and psychological assessments that will likely be useful in varied healthcare contexts.

On Ising models and algorithms for the construction of symptom networks in psychopathological research.

During the past 5 to 10 years, an estimation method known as eLasso has been used extensively to produce symptom networks (or, more precisely, symptom dependence graphs) from binary data in psychopathological research. The eLasso method is based on a particular type of Ising model that corresponds to binary pairwise Markov random fields, and its popularity is due, in part, to an efficient estimation process that is based on a series of l1-regularized logistic regressions. In this article, we offer an unprecedented critique of the Ising model and eLasso. We provide a careful assessment of the conditions that underlie the Ising model as well as specific limitations associated with the eLasso estimation algorithm. This assessment leads to serious concerns regarding the implementation of eLasso in psychopathological research. Some potential strategies for eliminating or, at least, mitigating these concerns include (a) the use of partitioning or mixture modeling to account for unobserved heterogeneity in the sample of respondents, and (b) the use of co-occurrence measures for symptom similarity to either replace or supplement the covariance/correlation measure associated with eLasso. Two psychopathological data sets are used to highlight the concerns that are raised in the critique. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A step-by-step guide on preregistration and effective data sharing for psychopathology research.

Data analysis in psychopathology research typically entails multiple stages of data preprocessing (e.g., coding of physiological measures), statistical decisions (e.g., inclusion of covariates), and reporting (e.g., selecting which variables best answer the research questions). The complexity and lack of transparency of these procedures have resulted in two troubling trends: the central hypotheses and analytical approaches are often selected after observing the data, and the research data are often not properly indexed. These practices are particularly problematic for (experimental) psychopathology research because the data are often hard to gather due to the target populations (e.g., individuals with mental disorders), and because the standard methodological approaches are challenging and time consuming (e.g., longitudinal studies). Here, we present a workflow that covers study preregistration, data anonymization, and the easy sharing of data and experimental material with the rest of the research community. This workflow is tailored to both original studies and secondary statistical analyses of archival data sets. In order to facilitate the implementation of the described workflow, we have developed a free and open-source software program. We argue that this workflow will result in more transparent and easily shareable psychopathology research, eventually increasing and replicability reproducibility in our research field. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Research Domain Criteria (RDoC) and the historical roots of psychopathology: A viewpoint.

In this article we aim at conceptual reconstruction of the historical background behind RDoC project. It incorporates some elements that have not heretofore been included in frameworks for psychopathology research. At the same time, however, RDoC - like any approach to mental illness - must grapple with longstanding challenges in addressing issues about the roles and relationships of mind, brain, and patients' reports in considering the nature of disorder. In this respect, the historical roots of psychopathology remain as relevant as ever.

Detail, dynamics and depth: useful correctives for some current research trends.

Several research trends in contemporary psychiatry would benefit from greater emphasis on detailed assessment, modelling dynamic change, and micro-level analysis. This may assist with clarifying nosological and pathoaetiological issues. We make this case by referring to three areas: psychopathology and nosology; prediction research; and 'big N' data sets.Declaration of interestNone.

Psychopathy in a Multiethnic World: Investigating Multiple Measures of Psychopathy in Hispanic, African American, and Caucasian Offenders.

Despite the forensic relevance of psychopathy and the overrepresentation of Hispanics in the United States' criminal justice system, these two issues remain underexplored, particularly with self-report measures of psychopathy. We investigated the criterion validity of three psychopathy measures among African Americans, Caucasians, and Hispanics in a sample of 1,742 offenders. More similarity than dissimilarity emerged across groups. The factor structures of psychopathy measures among Hispanic offenders were consistent with previous findings. Few significant differences emerged between Hispanic and Caucasian offenders, with most differences emerging between African Americans and the other ethnic groups. In such instances, the correlates of psychopathy were typically weaker for African Americans. The Psychopathy Checklist-Revised yielded fewer psychopathy × ethnicity interactions than the Psychopathic Personality Inventory and Levenson Primary and Secondary Psychopathy Scales. Overall, these psychopathy measures showed reasonable validity across these cultural groups.

A Question of Control? Examining the Role of Control Conditions in Experimental Psychopathology using the Example of Cognitive Bias Modification Research.

While control conditions are vitally important in research, selecting the optimal control condition can be challenging. Problems are likely to arise when the choice of control condition is not tightly guided by the specific question that a given study aims to address. Such problems have become increasingly apparent in experimental psychopathology research investigating the experimental modification of cognitive biases, particularly as the focus of this research has shifted from theoretical questions concerning mechanistic aspects of the association between cognitive bias and emotional vulnerability, to questions that instead concern the clinical efficacy of 'cognitive bias modification' (CBM) procedures. We discuss the kinds of control conditions that have typically been employed in CBM research, illustrating how difficulties can arise when changes in the types of research questions asked are not accompanied by changes in the control conditions employed. Crucially, claims made on the basis of comparing active and control conditions within CBM studies should be restricted to those conclusions allowed by the specific control condition employed. CBM studies aiming to establish clinical utility are likely to require quite different control conditions from CBM studies aiming to illuminate mechanisms. Further, conclusions concerning the clinical utility of CBM interventions cannot necessarily be drawn from studies in which the control condition has been chosen to answer questions concerning mechanisms. Appreciating the need to appropriately alter control conditions in the transition from basic mechanisms-focussed investigations to applied clinical research could greatly facilitate the translational process.

Father Participation in Child Psychopathology Research.

The purpose of the current study was two-fold: (1) To examine time trends of the inclusion of fathers in child psychopathology research from 2005 to 2015; and (2) to examine online crowdsourcing as a method to recruit and study fathers. In study 1, findings indicated that, relative to two earlier reviews of father participation from 1984 to 1991 and 1992-2004, there has been limited progress in the inclusion of fathers in child psychopathology research over the last decade. In study 2, without explicit efforts to recruit fathers, almost 40% of a sample of 564 parents recruited from online crowdsourcing (Amazon's Mechanical Turk) were fathers. Major demographic differences did not emerge between mother and father participants and data were equally reliable for mothers and fathers. Fathers were more likely to drop out over the course of a 12-month follow-up but these differences in retention between mothers and fathers were non-significant if fathers were retained at a 2-week follow-up. Finally, family process models tested across four assessments (baseline, 4, 8, and 12 month follow-ups) indicated that data from fathers are equally supportive of convergent validity as data from mothers. We concluded that online crowdsourcing is a promising recruitment methodology to increase father participation in child psychopathology research.

Socially Desirable Responding in Web-Based Questionnaires: A Meta-Analytic Review of the Candor Hypothesis.

Unproctored, web-based assessments supposedly reduce social desirability distortions in self-report questionnaires because of an increased sense of privacy among participants. Three random-effects meta-analyses focusing either on social desirability ( k = 30, total N = 3,746), the Big Five of personality ( k = 66, total N = 2,951), or psychopathology ( k = 96, total N = 16,034) compared social desirability distortions of self-reports across computerized and paper-and-pencil administration modes. Overall, a near-zero effect, Δ = 0.01, was obtained that did not indicate less socially desirable responding in computerized assessments. Moreover, moderator analyses did not identify differential effects for proctored and unproctored procedures. Thus, paper-and-pencil and computerized administrations of self-report scales yield comparable mean scores. Unproctored web-based surveys do not offer an advantage with regard to socially desirable responding in self-report questionnaires.

Sobre el juicio psiquiátrico y su pretensión de verdad: una mirada crítica / On psychiatric judgement and its pretension of truth: a critical approach

La legitimidad de la práctica psiquiátrica se fundamenta sobre una pretensión de verdad derivada de aquella metodología que desde los comienzos de la era moderna actúa como garante de conocimiento cierto y verdadero: las ciencias naturales. Sin embargo, la psiquiatría se sigue caracterizando por una inconsistencia teórica, práctica y conceptual que ha requerido hasta el día de hoy de incesantes esfuerzos destinados a alcanzar una estabilidad que jamás ha superado el umbral de la transitoriedad. Ante el fracaso experimentado por las ciencias naturales a la hora de estabilizar el ámbito de conocimiento de la subjetividad y de la experiencia psicopatológica, dirigiremos una mirada crítica hacia el objeto de estudio de la psiquiatría con el fin de esclarecer los motivos subyacentes a su falta de progreso, destacando la ilegitimidad de las pretensiones científico-naturales que ostenta en relación al estudio de la experiencia subjetiva. Encontraremos en la hermenéutica una alternativa metodológica capaz de articular un conocimiento sistemático adecuado a la peculiar naturaleza de la experiencia subjetiva y describiremos el concepto de objetividad hermenéutica como una herramienta epistémica destinada a legitimar la pretensión de verdad del juicio psiquiátrico sin apelar a una metodología, la de las ciencias positivas, que se revela como inadecuada a la hora de tratar de dar cuenta del fenómeno psicopatológico (AU)

Psychiatric practice is legitimized by its adscription to a methodological approach that has represented a sure path towards true knowledge all throughout the modern era: the natural sciences. In spite of this, the history of psychiatry is scattered with theoretical, practical and conceptual inconsistencies that have demanded continuous efforts aimed at reaching a degree of stability that has never been more than transient. In the face of the natural sciences’ failure to offer a stable framework of knowledge for psychopathology and subjective experience, we shall address psychiatry’s object of study in order to shed some light on the reasons underlying its lack of progress, highlighting the illegitimacy of a natural-scientific approach towards subjective experience. We will find in hermeneutics an alternative methodological approach that will settle the basis for a systematic approach towards an analysis of subjective experience. We will further describe the notion of hermeneutic objectivity as an epistemic device aimed at legitimizing psychiatry’s pretension of truth without resorting to a positivistic methodology, which has already proved to be inadequate when dealing with psychopathological phenomena (AU)

Las perturbaciones del objeto psiquiátrico y sus determinantes: el caso de la desaparición de la esquizofrenia / The disturbances of the psychiatric object and their determinants: the case of the disappearance of schizophrenia

Desde hace años existe un volumen creciente de literatura dedicada al análisis de las insuficiencias del concepto de esquizofrenia y a las propuestas de su sustitución. En el presente trabajo se realiza una exposición de las principales características de esta postura y se analiza desde el punto de vista conceptual. Se concluye que este proyecto es una continuación de la visión neopositivista y biológica dominante en la psiquiatría a la que contribuye también la influencia de la industria farmacéutica. Se apunta la necesidad de desarrollar una teoría psicopatológica que pueda dar cuenta del proceso de formación de los conceptos y abordar de manera crítica los cambios nosológicos que están por venir (AU)

In recent years there is an increasing number of studies devoted to the analysis of the insufficiencies of the schizophrenia concept and the need of a terminological change. In the present paper I analyze the core features of this proposal from a conceptual point of view. It is concluded that this view is a prolongation of the neopositivist and biological approaches in psychiatry in addition to the influence of the pharmaceutical industry. The necessity of a psychopathological theory that can give answer to future nosological changes is pointed out (AU)

Biomarcadores sanguíneos diferenciales de las dimensiones psicopatológicas de la esquizofrenia / Differential blood-based biomarkers of psychopathological dimensions of schizophrenia

La sintomatología de la esquizofrenia es heterogénea, no existiendo ningún síntoma patognomónico de la misma. Además, su diagnóstico presenta dificultades, ya que se basa en información subjetiva en lugar de en marcadores. El propósito de este estudio es ofrecer una revisión del estado actual de los biomarcadores sanguíneos de las dimensiones psicopatológicas de la esquizofrenia. En pacientes con esquizofrenia se han observado disfunciones inflamatorias, hormonales o metabólicas y se ha intentado establecer los biomarcadores responsables de esas disfunciones. La identificación de estos podría contribuir al diagnóstico y tratamiento de la esquizofrenia (AU)

Symptomatology of schizophrenia is heterogeneous, there is not any pathognomonic symptom. Moreover, the diagnosis is difficult, since it is based on subjective information, instead of markers. The purpose of this study is to provide a review of the current status of blood-based biomarkers of psychopathological dimensions of schizophrenia. Inflammatory, hormonal or metabolic dysfunctions have been identified in patients with schizophrenia and it has attempted to establish biomarkers responsible for these dysfunctions. The identification of these biomarkers could contribute to the diagnosis and treatment of schizophrenia (AU)

Rasgos psicopatológicos en personas con disforia de género / Psychopathological traits in people with gender dysphoria

Objetivos. En primer lugar, el objetivo es evaluar los rasgos psicopatológicos en personas con disforia de género y, en segundo lugar, establecer si existen diferencias entre los grupos de hombre a mujer y de mujer a hombre. Participantes y método. Se aplicó el Inventario clínico multiaxial de Millon (MCMI-II) a 32 sujetos con disforia de género, de los cuales 20 pertenecen al grupo de hombre a mujer y 12 al de mujer a hombre. Los participantes fueron seleccionados de forma intencional. Resultados. No se encuentran alteraciones psicopatológicas significativas. Las puntuaciones más elevadas se obtuvieron en los rasgos esquizoide, paranoide y delirante. Hay diferencias estadísticamente significativas entre los grupos de hombre a mujer y de mujer a hombre en los patrones clínicos de la personalidad esquizoide (p = 0,012), compulsiva (p = 0,047) y autodestructiva (p = 0,040) y en el síndrome clínico de gravedad moderada abuso de alcohol (p = 0,000). Conclusiones. Las personas con disforia de género no se caracterizan por alteraciones psicopatológicas. Los rasgos con puntuaciones más elevadas se corresponden con los señalados en estudios anteriores. Se aprecian diferencias por grupos, aunque solo en determinadas escalas (AU)

Objectives. Firstly, the aim is to evaluate psychopathological traits in people with gender dysphoria, and secondly, to establish if there are differences between groups of male to female and female to male. Participants and method. The Millon clinical multiaxial inventory (MCMI-II) was applied to 32 subjects with gender dysphoria, of which 20 belong to the group of male to female and 12 to the group female to male. Participants were selected intentionally. Results. No significant psychopathological alterations are found. The highest scores were obtained in the schizoid, paranoid and delusional traits. There are statistically significant differences between the male to female and female to male in clinical patterns of schizoid (P=.012), compulsive (P=.047) and self-destructive personality (P=.040), and in moderate clinical syndrome, abuse of alcohol (P=.000). Conclusions. People with gender dysphoria are not characterized by psychopathological alterations. The traits with higher scores correspond with those pointed out in previous studies. Differences were appreciated between groups, but only in certain scales (AU)

Clinicians and clients disagree: Five implications for clinical science.

Recent findings highlight the limited agreement between diagnostic ratings provided by practicing clinicians and the self-report and interview methods typically employed in research settings. Such discrepancies between the diagnoses assigned in research and applied settings greatly complicate the translation of empirical findings into practice. This review highlights these disagreements, offers explanations for these observed differences, and provides 5 implications for research. Specifically, we provide evidence that, despite criticisms, self-reported psychopathology may be at least as valid as clinicians' unstructured diagnoses. Further, we highlight the need for research that provides clinicians with the most valid tools, including those that focus on dimensional constructs, rather than diagnostic categories. In addition, we recommend that adult psychopathology research incorporate methodologies from general personality for unraveling informant discrepancies. We highlight recent work that has provided valuable tools for incorporating metaperception-the extent to which one is aware of how they are perceived by others-for contextualizing these differences. We also underscore the utility of emerging technologies that provide rich data, such as ambulatory assessment, for overcoming the criterion problem. Finally, we recommend that advances in combining data from multiple sources from the childhood psychopathology literature, such as examining the extent to which discrepancies themselves might aid in diagnosis, be incorporated into adult psychopathology research. In sum, we hope that these implications inspire research that improves the science of diagnostic assessment in a way that might ultimately improve practice. (PsycINFO Database Record

Reflexiones éticas cuando hablamos de adicciones en la adolescencia / Ethical considerations when talking about addictions in adolescence

El adolescente con un problema de consumo de sustancias o una dependencia a Internet no suele ser consciente de ello y tiende a minimizar las consecuencias hasta que los problemas relacionados con su uso y consumo se ponen de manifiesto. Debemos entender que se trata de una persona enferma que necesita ayuda y con todo el derecho a que se le atienda sin ninguna restricción. Durante la actividad asistencial con este tipo de pacientes, los profesionales suelen verse inmersos en situaciones donde la toma de decisiones implica no solo valorar los aspectos de salud, sino también las implicaciones legales y éticas que conllevan. Esto hace que nos enfrentemos a conflictos éticos que afectan a nuestra actividad y calidad asistencial (AU)

A teenager with a problem of substance abuse or dependence to social media does not usually realize and tends to minimize the consequences, until the problems related to its use and consumption appear. We may understand that this is a sick person who needs help and with full right to be assisted without any restrictions. During the health care activities with these patients, professionals are often involved in situations in which decision-making does not involve just assessing health aspects, but also the egal and ethical implications. Thus, we deal with some ethical issues that affect to our activity and the quality of care (AU)

[Network clusters of symptoms as elementary syndromes of psychopathology: implications for clinical practice]. / Netwerkclusters van symptomen als elementaire syndromen in de psychopathologie: consequenties voor de klinische praktijk.

BACKGROUND: In a recent publication we reported the existence of around 11 (to 15) 'elementary syndromes' that may combine in various ways, rather like 'building blocks', to explain the wide range of psychiatric symptoms. 'Bridge symptoms' seem to be responsible both for combining large sets of symptoms into elementary syndromes and for combining the various elementary syndromes to form one globally connected network structure. AIM: To discuss the implication of these findings for clinical practice. METHOD: We performed a network analysis of symptom scores. RESULTS: Elementary syndromes provide a massive simplification of the description of psychiatric disease. Instead of the more than 300 categories in DSM-5, we now need to consider only a handful of elementary syndromes and personality domains. This modular representation of psychiatric illnesses allows us to make a complete, systematic and efficient assessment of patients and a systematic review of treatment options. Clinicians, patients, managerial staff and insurance companies can verify whether symptom reduction is taking place in the most important domains of psychopathology. Unlike classic multidimensional methods of disease description, network models of psychopathology can be used to explain comorbidity patterns, predict the clinical course of psychopathology and to designate primary targets for therapeutic interventions. CONCLUSION: A network view on psychopathology could significantly improve everyday clinical practice.

The National Institute of Mental Health Research Domain Criteria and Clinical Research in Child and Adolescent Psychiatry.

OBJECTIVE: This review discusses the relevance of the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) to clinical research in child and adolescent psychiatry. METHOD: We summarize the characteristics of the NIMH RDoC project and then provide examples of RDoC designs that are of relevance to clinical investigators in child and adolescent psychiatry. The final section addresses questions regarding the impact of RDoC on clinical care. RESULTS: RDoC encourages investigators to investigate psychopathology dimensionally: greater or lesser degrees of healthy/adapted functioning of neurobiological, cognitive, and behavioral processes (constructs) that cut across current diagnostic categories. Elucidation of the developmental components of RDoC constructs is needed to ensure they are fully validated. Integrating RDoC approaches into clinical research of child and adolescent psychopathology is contributing to our understanding of development as an aspect of the heterogeneity within DSM disorders and commonalities across seemingly disparate disorders. Continued efforts promise to also explain the processes that lead to mental illness in at-risk populations. CONCLUSION: Incorporating an RDoC approach in clinical research in child and adolescent psychiatry promises to be a fruitful avenue of research into the root causes and manifestations of mental illness, which will eventually lead to more precise treatments. Although the long-term aspiration of RDoC is to help reduce the burden of suffering for those with mental illnesses, it is not intended to be used for practical clinical purposes at this early stage.

Transtornos depressivos em pacientes que buscam cirurgia plástica estética: uma visão ampla e atualizada / Depressive disorders in patients who seek cosmetic surgery: a broad and updated view

INTRODUÇÃO: A cirurgia estética pode melhorar a qualidade de vida de pacientes, porém alguns que se apresentam para o procedimento são portadores de transtornos depressivos (TD) e podem evoluir, no pós-operatório, de forma desastrosa do ponto de vista psicológico e até mesmo evoluir para o suicídio. A prevalência de TD em pacientes de cirurgia plásticaestética é em média de 20%, podendo chegar até 70%. Este artigo tem por objetivo fazer uma revisão sobre depressão e cirurgia estética bem como alertar e conscientizar os cirurgiões plásticos sobre o crescente aumento destes pacientes nos consultórios. Objetiva, ainda, orientar os cirurgiões quanto a abordagem adequada e condutas específicas perante estes. MÉTODOS: Realizou-se busca nos bancos de dados MEDLINE/PubMed e Embase e cruzamento de palavras chaves, incluindo "cirurgia plástica estética", "depressão"; "transtornos de humor", "transtorno depressivo", "sintomas depressivos", "suicídio e cirurgia plástica". RESULTADOS: O sucesso de uma cirurgia plástica depende em muito da seleção dos pacientes para o procedimento. Pacientes suspeitos, pacientes com sintomas depressivos elevados nos questionários (como o BDI) e pacientes com "marcadores" de psicopatologia deverão ser encaminhados ao psiquiatra para avaliação adequada. CONCLUSÃO: Pela elevada prevalência de TD em cirurgia plástica estética, todo paciente de cirurgia plástica deverá ser avaliado adequadamente para identificação daqueles com possíveis TD no pré-operatório e encaminhado ao psiquiatra, para assim tentar se evitar evolução psicológica desfavorável pós-operatória.

INTRODUCTION: Aesthetic surgery can improve the quality of life of patients, but some candidates for the procedure have depressive disorders (DDs) that may develop, in the postoperative period, in a disastrous manner from a psychological point of view and even progress to suicide. The prevalence of DDs in cosmetic surgery patients is 20% on average and reaches 70%. This article aims to review depression and aesthetic surgery as well as to alert and educate plastic surgeons on the growing number of these patients in clinical settings. It also aims to guide surgeons to the appropriate approach and specific behaviors with these patients. METHODS: A search was performed in MEDLINE/PubMed and Embase, and key words were entered, including "cosmetic surgery," "depression," "mood disorders," "depressive disorder," "depressive symptoms," and "suicide and plastic surgery." RESULTS: The success of plastic surgery depends a great deal on the selection of patients for the procedure. Suspect patients, patients with elevated depressive symptoms in questionnaires (such as the BDI), and patients with psychopathology "markers" should be forwarded to a psychiatrist for proper evaluation. CONCLUSION: Due to the high prevalence of DDs in aesthetic plastic surgery patients, every plastic surgery patient should be evaluated properly to identify those with possible DDs in the preoperative period, and those should be forwarded to a psychiatrist, thus avoiding an unfavorable postoperative psychological evolution.