Trayectoria del trastorno formal del pensamiento, desde la observación clínica al análisis computacional / Trajectory of formal thought disorder, from clinical observation to computational analysis

La adecuada comprensión de un término psicopatológico requiere, no solo del conocimiento de la alteración descrita, sino también de los contextos y conceptos a partir de los cuales fue acuñado y de la transformación de los mismos a lo largo del tiempo. En el caso del trastorno formal del pensamiento se describe su evolución desde su incorporación a la psicopatología con fines puramente descriptivos y asociado a la influencia del asociacionismo y a la idea de una dependencia directa entre pensamiento y lenguaje hasta la actualidad, en que el uso de herramientas computacionales y de hipótesis provenientes de la lingüística han promovido su uso como instrumento diagnóstico y marcador pronóstico, al tiempo que ha significado la incorporación de nueva terminología. (AU)

Properly understanding a psychopathological term requires knowledge of the disorder described, the contexts and concepts from which it was coined, and its modification over time. In the case of formal thought disorder, we describe its evolution from its incorporation into psychopathology for purely descriptive purposes and associated with the influence of associationism and the idea of a direct dependence between thought and language to the present day, in which the use of computational tools and hypotheses from linguistics have promoted its use as a diagnostic tool and prognostic marker, while simultaneously leading to the incorporation of new terminology. (AU)

Crisis y encrucijadas de una psiquiatría en busca de futuro / The crisis and crossroads experienced by a psychiatry in search of the future

Asumiendo la metáfora de la encrucijada, propuesta por Santiago Levín, en la que estaría situada la psiquiatría en la actualidad, el presente artículo pretende reflexionar sobre algunos aspectos de una crisis paradigmática de la medicina mental que ha hecho a algunos temer por su futuro. Se abordan algunas cuestiones epistemológicas de cierto calado, como el régimen de "verdad" en el que supuestamente deben manejarse los expertos, así como los dilemas planteados en los dos elementos clave del encuentro clínico: el diagnóstico y el tratamiento. Finalmente, se insiste en la importancia de lo ético, lo social, y lo político a la hora de replantear saberes y prácticas. (AU)

On the understanding we accept where psychiatry would today be located in the metaphor of the crossroads, as proposed by Santiago Levín, the purpose of this article is to explore certain aspects of a paradigmatic crisis in mental medicine that has raised some concerns as to its future. Certain deep epistemological questions are addressed, such as the schema of "truth", where experts should supposedly manage themselves, and the dilemmas raised from the two key elements of a clinical session: diagnosis and treatment. Finally, the study emphasises the importance of the ethical, social, and political aspects of rethinking knowledge and practices. (AU)

Normality, subjectivity and mental health: A genealogy of Danish psychiatry, 1938-2017.

The increasing prevalence of mental disorders together with the uncertain validity of psychopathological diagnostics challenges psychiatry as the primary home of studying, diagnosing and treating mental health problems and developing mental healthcare. This marks an emerging paradigmatical shift towards 'alternative' mental health perspectives. With the ambition of attending authoritatively in definitory practices, contemporary scholars of psychology, sociology, anthropology and philosophy call for an interdisciplinary approach to mental health, with a predominant focus on the subject. We argue that a paradigmatical shift of mental health requires structural-historical considerations of the foundations upon which subjectivity has been and still is manifested through psychiatry. On this basis, we critically investigate fluctuating psychiatric discourses on subjectivity, normality and pathology. We conducted a genealogical analysis of 13 psychiatric sources (1938-2017) focusing on 'Psychopathy' as a fluctuating diagnosis. We elucidate how subject concepts in psychiatry develop in parallel to subject concepts in society and culture, exemplified through convincing similarities between psychopathic symptoms and neoliberal ideals. Considerations like these, offer scholars valuable bases for mental health research and debate, and also valuable insights to healthcare professionals.

Longitudinal Research at the Interface of Affective Neuroscience, Developmental Psychopathology, Health and Behavioral Genetics: Findings from the Wisconsin Twin Project.

The Wisconsin Twin Project comprises multiple longitudinal studies that span infancy to early adulthood. We summarize recent papers that show how twin designs with deep phenotyping, including biological measures, can inform questions about phenotypic structure, etiology, comorbidity, heterogeneity, and gene-environment interplay of temperamental constructs and mental and physical health conditions of children and adolescents. The general framework for investigations begins with rich characterization of early temperament and follows with study of experiences and exposures across childhood and adolescence. Many studies incorporate neuroimaging and hormone assays.

Memory editing from science fiction to clinical practice.

Science fiction notions of altering problematic memories are starting to become reality as techniques emerge through which unique memories can be edited. Here we review memory-editing research with a focus on improving the treatment of psychopathology. Studies highlight two windows of memory vulnerability: initial storage, or consolidation; and re-storage after retrieval, or reconsolidation. Techniques have been identified that can modify memories at each stage, but translating these methods from animal models to humans has been challenging and implementation into clinical therapies has produced inconsistent benefits. The science of memory editing is more complicated and nuanced than fiction, but its rapid development holds promise for future applications.

[The psychopathology of the Wernicke-Kleist-Leonhard School and its relevance for present-day psychiatry]. / Die Psychopathologie der Wernicke-Kleist-Leonhard Schule und ihre Bedeutung für die aktuelle Psychiatrie.

Historically, the Wernicke-Kleist-Leonhard School represents a countermovement to psychopathology as described by Karl Jaspers and Kurt Schneider. The School aimed to interlink psychopathological and neurobiological aspects. Starting from the model of different functional neuronal systems, each of which can be disturbed in the sense of a hypofunction, hyperfunction, or parafunction, it developed a comprehensive phenomenology of psychopathological symptoms and syndromes that finally culminated in Karl Leonhard's course descriptions. This school of thought can provide important impulses even today. Thus, on the one hand, the neurobiological models can serve as the basis for additional research projects and on the other hand, the psychopathological descriptions of disorders can perhaps also be interpreted in the sense of typological constructs that can contribute to pragmatic clinical decisionmaking.

Psychiatry and developmental psychopathology: Unifying themes and future directions.

In the past 35 years, developmental psychopathology has grown into a flourishing discipline that shares a scientific agenda with contemporary psychiatry. In this editorial, which introduces the special issue, we describe the history of developmental psychopathology, including core principles that bridge allied disciplines. These include (1) emphasis on interdisciplinary research, (2) elucidation of multicausal pathways to seemingly single disorders (phenocopies), (3) description of divergent multifinal outcomes from common etiological start points (pathoplasticity), and (4) research conducted across multiple levels of analysis spanning genes to environments. Next, we discuss neurodevelopmental models of psychopathology, and provide selected examples. We emphasize differential neuromaturation of subcortical and cortical neural networks and connectivity, and how both acute and protracted environmental insults can compromise neural structure and function. To date, developmental psychopathology has placed greater emphasis than psychiatry on neuromaturational models of mental illness. However, this gap is closing rapidly as advances in technology render etiopathophysiologies of psychopathology more interrogable. We end with suggestions for future interdisciplinary research, including the need to evaluate measurement invariance across development, and to construct more valid assessment methods where indicated.

O modelo e o exemplo na nosologia psicanalítica / The model and example in psychoanalytic nosology / Le modèle et l'exemple en nosologie psychanalytique

Diversamente do modelo nosológico que opera com um saber sobre a patologia do indivíduo, o recurso ao exemplo nos auxilia a pensar a condução clínica como uma prática guiada pelo saber construído pelo próprio sujeito em sua experiência de vida. É por isso que no lugar da simplificação homogênea do modelo, valemo-nos do exemplo como chamado para fazer a mesma coisa de forma diferente, no sentido em que uma situação clínica pode ser tomada como paradigmática para se pensar o que cada caso comporta de absolutamente inédito

Unlike the nosological model that operates with a knowledge about the pathology of the individual, the use of example helps us to think about clinical conduction as a practice guided by the knowledge built by the subject himself in his life experience. That is why, instead of the homogeneous simplification of the model, we use the example as called to do something differently in the sense that a clinical situation can be taken as paradigmatic to think about what is absolutely unheard of in each case

Contrairement au modèle nosologique qui utilise une connaissance de la pathologie de l'individu, l'utilisation de l'exemple nous aide à réfléchir à la conduction clinique en tant que pratique guidée par la connaissance construite par le sujet lui-même dans son expérience de vie. C'est pourquoi, au lieu de la simplification homogène du modèle, nous utilisons l'exemple comme appel à faire la même chose différemment dans le sens où une situation clinique peut être considérée comme paradigmatique pour réfléchir à ce que chaque cas comporte d' absolument inédit

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.

Intervención psicológica escalonada con trastornos mentales comunes en Atención Primaria / Stepped psychological intervention with common mental disorders in Primary Care

Se analiza un modelo de intervención psicológica para trastornos mentales comunes realizado en seis centros de Atención Primaria (CAP). Dos psicólogos/as clínicos/as (PC) y cuatro psicólogas internas residentes (PIR) entrevistan a 566 usuarios para intervenir en trastornos leves o moderados de ansiedad y/o depresión, duelo e insomnio no orgánico. Tras una evaluación estandarizada se propone una intervención escalonada en función del diagnóstico y la gravedad del trastorno: indicación de no tratamiento, intervención breve en CAP (grupal o individual) o derivación. Se recogen variables sociodemográficas y clínicas que permiten describir la muestra y hacer comparaciones entre grupos. De las 566 personas derivadas la edad media fue de 37 años, el 70 % son mujeres, 50% en tratamiento psicofarmacológico y 10% de baja laboral. Se indica no tratamiento al 19%, intervención en CAP al 71% y derivación a salud mental al 10%. Predominan trastornos adaptativos, afectivos y de ansiedad generalizada, existiendo diferencias significativas según ubicación del CAP y modo integración del PC en el CAP. La mayor accesibilidad a intervenciones psicológicas integrando al PC en AP reduce la medicalización de patologías mentales leves y/o moderadas. La evaluación previene el inicio de tratamientos innecesarios, aumentando la probabilidad de indicación apropiada de tratamiento, lo que resultaría coste-efectivo (AU)

A model of psychological intervention for common mental disorders in Primary Care is analized. Two clinical psychologists and four resident psychologists interviewed 566 users to treat mild to moderate anxiety / depression disorders, bereavement or nonorganic insomnia disorders. Standardized assessment leads to a stepped intervention: indication of no treatment, brief group or individual intervention in Primary Care Center (PCC) or referral to Mental Health. Socio-demographic and clinical variables describe the sample and allow comparison betwen groups. Of the 566 interviewees, the mean age was 37 years, 70% were women, 50% with psychopharmacological treatment and 10% on sick leave. The steps of intervention were: 19% were intervention indication of no treatment, 71% PCC intervention and 10% were referred to Mental Health. Adaptive, emotional and generalized anxiety disorders were predominant, with significant differences between centers depending on the location and clinical psychologist integration mode in PCC. Integrating the clinical psychologist in PCC improve access to psychological interventions and reduces mild to moderate mental disorders medication. Assessment prevents unnecessary treatment onset and increases the likelihood of appropriate treatment indications, which is cost-effective (AU)

Análisis de redes: ¿una nueva forma de comprender la psicopatología? / Network analysis: a new way of understanding psychopathology?

Los sistemas taxonómicos actuales se basan en un enfoque categorial, de corte descriptivo, donde los síntomas y signos psicopatológicos son causados por un hipotético trastorno mental subyacente. Con la finalidad de soslayar las limitaciones de los sistemas clasificatorios, se hace necesario incorporar nuevos modelos conceptuales y psicométricos que permitan comprender, analizar e intervenir en los fenómenos psicopatológicos desde otra perspectiva. El objetivo general de este trabajo fue presentar un nuevo enfoque denominado análisis de redes (network analysis) para su aplicación al campo de la psicopatología. En primer lugar se lleva a cabo una breve introducción al análisis de redes, donde se conciben los trastornos psicopatológicos como sistemas complejos dinámicos. A continuación se comentan conceptos clave, los diferentes tipos de redes y los procedimientos para su estimación. Seguidamente se abordan las medidas de centralidad importantes para comprender la estructura de la red así como para examinar la relevancia de las variables dentro de la misma. Posteriormente se ejemplifica todo lo anterior mediante la estimación de una red de síntomas psicopatológicos autoinformados en una muestra representativa de adolescentes. Finalmente, a modo de conclusión, se realiza una breve recapitulación y se comentan posibles líneas de investigación futuras (AU)

Current taxonomic systems are based on a descriptive and categorical approach where psychopathological symptoms and signs are caused by a hypothetical underlying mental disorder. In order to circumvent the limitations of classification systems, it is necessary to incorporate new conceptual and psychometric models that allow to understand, analyze and intervene in psychopathological phenomena from another perspective. The main goal was to present a new approach called network analysis for its application in the field of psychopathology. First of all, a brief introduction where psychopathological disorders are conceived as complex dynamic systems was carried out. Key concepts, as well as the different types of networks and the procedures for their estimation, are discussed. Following this, centrality measures, important for the understanding of the network as well as to examine the relevance of the variables within the network were addressed. These factors were then exemplified by estimating a network of self-reported psychopathological symptoms in a representative sample of adolescents. Finally, a brief recapitulation is made and future lines of research are discussed (AU)

Positive and negative mental health across the lifespan: A cross-cultural comparison / Salud mental positiva y negativa a lo largo de la vida: una comparación transcultural

Mental health and well-being are closely related to age. Complete mental health includes psychopathological symptoms (negative mental health) and subjective well-being (positive mental health). The aim was to compare indicators of complete mental health across the lifespan cross-culturally. Method: We tested age trends in measures of resilience, social support and positive and negative mental health, including the subscales depression, anxiety and stress using data from national representative samples from Germany, Russia and the United States (U.S.) ranging in age from 18 to 100 (N=6,303). Results: The effects of age differed in each country. Today’s older Germans experienced more positive and less negative mental health whereas today's older Russians experienced less positive and more negative mental health than the younger people. In the U.S., positive mental health was higher among the older adults, but there was no effect of age for negative mental health. Age also had significant linear and curvilinear effects on resilience and social support. Conclusions: The pattern of mental health across the lifespan is clearly dependent on the nation (AU)

La salud mental y el bienestar están relacionados con la edad. La salud mental completa incluye síntomas psicopatológicos (salud mental negativa) y bienestar subjetivo (salud mental positiva). El objetivo es una comparación transcultural de los indicadores de salud mental completa a lo largo de la vida. Método: Hemos probado las tendencias de edad en medidas de resiliencia, apoyo social y salud mental positiva y negativa, incluyendo depresión, ansiedad y estrés, utilizando datos de muestras nacionales representativas de Alemania, Rusia y Estados Unidos con edades entre 18 y 100 años (N=6.303). Resultados: Los efectos de la edad diferían en cada país. Los alemanes mayores experimentaron una salud mental más positiva y menos negativa, mientras que los rusos mayores experimentaron una salud mental menos positiva y más negativa que los jóvenes. En Estados Unidos, la salud mental positiva fue mayor entre los adultos mayores, pero no hubo efectos de la edad para la salud mental negativa. La edad también tuvo efectos lineales y curvilíneos significativos sobre la resiliencia y el apoyo social. Conclusiones: El patrón de salud mental a lo largo de la vida depende claramente de la nación (AU)

The Impact of Translational Neuroscience on Revisiting Psychiatric Diagnosis: State of the Art and Conceptual Analysis.

This paper reviews translational research in psychiatry, focusing on those programs addressing the problem of the validity of psychiatric diagnoses. In medicine in general, and in psychiatry in particular, the term "translational" is used with different meanings. A conceptual analysis suggests that there are at least seven different types of translational research in psychiatry: T1 ("bench-to-bedside" development of tools and treatments), T2 (application of animal models to human psychiatry), T3 (papers focusing on the mind-brain gap, studying biological, neurobiological and cognitive dysfunctions), T4 (personalised therapies and prediction of treatment responses), T5 ("bedside-to-bench" translation of population data for laboratories), T6 (implementation of treatments at the population level, including accessibility and quality of services), and T7 (improving translational knowledge in residents' trainings and researchers' careers). Concerning the problem of validity of psychiatric diagnoses, new neurocognitive models like the Research Domain Criteria project are considered, in particular the translational program of cross-validation aimed at reducing the gap between neuroimaging data and psychopathological scores derived from rating-scales. It is shown that these programs are useful, filling some of the current research gaps, but it is also stressed that they carry implicit realist and reductionist assumptions. It is finally suggested that the formation of mental symptoms is a complex process involving both neurocognitive and semantic factors, which raises doubts about the possibility of complete translations, without residuals.

Trastornos generalizados del desarrollo. Evaluación diagnóstica e intervención para pediatras de Atención Primaria con criterios de evidencia científica / Pervasive developmental disorders. Diagnostic evaluation and intervention with scientific evidence criteria for Primary Care pediatricians

Contextualizar el incremento de la prevalencia de los trastornos mentales prioriza revisar y actualizar los criterios diagnósticos para evaluar su fiabilidad y su pertinencia a la hora de hacer el diagnóstico. Esto es más importante si no existe ninguna prueba específica para el diagnóstico y el determinante es el criterio clínico. En el caso de los trastornos generalizados del desarrollo, o del espectro autista, la confusión puede aparecer por la imprecisión en la traducción de los términos utilizados. En estos procesos hay que tener mucha sutileza en la recogida de los datos clínicos, pues son síntomas inespecíficos y la semántica induce a errores. Elaboramos diagramas de flujo para el diagnóstico de los procesos, con gran utilidad para el pediatra y otros profesionales de la salud, sobre todo de Atención Primaria. Se termina con recomendaciones dirigidas a la intervención del pediatra de Atención Primaria en estos procesos (AU)

Contextualizing the increase in the prevalence of mental disorders prioritizes review and update the diagnostic criteria to evaluate their reliability and relevance when making the diagnosis. It is more important if there is no specific test for the diagnosis and the clinical criterion is the determinant. In the case of pervasive developmental disorders or autism spectrum disorders, the confusion can arise from the imprecision that occurred in the translation of the terms used. In these processes, a lot of subtlety is necessary in the collection of clinical data because they are non-specific symptoms and the semantics induce errors. We developed flow diagrams for the diagnosis of the processes, with great utility for Pediatricians and other health professionals, especially Primary Care professionals. Recommendations aimed at the intervention of the Primary Care Pediatrician in these processes (AU)

Estudio de caso: ¿simulación o trastorno de personalidad múltiple? / Case study: malingering or multiple personality disorder?

El trastorno de identidad disociativo (TID) puede considerarse un trastorno raro, dada su aparentemente baja prevalencia, pero en los últimos años se apunta a su posible infradiagnóstico a causa de su complejidad y de la confusión que puede haber a la hora de establecer el diagnóstico diferencial. Por otro lado, la simulación de psicopatología mental puede tener un gran impacto socioeconómico y jurídico, de especial relevancia en este tipo de trastorno, dada la gran incapacidad que genera y su complejidad diagnóstica. En este trabajo referiremos el caso de un paciente que ingresa en la unidad de hospitalización breve del Hospital Dr. Rodríguez Lafora (Madrid) con sintomatología depresiva, que posteriormente pareció evolucionar hacia un caso de TID. La evaluación consistió en una anamnesis psicológica y la aplicación del Inventario Semiestructurado de Simulación de Síntomas (SIMS) y del Inventario Clínico Multiaxial de Millon (MCMI-II). Los resultados mostraron un perfil claramente alterado de personalidad, así como una posible simulación de síntomas que impidieron concretar la existencia o inexistencia del TID. A la luz de los resultados se discuten las posibles implicaciones de este caso

The dissociative identity disorder (DID) can be considered a rare disorder because of its seemingly low prevalence. However, in recent years it points to the possible underdiagnosis because its complexity and confusion at the time of differential diagnosis. On the other hand, the malingering of mental psychopathology can have a major socio-economic and legal impact, particularly important in this type of disorder, given the inability it generates and its complex diagnostic. This paper refers the case of a patient admitted to the short-term hospitalization unit of Dr. Rodríguez Lafora Hospital (Madrid) with depressive symptoms. Then the patient seemed to become a TID case. The evaluation consisted of a psychological history and the application of the Structured Inventory of Malingered Symptoms (SIMS) and the Millon Clinical Multiaxial Inventory (MCMI-II). The results showed an altered personality profile as well as likely malingered symptoms, what prevented us from a DID diagnosis. In view of the results, possible implications of this case for the clinical setting are discussed

Future Directions in Sleep and Developmental Psychopathology.

It is critical for psychologists to gain a better understanding about the intersection between sleep and developmental psychopathology. However, while many strive to answer the question of whether sleep causes developmental psychopathology, or vice versa, ultimately the relationship between sleep and developmental psychopathology is complex and dynamic. This article considers future directions in the field of clinical child and adolescent psychology that go beyond this mechanistic question, highlighting areas important to address for clinicians and researchers who strive to better understand how best to serve children and adolescents with developmental psychopathology. Questions are presented about what is normal in terms of sleep across development, the role of individual variability in terms of sleep needs and vulnerability to sleep loss, and how sleep may serve as a risk or resilience factor for developmental psychopathology, concluding with considerations for interventions.

Influence of core affect in the differential efficacy of a personality disorder intervention program

The usual emotional experience of the person (affective style) is an influential factor in therapeutic assimilation. Based on a dynamic model of affect shaped dimensionally by the valence and arousal axes (core affect) that fluctuate over time according to the specific context of the individual, its relationship with different variables was investigated and the changes after a 6-month intervention in a specialized hospital unit (N = 103) were observed. The orthogonal structure of core-affect was confirmed. Emotional valence appeared to be positively related to social skills (r = .375; p < .01) and self-esteem (r = .491; p < .01) and negatively to depressive symptoms (r = -.631; p < .01), general disturbance (r = -.395; p < .01) and suicidality (r = -.490; p < .01). Emotional arousal is associated with impulsivity (r = .345; p < .01). The group of patients with an affective style characterized by negative valence and low arousal core-affect gained less therapeutic benefit compared to those with positive valence core-affect (p < .05). Throughout the treatment, valence became more positive (d = .26; IC 95%: 1.9 - 7.2; p = .001), arousal increased (d = .23; IC 95%: 0.2 - 1.7; p = .015) and variability decreased (d = -.44; IC 95%: (-2.9) - (-1.1); p = .001). Changes in the core-affect are related to therapeutic improvement. Adjusting expectations of change can reduce therapeutic frustration, which is as common as it is harmful in the treatment of severe personality disorders (AU)

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