Sensitivity and specificity of the three Whooley and Arroll questions for detecting perinatal depression in Mexican women / Sensibilidad y especificidad de las tres preguntas de Whooley y Arroll para detectar depresión perinatal en mujeres mexicanas

Abstract: Objective: To evaluate the sensitivity and specificity of the Two Whooley questions and the Arroll question, using the SCID, The Structured Clinical Interview (SCID-I) as the gold standard for detecting perinatal depression. Materials and methods: We interviewed 210 women during pregnancy and 6 months postpartum. Results: The criterion with the greatest sensitivity was responding positively to either Whooley question (pregnancy= 94.7 %; postpartum=100.0%), while the most specific criterion was responding positively to the two Whooley questions plus the Arroll question (Pregnancy=90.0% Postpartum = 85.7%). Conclusion: The Whooley and Arroll questions have adequate psychometric properties to detect possible cases of depression during the perinatal period. They can be applied during prenatal check-ups and postpartum consultations. Timely detection of women at risk of perinatal depression can contribute to their treatment for reducing their adverse consequences in mothers and infants.

Resumen: Objetivo: Evaluar la sensibilidad y la especificidad de la Escala de las dos preguntas de Whooley y la pregunta de Arroll para detectar riesgo de depresión perinatal, usando la SCID como estándar de oro. Material y métodos: Se entrevistó a 210 mujeres durante el embarazo y 6 meses después del parto. Resultados: El criterio con mayor sensibilidad fue responder positivamente a cualquiera de las Preguntas de Whooley (embarazo = 94.7%; posparto = 100.0%) y, el más específico, responder positivamente a las preguntas de Whooley más la de Arroll (embarazo = 90.0% , Posparto = 85.7%). Conclusiones: Las preguntas de Whooley y Arroll tienen propiedades psicométricas adecuadas para detectar posibles casos de depresión durante el periodo perinatal. Pueden aplicarse durante las citas de control prenatal y consultas en el postparto. Detectar de manera oportuna a mujeres en riesgo de depresión perinatal puede ayudar a su atención para reducir sus consecuencias adversas en madres e infantes.

La creatividad y el relato en los diferentes tipos de delirios crónicos: un estudio descriptivo

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Summary Delusions are unreal beliefs out of the boundaries of logic which are not shared by the members of a given culture (APA). Henri Ey classified them into two general groups: acute delusions and chronic delusions. This paper is focused on chronic delusions, which are divided according to different phenomenological features into paranoid, fantastic, and schizophrenic. Paranoid delusions are mainly characterized by high systematization, persecutory theme, and absence of disintegration of the cognitive and personality functions. Fantastic delusions are mainly composed by a great imaginative content that contrasts with the maintenance of objective reality, preservation of cognitive functions, and absence of personality disintegration. Finally, schizophrenic delusions are shaped by incoherence, level of personality disintegration, and cognitive worsening. When delusions are orally expressed, their narrative structure can be analyzed. Siegel defined narrative as a description that joins internal and external experiences; it contrasts histories that give coherence and understanding to an individual living in the world and in time. Ramos stated that narrative is comprised by several elements: theme, order, structure, and an identifiable narrative voice. We suggest that when narrating their experiences, the delusional patients try to give coherence to their internal and external worlds, which have been transformed to the extent that other human beings see these as unreal. We also afirm that in their reconstruction of the world, the individual uses his or her creativity, and that creativity is influenced by the psychotic process or the very own creative qualities of the individual. Chavez defined creativity as the process of generating something, transforming or transcending the existing. This process comprises three overlapping phases: (A) Association-integration: the subject makes associations between elements of the external world and the own subjectivity. During this phase occurs a perceptual, sensorial, cognitive and affective integration. Different levels of consciousness are involved in this phase. (B) Elaboration: the person works with the association building a product, using her or his particular talents and abilities. This phase is conscious and involves volition. (C) Communication: by sharing the work the associations are transmitted and reproduced in others, as well as the sensorial and emotional experience. Communication ends the process at the time that it begins a new creative processes in others. Reality is in consequence understood from a new perspective. The purpose of this study is to describe the narrative structure of different kinds of delusions, and to describe the performance of patients with different kinds of chronic delusions in the Torrance Test for Creative Thinking (TTCT) Figural form. Material and method A descriptive investigation was developed to analyze the narrative structure of each one of the delusions previously mentioned, using a frequency table of linguistic transformations (LT), and the elements to evaluate thought content and cognitive-oral disorders from the Positive and Negative Schizophrenic Symptoms scale (PANSS). Creative thought was measured in each delusional patient with the figural TTCT. Three patients from the Instituto Nacional de Psiquiatría Ramón de la Fuente were evaluated, each one with a different kind of chronic delusion according to Ey's criterion. Results There is a shorter number of TL in paranoid delusion, and higher severity scores for delusion and suspicion in PANSS. Regarding the figural TTCT, elaboration has a score above percentil 85, and title expressiveness and synthesis are notorious while fluency and originality have scores below percentile 25. In the fantastic delusion some linguistic transformations were found: 5 metaphors and 3 neologisms. Greater severity was found in PANSS for delusion, suspicion, and unusual content items. In the figural TTCT a score above percentile 85 was found in elaboration and abstraction, it also stood out the context articulation and the limits extension. The patient with this delusion got the highest overall score in the figural TTCT. Most of the TL were found in the schizophrenic delusion: this derailment got to the point of incoherence and association by assonance. Grater score of conceptual disorganization was found in severity of PANSS areas. Some dimensions below percentile 25 were found in the figural TTCT: fluency, originality, elaboration, and resistance to premature closing. The patient with this delusion got the lowest global score in the figural TTCT. Different characteristics were present in narrative of the three kinds of delusions -as shown in frequency tables of TL, in cognitive-oral disorders, and in thought content on PANSS. Among these patients there were interesting variations within creative thought in the figural TTCT. Discussion In fantastic and paranoid delusions we found similarities in suspicion and systematization, and also in the elaboration dimension evaluated with the figural TTCT. Elaboration refers to the detail in developing an idea. This may be related to the subject's ability in explaining the how, when, and why of the story present in the delusion. However this is more obvious in the paranoid delusion, where the synthesis dimension is high. Synthesis refers to the ability to connect, combine, and summarize ways of associating things. This same delusion stands out because of its low scoring in originality and fluency in the figural TTCT; the first one tends to appear diminished when elaboration develops in a higher degree. The loss on fluency in creative thought could match personality tightness observed in this kind of patients. Unusual content and limits extension predominate in the fantastic delusion, this has to do with going out of established routes and breaking defined problem limits, which may be related to the unusualness of the narrative theme in this reconstruction of the world implicit in the delusion; that represents a space where even the patient has the need to invent new words. It is interesting to notice the high score in abstraction; understood as the synthesis and organization ability for thought processes it coincides with the use of metaphors. In this delusion the high score in the context articulation, which refers to the clear an powerful communication of the history, could be related to the delusion demarcation that gives the patient the opportunity to function properly in some degree. In the case of schizophrenic delusion it was observed that there is a severe alteration of the cognitive and personality functioning, and also oral incoherence was found as well as an important loss of the dimensions evaluated with the test of creative thinking. Narrative is a phenomenon that integrates different cognitive processes which are transformed by the psychotic condition, where the internal and external worlds of the patient are rebuilt. Creative thinking intervenes in several ways in this reconstruction. Thus, and based on the results from this study, we hypothesize that some characteristics of the narrative of delusions could be related with certain dimensions of creative thinking. Some of these dimensions were affected, others seemed to be more developed than in general population. However, another possibility could be that the creative potential previous to the outcome of the disease could affect the clinical course. This could have implications in the rehabilitation process of these patients. Nevertheless, this has to be tested in future research.