Construct representation and definitions in psychopathology: the case of delusion.

BACKGROUND: Delusion is one of the most intriguing psychopathological phenomena and its conceptualization remains the subject of genuine debate. Claims that it is ill-defined, however, are typically grounded on essentialist expectations that a given definition should capture the core of every instance acknowledged as delusion in the clinical setting. OBJECTIVE: In this paper, we attempt to show the major limitations of the definition of delusion from a non-essentialist point of view. METHOD: The problem is analyzed within the framework of constructs and their translation into definitions. Different linguistic and epistemological perspectives that do concur when one deals with psychopathological phenomena are also considered. RESULTS: The 'construct of delusion', rather than its clinical instances, is the reference in which its definition appears inept. Here we claim that the broad contextual and pragmatic bases that underpin the construct of delusion tend to be either overlooked or downplayed in the quest for a satisfactory definition of this phenomenon.

Delusional misidentification syndrome: why such nosologic challenge remains intractable.

The delusional misidentification syndrome has lately been the object of lengthy psychopathological discussions. Controversies persist as to how best to define it, distinguish its subtypes and set their limits. Attempts to provide this syndrome with a better conceptual framework have usually relied on proposing new definitions and classifications. In this article, we suggest that some prevailing difficulties are basically related to two separate but intertwined issues: the self-reflexive property of the human mental functioning and the first-person linguistic expression of human experience. We argue that this discussion belongs to a broader context than the one it is usually referred to, as it deals with problems germane to conceptual psychopathological investigations in general. In that regard, DMS provides us with a very telling example, to the extent to which it has, at its core, to account for the puzzling phenomena of identity, which are particularly affected by cultural and linguistic variables.

[Neuropsychiatric disturbances in Wilson's disease and use of electroconvulsive therapy: case report]. / Alterações neuropsiquiátricas na doença de Wilson e uso da eletroconvulsoterapia: relato de caso.

Wilson's disease consists in a inborn error of metabolism with marked neuropsychiatric manifestations. These manifestations need to be correctly identified and treated. There are four neuropsychiatric symptoms clusters established for Wilson's disease patients: behavior and/or personality disorders, mood disorders, cognitive deficits, and psychotic manifestations. Although such patients are more commonly seen in neurological and hepatological settings, mental health professionals must keep in mind a high level of suspicion, once first presentations may be of psychiatric nature. This study presents a review of literature about neuropsychiatric aspects of Wilson's disease, emphasizing diagnostic issues. It is presented the case of a 26 years old male patient initially with psychiatric polimorfic symptoms. The treatment of this patient with electroconvulsive therapy is presented, adding a report of this therapeutic modality, applied to that case, to the two only previous records in the literature.

Alteraçöes neuropsiquiátricas na doença de Wilson e uso da eletroconvulsoterapia: relato de caso / Neuropsychiatric disturbances in Wilson's disease and use of electroconvulsive therapy: case report

A doença de Wilson (DW) é condiçäo sistêmica decorrente de erro inato do metabolismo, com importantes manifestaçöes neuropsiquiátricas. Estas requerem identificaçäo diagnóstica adequada e intervençöes terapêuticas eficazes. Existem, estabelecidos, quatro clusters de sintomas neuropsiquiátricos na DW: distúrbios de comportamento e/ou personalidade, distúrbios do humor, déficit cognitivo e quadros psicóticos. Embora tais pacientes sejam vistos, mais comumente, em clínicas neurológicas e de hepatologia, os profissionais de saúde mental devem manter alto nível de suspeiçäo para DW, já que os quadros iniciais podem se manifestar como síndromes psiquiátricas. Neste artigo é apresentada uma revisäo da literatura sobre os aspectos neuropsiquiátricos da doença de Wilson, enfatizando-se as dificuldades diagnósticas. Um homem de 26 de idade DW com apresentaçäo psiquiátrica inicial polimórfica é apresentado. O tratamento deste paciente com a eletroconvulsoterapia é relatado, somando-se esta forma de intervençäo terapêutica, neste caso, aos dois únicos existentes na literatura.