Thirty years with the Edinburgh Postnatal Depression Scale: voices from the past and recommendations for the future.

The Edinburgh Postnatal Depression Scale (EPDS) was published over 30 years ago as a ten-item self-report questionnaire to facilitate the detection of perinatal depression - and for use in research. It is widely used at the present time in many regions of the world and has been translated into over 60 languages. It is occasionally misused. In this editorial, updated recommendations for optimal use in primary and secondary care as well as research are provided. Future studies to evaluate its use and validity in naturalistic community populations are now required, and to determine the psychometric properties and practical usefulness of the EPDS when completed online.Declaration of interestJ.C. has no financial interest in the use of, or reproduction of, the EPDS.

The MMPI-2-Restructured Form (MMPI-2-RF): Assessment of Personality and Psychopathology in the Twenty-First Century.

This article describes the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and situates the instrument in contemporary psychopathology and personality literature. The historical evolution of the MMPI instruments is highlighted, including how failure to update the test for several decades resulted in increasing disinterest by basic researchers and how the restructuring efforts beginning in the 2000s promised to realign the instrument with basic research. In this regard, the construct validity associated with MMPI-2-RF scores in the context of contemporary dimensional models of psychopathology is considered. Research supporting the applied utility of the MMPI-2-RF scales in a variety of contexts-including mental health screenings, presurgical evaluations, forensic assessment, and public safety screening-is also reviewed. Critiques of the MMPI-2-RF are described and addressed. Finally, a series of recommendations for future updates of the MMPI-2-RF are described along with a path toward the MMPI-3.

Experiencia e historia crítica de la locura en Michel Foucault / Experience and critical history of madness in Michel Foucault

El presente artículo argumenta que, si bien es complicado establecer continuidades en la obra de Michel Foucault, hay al menos dos cuestiones, una teórica y otra temática, que pueden ser consideradas como constantes a lo largo de su trayectoria. Así, si bien se consideran adecuadas las lecturas de la obra de Foucault que desde lo metodológico dividen su trayectoria en dos (arqueología y genealogía), o mejor aún, las perspectivas temáticas que dividen su obra en tres (saber, poder y subjetividad), se comparte lo propuesto por Luca Paltrinieri en cuanto a que es más útil comprender su producción intelectual en función de una serie de transformaciones clave en torno al concepto de experiencia. Tomando en cuenta esta consideración, el artículo aborda las consecuencias de dichas transformaciones con el objetivo de brindar un panorama esquemático de las contribuciones teóricas y analíticas de Michel Foucault para una historia crítica de la psiquiatría

The present article argues that, although it is difficult to find continuities in the work of Michel Foucault, there are at least two questions, one theoretical and one thematic, that can be considered constant throughout his career. Thus, although the interpretations of Foucault’s work that divide his trajectory into two periods (archeology and genealogy), or better, into three thematic perspectives (knowledge, power and subjectivity), are considered adequate, we share Luca Paltrinieri’s proposal according to which it is more useful to understand his intellectual production in terms of a series of key transformations in the concept of experience. Taking this consideration into account, the article addresses the consequences of these transformations with the aim of providing a schematic overview of the theoretical and analytical contributions of Michel Foucault for a critical history of psychiatry

Athanasios Koukopoulos' Psychiatry: The Primacy of Mania and the Limits of Antidepressants.

BACKGROUND: Athanasios Koukopoulos provided a radical model for understanding depressive and manic conditions. OBJECTIVE: To review, explain, and analyze Koukopoulos' concept of the primacy of mania, with special attention to the role of antidepressants. METHOD: A conceptual review of Koukopoulos' writings and lectures on this topic is given. RESULTS: Koukopoulos held that depressive states are caused by manic states; the former do not occur without the latter. The most common scenario of the inseparability of depressive and manic symptoms occurs in mixed states, which we estimate to represent about one-half of all depressive episodes in all patients (not just bipolar illness). In a review of the empirical evidence for this topic, we conclude that empirical evidence exists to support the primary of mania thesis in almost 80% of depressed patients. Since antidepressants worsen mania, they would be expected to worsen depression as well in this model. We provide evidence that supports this view in most persons with depressive states. CONCLUSION: Koukopoulos' model of affective illness is one where manic states are the primary pathology, and depressive conditions are a secondary consequence. Hence treatment of depression with antidepressants would be less effective than treatment with mood stabilizers, since treating an effect is less successful than treating its cause. This approach would reverse current assumptions in psychiatry.

Young people who sexually abuse: a historical perspective and future directions.

This article presents a historical overview of research on sexually abusive youth. The evolution of the field over the past 30 years is discussed-from the initial development of treatment interventions to contemporary efforts of professionals to move from traditional, adult-oriented interventions toward developmentally sensitive assessment strategies and practice models. Focus is on two critical areas: risk assessment and trauma-informed care. The article reviews contemporary research on risk assessment tools, stressing the need for validated tools that can accurately assess youth and follow changes in risk over time. Etiological models for understanding effects of trauma (Trauma Outcome Process Assessment and Family Lovemap) are presented. Discussed are new ecologically based therapy models for working with sexually abusive youth that approach the youth holistically and are attuned to youths' needs, including providing interventions to address effects of past trauma.

The Hamilton Rating Scale for Depression: The making of a "gold standard" and the unmaking of a chronic illness, 1960-1980.

OBJECTIVES: To show why and how the Hamilton Rating Scale for Depression became the 'Gold Standard' for assessing therapies from the mid-1960s and how it was used to frame depression as a short-term and curable illness rather than a chronic one. METHODS: My approach is that of the social construction of knowledge, identifying the interests, institutional contexts and practices that produce knowledge claims and then mapping the social processes of their circulation, validation and acceptance. RESULTS: The circulation and validation of Hamilton Rating Scale for Depression was relatively slow and it became a 'Gold Standard' 'from below', from an emerging consensus amongst psychiatrists undertaking clinical trials for depression, which from the 1960s were principally with psychopharmaceuticals for short-term illness. Hamilton Rating Scale for Depression, drug trials and the construction of depression as non-chronic were mutually constituted. DISCUSSION: Hamilton Rating Scale for Depression framed depression and its sufferers in new ways, leading psychiatrists to understand illness as a treatable episode, rather than a life course condition. As such, Hamilton Rating Scale for Depression served the interests of psychiatrists and psychiatry in its new era of drug therapy outside the mental hospital. However, Hamilton Rating Scale for Depression was a strange kind of 'standard', being quite non-standard in the widely varying ways it was used and the meanings given to its findings.

The death of specificity in psychiatry: cheers or tears?

During the past five decades, psychiatry has pursued two goals, one being specificity of diagnosis and treatment, and the other a series of all-inclusive diagnostic manuals that paradoxically emphasized the absence of definite boundaries between disorders, and the absence of definite boundaries between disorders and normality (although normality was never defined). Leaders in the field continue to emphasize that diagnoses must be validated by the pathogenesis, course, and response to treatment of specific disorders. However, many current genetic and family studies have failed to support the concept of diagnostic specificity, as has the current use of psychotropic agents, which are now being prescribed with little regard for diagnosis. Although the switch from a categorical diagnostic system to a dimensional system has not been formalized, it seems to have already occurred in practice.

The Peabody Treatment Progress Battery: history and methods for developing a comprehensive measurement battery for youth mental health.

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

Adaptación española de la Escala de Insight Cognitivo de Beck (EICB) en esquizofrénicos / Spanish Adaptation of the Beck Cognitive Insight Scale (BCIS) for Schizophrenia

Introducción. La Escala de Insight Cognitivo de Beck ha sido diseñada para evaluar la capacidad de insight cognitivo esto es, la práctica de la auto-reflexión como mecanismo metacognitivo de examen y análisis de los síntomas de la enfermedad que permite la reevaluación continua de interpretaciones inadecuadas. Metodología. Este estudio examina las propiedades psicométricas, la estructura dimensional y la validez interna de la versión española de la Escala de Insight Cognitivo de Beck (EICB). Igualmente se analiza su relación con la Escala de Síndrome Positivo y Negativo en Esquizofrenia (PANSS). La escala de Insight Cognitivo fue traducida y adaptada al castellano en 129 pacientes esquizofrénicos ingresados y no ingresados. Resultados. El análisis de componentes principales mostró una estructura de dos factores semejantes a la original reconocibles como auto-reflexión (R) y auto-certeza (C), con similar fiabilidad a la versión americana. Auto-reflexión y el índice R-C correlacionaron con pérdida de insight de la PANSS. En general la EICB se asoció significativamente con subescalas de la PANSS. Los pacientes comunitarios puntuaron significativamente más alto en autoreflexión y el índice R-C que los ingresados y más bajo en autocerteza. Conclusión. Las propiedades psicométricas obtenidas con la versión española adaptada de la EICB garantizan la adecuada evaluación del insight cognitivo (AU)

Introduction. The Beck Cognitive Insight Scale has been designed to evaluate the cognitive insight capacity, that is to say, the practice of self-reflectiveness as a meta-cognitive mechanism for examining and analysing the disorder’s symptoms, it also permits a continuous reevaluation of inadequate interpretations. Methodology. The aim of this study is to examine the psychometric properties, the dimensional structure and the internal validity of the Spanish version of Beck’s Cognitive Scale of Insight (BCIS). In this paper we also analyse its relation with the Positive and Negative Symptoms Scale (PANSS). The Cognitive Insight Scale was translated and adapted to Spanish with 129 in- and out- schizophrenic patients. Results. Principal component analysis showed a two factor structure that was similar to the original one, recognizable as self-reflectiveness (R) and self-certainty (C) with similar reliability as the American version. Self-reflectiveness and the R-C index correlated with loss of insight of the PANSS scale. In general, BCIS showed significant associations with the PANSS subscales. Out patients scored self-reflectiveness and R-C index signicantly higher than in-patients and lower in self-certainty. Conclusion: Psychometric properties obtained with the adapted Spanish version of BCIS guarantee the adequate evaluation of cognitive insight (AU)

[Serious mental illness--in a historical perspective]. / Alvorlig sinnslidelse i et historisk perspektiv.

BACKGROUND: The term schizophrenia is being debated worldwide in connection with the updating of current classification systems for mental illness. There is a growing tendency towards a more uniform and dimensional way of thinking, where it is recognised that there is a gradual transition between the symptom patterns in the bipolar and schizophrenia spectrum and individual symptoms are manifested in a continuum extending from well to ill. MATERIAL AND METHOD: We have selected some texts from the 1800 s and studied them in the light of the current debate. The purpose of this article is not to explain historical events, and our selection of texts is not claimed to be representative. Rather, we have attempted to bring texts from the past into the current discussion concerning classification and the concept of continuum. RESULTS: In texts from the 1800 s, mental illness was perceived as a spectrum of disorders that ranged from ill to well. Rather than set clear and distinct boundaries between disorders, these authors made it clear that the transitions were gradual. A number of them believed that the different forms taken by mental illness were merely different manifestations of one and the same disorder. INTERPRETATION: Both the manifestations of the illnesses and psychiatrists' diagnostic constructs reflect the practice and thinking of the past. This makes historical reviews fruitful as a backdrop to the current debate.

¿Es mejorable la versión castellana del General Health Questionnaire en escalas (GHQ-28)? / Is there room for improvement in the Spanish version of the scaled General Health Questionnaire (GHQ-28)?

Objetivo: Desarrollar una versión en escalas del GHQ (GHQ-28) para una población de atención primaria de nuestro medio. Diseño:Análisis de componentes principales del GHQ-60 con selección posterior de los 7 ítems con mejores coeficientes en sus 4 primeros componentes. Emplazamiento: 3 centros de atención primaria en el área metropolitana de Bilbao. Participantes: 202 pacientes procedentes de un estudio previo sobre frecuentación asistencial en atención primaria. Mediciones principales: Comparación de la versión del GHQ-28 obtenida y de la canónica respecto a la discriminación entre casos psiquiátricos y no casos, diagnosticados de manera independiente mediante entrevista estructurada. Resultados: La estructura de 2 de las escalas fue similar a la conocida. Las otras 2 presentaron mayor variabilidad, con inclusión de nuevos ítems, y combinaciones de otros previamente asociados a diferentes escalas. No hubo diferencia significativa en la discriminación de casos entre la nueva versión y la previamente validada en nuestro medio (p=0,63). Conclusiones: Las escalas del GHQ-28 más estables son la de disfunción social y depresión. La variabilidad obtenida en las otras 2 escalas pudiera reflejar mejor que la versión previamente validada la sintomatología psiquiátrica inespecífica presente en atención primaria(AU)

Objective: To develop a new scaled GHQ version (GHQ-28) for use in Primary Care in Spain. Design: Principal components analysis of the parental version (GHQ-60) with subsequent selection of 7 items with higher loadings for the first 4 components. Site: Three Primary Care Centres in the metropolitan area of Bilbao. Participants: A total of 202 patients coming from a prior study on frequent visits to Primary Care clinics. Main measurements: Comparison between the new and the authorised version of GHQ-28 in discriminating between psychiatric and non-psychiatric cases, diagnosed independently by psychiatric interview. Results: Whereas the structure of two scales was similar to that described previously, the other two scales showed higher variability with the inclusion of new items and a combination of others previously ascribed to different measurement constructs. No significant difference (P=.63) was observed between both versions regarding their discriminant validity. Conclusions: The most stable GHQ-28 scales were social dysfunction and depression. The variability found among the other scales could be explained by the non-specificity of psychiatric symptoms presented in Primary Care(AU)

[Erik Essen-Möller and the roots of multiaxial classification in psychiatry]. / Erik Essen-Möller und die Wurzeln der Multiaxialen Diagnostik in der Psychiatrie.

Against the background of the preparation of ICD-11 and DSM-V, the historical roots of a multiaxial diagnostic assessment in psychiatry are reviewed. The principles of such an approach are traced back to the Swedish psychiatrist Erik Essen-Möller who had proposed a distinction between aetiological and descriptive aspects in the classification of mental disorders. Furthermore, he suggested to break down the descriptive classification into the cross-sectional psychopathological picture and the clinical course. Nowadays, a multiaxial assessment is used in diagnostic systems such as DSM-IV. However, these current concepts differ considerably from Essen-Möller's suggestions. A return to the original approach of multiaxial diagnostic assessment comprising the axes "syndromes", "course types" and "aetiology" would be in line with current neurobiological findings and may provide a bridge between the traditional categorical diagnostic approach and dimensional models.