Cut-off scores for mild and moderate dementia on the Addenbrooke's Cognitive Examination-III and the Mini-Addenbrooke's Cognitive Examination compared with the Mini-Mental State Examination

AIMS AND METHOD

We aimed to establish cut-off scores to stage dementia on the Addenbrooke's Cognitive Examination-III (ACE-III) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) compared with scores traditionally used with the Mini-Mental State Examination (MMSE). Our cross-sectional study recruited 80 patients and carers from secondary care services in the UK.

RESULTS

A score ≤76 on the ACE-III and ≤19 on the M-ACE correlated well with MMSE cut-offs for mild dementia, with a good fit on the receiver operating characteristic analysis for both the ACE-III and M-ACE. The cut-off for moderate dementia had lower sensitivity and specificity. There were low to moderate correlations between the cognitive scales and scales for everyday functioning and behaviour.

CLINICAL IMPLICATIONS

Our findings allow an objective interpretation of scores on the ACE-III and the M-ACE relative to the MMSE, which may be helpful for clinical services and research trials.

Latent profiles identified from psychological test data for people convicted of sexual offences in the UK

BACKGROUND

One size does not fit all in assessment and intervention for people with convictions for sexual offences. Crime scene indicators and risk-related variables have been used to identify distinct clusters of people with convictions for sexual offences, but there is a need for more robust typologies that identify clusters based on psychologically meaningful risk factors that can be targeted in treatment.

AIMS

To use robust modelling techniques to identify latent profiles of people with convictions for sexual offences based on indicators of dynamic risk.

METHOD

Adult male participants, who had been convicted for sexual offences and assessed for eligibility for the prison-based Core Sex Offender Treatment Programme delivered by His Majesty's Prison and Probation Service (UK), were randomly allocated to a test (n = 1577: 70.2%) or validation (n = 668: 29.8%) data-set. Exploratory factor analysis (EFA) was used to select measures of dynamic risk from psychological test data. EFA indicated four factors, from which six measures were selected for inclusion in latent profile analysis.

RESULTS

Five latent profiles were identified in the test and validation data-sets. These were labelled low psychological impairment, impulsive, distorted thinker, rape preoccupied and child fantasist. Profiles varied in individual characteristics, offence histories, victim preferences and level of risk.

CONCLUSIONS

Our findings should be used to guide assessment and intervention practices that are tailored to distinct psychological profiles consistent with principles of risk, need and responsivity.

Gender bias in autism screening: measurement invariance of different model frameworks of the Autism Spectrum Quotient

BACKGROUND

The Autism Spectrum Quotient is a popular autism screening tool recommended for identifying potential cases of autism. However, many women with autism demonstrate a different presentation of traits to those currently captured by screening measures and assessment methods, such as the Autism Spectrum Quotient.

AIMS

Different models of the Autism Spectrum Quotient have been proposed in the literature, utilising different items from the original 50-item scale. Within good-fitting models, the current study aimed to explore whether these items assess autistic traits similarly across men and women.

METHOD

Seventeen Autism Spectrum Quotient models were identified from the literature. Using the responses of a large sample of adults from the UK general population (5246 women, 1830 men), confirmatory factor analysis was used to evaluate the fit of each model. Measurement invariance with respect to gender, adjusting for age, was explored in the 11 model frameworks that were found to have satisfactory fit to our data.

RESULTS

It emerged that only two items were gender invariant (non-biased), whereas for the remaining items, the probability of endorsement was influenced by gender. In particular, women had a higher probability of endorsing items relating to social skills and communication.

CONCLUSIONS

If the items of the Autism Spectrum Quotient indeed reflect autism-related traits, those items should be rephrased to ensure they do not present a gender-related bias. This is vital for ensuring more timely diagnoses and support for all people with autism.

Measuring Vulnerability in Grief: The Psychometric Properties of the Italian Adult Attitude to Grief Scale

Although experiences of loss and the consequent grief are natural in human life, some individuals may have difficulty managing these events, to the point of developing significant impairment in their functioning in important life areas. Given this, the present research aimed to explore the psychometric properties of the Italian version of the Adult Attitude to Grief scale (AAG) to facilitate research on adult vulnerability to grief among Italian-speaking populations. A sample of 367 participants (M_age = 30.44, SD = 11.21; 78% females) participated in this research. A back-translation procedure was implemented to develop the Italian AAG. Then, participants completed the Italian AAG alongside a battery of other self-report psychometric scales in order to assess aspects of the construct validity of the AAG: the Forty-Item Defense Style Questionnaire, the Impact of Event Scale-Revised, and the Beck Depression Inventory-II. A bifactor structure was found to have the best fit to the data, supporting the possibility of using both the general factor (i.e., vulnerability) and three dimensions (i.e., overwhelmed, controlled, and resilient). Unlike the original version, the control dimension emerged as a "protective" factor in the Italian population, together with the resilient factor. Furthermore, results provided satisfactory indications of internal consistency and construct validity. In conclusion, the Italian AAG was shown to be a valid, reliable, quick, and easy-to-use scale that can be used both for research and clinical practice in the Italian context.

The Brain Medicine Clinic: two cases highlighting the advantages of integrative care

BACKGROUND

Current assessment and management models often do not adequately address the many aspects of managing complex brain disorders involving disordered affect, behaviour and cognition (ABC). A more collaborative model of care, where several specialties can jointly assess and manage patients with complex brain disorders, is gaining attention.

AIMS

In this case report, we present two cases that highlight the benefits of the 'brain medicine' clinical model.

METHOD

The Brain Medicine Clinic employs an integrated clinical model in which psychiatrists and neurologists provide integrated interdisciplinary assessments of patients with complex brain disorders, leading to comprehensive assessment. We describe the clinical model and the trajectories of two patients with complex brain disorders seen in this clinic. In these case descriptions, we explain how the brain medicine clinical approach leads to an improved patient experience.

RESULTS

The Brain Medicine Clinic assessments resulted in a neurobiopsychosocial formulation of symptoms and, consequently, holistic individualised treatment plans for two patients with complex brain disorders. This approach to patients' conditions emerges from the understanding that there are multifactorial causes of brain disorders at the social, cultural, psychological and biological level.

CONCLUSIONS

Integrated interdisciplinary assessments allow for tailored treatment plans for individuals experiencing complex brain disorders, while creating efficiencies for the patient and the healthcare system.

Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country

BACKGROUND

A critical step in research on the epidemiology of post-traumatic stress disorder (PTSD) in low-resource settings is the validation of brief self-reported psychometric tools available in the public domain, such as the Impact Event Scale - Revised (IES-R).

AIMS

We aimed to investigate the validity of the IES-R in a primary healthcare setting in Harare, Zimbabwe.

METHOD

We analysed data from a survey of 264 consecutively sampled adults (mean age 38 years; 78% female). We estimated the area under the receiver operating characteristic curve and sensitivity, specificity and likelihood ratios for different cut-off points of the IES-R, against a diagnosis of PTSD made using the Structured Clinical Interview for DSM-IV. We performed factor analysis to evaluate construct validity of the IES-R.

RESULTS

The prevalence of PTSD was 23.9% (95% CI 18.9-29.5). The area under the curve for the IES-R was 0.90. At a cut-off of ≥47, the sensitivity of the IES-R to detect PTSD was 84.1 (95% CI 72.7-92.1) and specificity was 81.1 (95% CI 75.0-86.3). Positive and negative likelihood ratios were 4.45 and 0.20, respectively. Factor analysis revealed a two-factor solution, with both factors showing good internal consistency (Cronbach's factor-1 α = 0.95, factor-2 α = 0.76). In a post hoc analysis, we found the brief six-item IES-6 also performed well, with an area under the curve of 0.87 and optimal cut-off of 15.

CONCLUSIONS

The IES-R and IES-6 had good psychometric properties and performed well for indicating possible PTSD, but at higher cut-off points than those recommended in the Global North.

Psychological Testing in Forensic Contexts Conducted Remotely

The use of videoconferencing technology to conduct forensic psychiatric and forensic psychological evaluations remotely has grown considerably in the last decade. This commentary addresses a number of points made by Recupero regarding the use of remote technology to conduct forensic psychiatric evaluations. These points include the research supporting telepsychiatry and its generalizability to forensic assessment, the error rate associated with remote forensic assessment, and its general acceptance in the field. The commentary also considers the inclusion of psychological testing and specialized forensic measures in forensic assessment and describes criteria for considering tests and measures that can reasonably be included in a remotely conducted forensic assessment.

Does folic acid supplementation have a positive effect on improving memory? A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

The results of randomized controlled trials (RCTs) on the effect of folic acid supplementation on memory status due to various heterogeneity, dosage, duration, and cognitive function assessments were inconclusive. Therefore, we have performed a systematic review and meta-analysis to investigate the effect of folic acid supplementation on memory in RCTs.

METHOD

Comprehensive computerized systematic searches were conducted throughout Scopus, PubMed/Medline, and Google Scholar from inception until February 2022 to investigate the effect of folic acid supplementation memory levels in RCTs. The standardized mean difference (SMD) and 95% confidence interval (CIs) were used to estimate the overall effect size using random-effects meta-analyses.

RESULTS

The overall results of nine trials with 641 participants, revealed that folic acid supplementation did not significantly change memory score compared to placebo (SMD: 0.12; 95% CI: -0.17, 0.40, p = 0.418; I 2 = 62.6%). However, subgroup analyses showed that supplementation with folic acid had favorable effects on memory levels considering the following conditions: (1) doses lower than 1 mg/day, (2) treatment lasting more than 6 months, (3) conducted in eastern countries, and (4) in participants equal to or older than 70 years old. The dose-response analysis suggested a significant favorable effect on memory status at doses of 6-11 mg/d and a significant decline at doses of 17-20 mg/d.

DISCUSSION

Although we did not find a significant effect of folic acid supplementation on memory, there were some suggestions of beneficial effects in the subgroup analyses.

The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment

BACKGROUND

A variety of information sources are used in the best-evidence diagnostic procedure in child and adolescent mental healthcare, including evaluation by referrers and structured assessment questionnaires for parents. However, the incremental value of these information sources is still poorly examined.

AIMS

To quantify the added and unique predictive value of referral letters, screening, multi-informant assessment and clinicians' remote evaluations in predicting mental health disorders.

METHOD

Routine medical record data on 1259 referred children and adolescents were retrospectively extracted. Their referral letters, responses to the Strengths and Difficulties Questionnaire (SDQ), results on closed-ended questions from the Development and Well-Being Assessment (DAWBA) and its clinician-rated version were linked to classifications made after face-to-face intake in psychiatry. Following multiple imputations of missing data, logistic regression analyses were performed with the above four nodes of assessment as predictors and the five childhood disorders common in mental healthcare (anxiety, depression, autism spectrum disorders, attention-deficit hyperactivity disorder, behavioural disorders) as outcomes. Likelihood ratio tests and diagnostic odds ratios were computed.

RESULTS

Each assessment tool significantly predicted the classified outcome. Successive addition of the assessment instruments improved the prediction models, with the exception of behavioural disorder prediction by the clinician-rated DAWBA. With the exception of the SDQ for depressive and behavioural disorders, all instruments showed unique predictive value.

CONCLUSIONS

Structured acquisition and integrated use of diverse sources of information supports evidence-based diagnosis in clinical practice. The clinical value of structured assessment at the primary-secondary care interface should now be quantified in prospective studies.

Cultural modification of neuropsychiatric assessment: complexities to consider

Cognitive screening tests are culture bound and have been shown to perform differently depending on the culture, even with adequate translation. Khan et al examine in detail ways in which the Montreal Cognitive Assessment (MoCA) has been modified for different languages and cultures and produce a systematic guide for future modifications. However, questions arise regarding the availability of the MoCA. Other important issues in the transcultural use and modification of neuropsychiatric tests include providing a culturally safe context for testing, understanding the cultural context in which screening takes place and assessing other neuropsychiatric conditions, which may manifest differently in different cultural contexts and which affect cognition.

Increased suicidal ideation in the COVID-19 pandemic: an employee cohort in Japan

OBJECTIVES

This study investigated the change in suicidal ideation and its risk factors among employees. A longitudinal cohort study was conducted, starting with the baseline online survey in March 2020 (T1), followed by May (T2), and August (T3). The change in suicidal ideation from T2 to T3 and relevant factors associated with suicidal ideation at T3 were examined. Suicidal ideation significantly increased between May and August 2020 among females, younger (under 39 years old), highly educated population, and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at T2, and with pre-existing mental health conditions. Loneliness at T2 showed a significant association with suicidal ideation, if adjusting those without pre-existing mental health conditions. National and community support is needed to target people who are likely to be left behind, such as young people and those with pre-existing mental health conditions, in the pandemic.

METHOD

A longitudinal study was conducted with a cohort of full-time employees, starting with the baseline online survey in March 2020 (time point 1), followed by May (time point 2) and August (time point 3). The change in suicidal ideation from time point 2 to 3, and relevant factors associated with suicidal ideation at time point 3, were examined.

RESULTS

Suicidal ideation significantly increased between time points 2 and 3 among women, younger people (aged <39 years), those who were highly educated and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at time point 2 and pre-existing mental health conditions. Loneliness at time point 2 showed a significant association with suicidal ideation when adjusting for those without pre-existing mental health conditions.

CONCLUSIONS

National and community support is needed to target people who are likely to be left behind, such as young people, those with pre-existing mental health conditions and those experiencing loneliness, in the COVID-19 pandemic.

Long-term trajectory of cognitive performance in people with bipolar disorder and controls: 6-year longitudinal study

BACKGROUND

Cross-sectional studies have found impaired cognitive functioning in patients with bipolar disorder, but long-term longitudinal studies are scarce.

AIMS

The aims of this study were to examine the 6-year longitudinal course of cognitive functioning in patients with bipolar disorder and healthy controls. Subsets of patients were examined to investigate possible differences in cognitive trajectories.

METHOD

Patients with bipolar I disorder (n = 44) or bipolar II disorder (n = 28) and healthy controls (n = 59) were tested with a comprehensive cognitive test battery at baseline and retested after 6 years. We conducted repeated measures ANCOVAs with group as a between-subject factor and tested the significance of group and time interaction.

RESULTS

By and large, the change in cognitive functioning between baseline and follow-up did not differ significantly between participants with bipolar disorder and healthy controls. Comparing subsets of patients, for example those with bipolar I and II disorder and those with and without manic episodes during follow-up, did not reveal subgroups more vulnerable to cognitive decline.

CONCLUSIONS

Cognitive performance remained stable in patients with bipolar disorder over a 6-year period and evolved similarly to healthy controls. These findings argue against the notion of a general progressive decline in cognitive functioning in bipolar disorder.

Development of a valid psychological scale for youth police selection among young unemployed and excluded persons: The Nemesis scale

BACKGROUND

Youth, unemployment and poverty confirm a set of situations that are often inseparable. An example of this is the case of young people from the Andean coca areas.

OBJECTIVE

To develop and validate a psychological test that can be used as a predictor of adequate police performance for use in police force recruitment.

METHODS

The study comprised a sample of 713 young people, who were selected to join a pre-police training program designed to allow them to subsequently join the Peruvian police force. A new 200-item instrument, called Nemesis, was created. Derogatis' SCL-90 test was administered to determine the validity of the new instrument. The suitability of the items for the future questionnaire was determined through factor analysis, which reduced the questionnaire to 14 items. Logistic regression was used to determine whether the items on the scale could predict possible admittance into the police training academy.

RESULTS

A statistical regression analysis showed that the global percentage of correct predictions exceeded chance by almost 15%. Based on this analysis, the scale was determined to be valid.

CONCLUSIONS

The proposed objective of verifying the psychometric properties of the Nemesis scale was fulfilled, as the scale has adequate reliability and validity.

Encouraging recruitment into psychiatry: practical initiatives

This article highlights key findings from a recent Royal College of Psychiatrists project showing that many UK medical schools are embracing the dual challenge of raising students' interest in psychiatry and ensuring that all doctors can support patients with mental illness. It focuses on two novel approaches to boosting recruitment into psychiatry: I'm a Medic Get Me Out of Here, an online outreach activity enabling schoolchildren to ask questions of health professionals in real time; and a living library, which creates a safe space for dialogue where topics are discussed openly between human books (professionals) and readers (undergraduate students) to challenge stereotypes. It is recommended that sharing these and other examples of good practice will help all medical schools encourage recruitment in psychiatry more widely.

A biopsychosocial interpretation of the Neuropsychiatric Inventory - Nursing Home assessment: reconceptualising psychiatric symptom attributions

BACKGROUND

The Neuropsychiatric Inventory (NPI) is predicated on the assumption that psychiatric symptoms are manifestations of disease. Biopsychosocial theories suggest behavioural changes viewed as psychiatric may also arise as a result of external behavioural triggers. Knowing the causes of psychiatric symptoms is important since the treatment and management of symptoms relies on this understanding.

AIMS

This study sought to understand the causes of psychiatric symptoms recorded in care home settings by investigating qualitatively described symptoms in Neuropsychiatric Inventory-Nursing Home (NPI-NH) interviews.

METHOD

The current study examined the NPI-NH interviews of 725 participants across 50 care homes. The qualitatively described symptoms from each of the 12 subscales of the NPI were extracted: 347 interviews included at least one qualitatively described symptom (n = 651 descriptions). A biopsychosocial algorithm developed following a process of independent researcher coding (n = 3) was applied to the symptom descriptions. This determined whether the description had predominantly psychiatric features, or features that were cognitive or attributable to other causes (i.e. issues with orientation and memory; expressions of need; poor care and communication; or understandable reactions).

RESULTS

Our findings suggest that the majority (over 80%) of descriptions described symptoms with features that could be attributable to cognitive changes and external triggers (such as poor care and communication).

CONCLUSIONS

The finding suggest that in its current form the NPI-NH may over attribute the incidence of psychiatric symptoms in care homes by overlooking triggers for behavioural changes. Measures of psychiatric symptoms should determine the causes of behavioural changes in order to guide treatments more effectively.

Baseline predictors of cognitive change in the treatment of major depressive episode: systematic review

BACKGROUND

Cognitive impairment is a core feature of depression and has a negative effect on a person's functioning, in psychosocial and interpersonal areas, and on workforce performance. Cognitive impairment often persists, even with the remittance of mood symptoms. One potential way of improving treatment of cognitive impairment would be to identify variables that predict cognitive change in patients with depression.

AIMS

To systematically examine findings from studies that investigate baseline variables and how they predict, or correlate with, cognitive change in mood disorders, and to examine methodological issues from these studies.

METHOD

Studies that directly measured associations between at least one baseline variable and change in cognitive outcome in patients with current major depressive episode were identified using PubMed and Web of Science databases. Narrative review technique was used because of the heterogeneity of patient samples, outcome measures and study procedures. The review was registered on PROSPERO with registration number CRD42020150975.

RESULTS

Twenty-four studies met the inclusion criteria. Evidence from the present review for prediction of cognitive change from baseline variables was limited for demographic factors, with some preliminary evidence for depression, cognitive and biological factors. Identification of patterns across studies was difficult because of methodological variability across studies.

CONCLUSIONS

Findings from the present review suggest there may be some baseline variables that are useful in predicting cognitive change in mood disorders. This is an area warranting further research focus.

Effect of acute citalopram on self-referential emotional processing and social cognition in healthy volunteers

BACKGROUND

Depression is characterised by negative views of the self. Antidepressant treatment may remediate negative self-schema through increasing processing of positive information about the self. Changes in affective processing during social interactions may increase expression of prosocial behaviours, improving interpersonal communications.

AIMS

To examine whether acute administration of citalopram is associated with an increase in positive affective learning biases about the self and prosocial behaviour.

METHOD

Healthy volunteers (n = 41) were randomised to either an acute 20 mg dose of citalopram or matched placebo in a between-subjects double-blind design. Participants completed computer-based cognitive tasks designed to measure referential affective processing, social cognition and expression of prosocial behaviours.

RESULTS

Participants administered citalopram made more cooperative choices than those administered placebo in a prisoner's dilemma task (β = 20%, 95% CI: 2%, 37%). Exploratory analyses indicated that participants administered citalopram showed a positive bias when learning social evaluations about a friend (β = 4.06, 95% CI: 0.88, 7.24), but not about the self or a stranger. Similarly, exploratory analyses found evidence of increased recall of positive words and reduced recall of negative words about others (β = 2.41, 95% CI: 0.89, 3.93), but not the self, in the citalopram group.

CONCLUSIONS

Participants administered citalopram showed greater prosocial behaviours, increased positive recall and increased positive learning of social evaluations towards others. The increase in positive affective bias and prosocial behaviours towards others may, at least partially, be a mechanism of antidepressant effect. However, we found no evidence that citalopram influenced self-referential processing.

Psychological assessment of gestational carrier candidates: current approaches, challenges, and future considerations

The role of a mental health professional (MHP) in the psychological assessment of gestational carrier (GC) candidates has evolved over time, with clinical practices well established in the United States. Current ASRM guidelines recommend that all GC candidates undergo a psychosocial consultation and psychological testing (where deemed appropriate). Practice standards are relatively consistent among mental health disciplines, with assessments typically involving a clinical interview and the administration of a single, objective, self-report personality inventory. Although recent studies have established normative data for GCs, there has been little research into which assessment protocols are best suited to answer the referral questions of interest. Current challenges for MHPs placed in a gate-keeping role include providing a thorough screening using measures that typically yield defensive profiles that make them difficult to interpret. Research is emerging that suggests that using a multimethod approach in the psychological assessment of GCs may yield a more comprehensive psychological profile of GC candidates. This could allow MHPs to determine psychological appropriateness with more confidence and contribute additional data to be used in pre-surrogacy counseling. Assessing the psychological appropriateness of a woman to serve as a GC is a complex process, and there are a multitude of factors that must be considered, not the least of which are the psychological well-being of a potential GC, her partner, and her children throughout the process and beyond.

Understanding cognitive impairment in mood disorders: mediation analyses in the UK Biobank cohort

BACKGROUND

Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.

AIMS

To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.

METHOD

Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.

RESULTS

Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease.

CONCLUSIONS

In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.

DECLARATION OF INTEREST

I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.

Cultural Adaptation of the Modified Version of the Conflicts Tactics Scale (M-CTS) in Mexican Adolescents

Several scales are used in Dating Violence studies assuming cross-cultural invariance and equivalence of the measures without making the proper validation in the intended populations. This study focuses on the importance of adapting existing dating violence psychological instruments (as the widely recognized Modified Version of the Conflict Tactics Scale, M-CTS) in diverse adolescent populations adjusting to international validation procedures that ensure the cultural fit of the instrument and the measurement invariance of the construct. We sought to adapt the M-CTS in Mexican adolescents (N = 1861; 57.5% woman) following the ITC Guidelines for Translating and Adapting Test. We made an analysis of the linguistic and cultural variables, followed by a Confirmatory Factor Analysis, and the evaluation of Construct and Known Groups Validities. We culturally modified six items and verified the four-factorial structure of the questionnaire proposed in previous studies (argumentation, psychological aggression, mild physical aggression, and sever physical aggression). We also found significant correlations in between the scores of the M-CTS and the Aggression Questionnaire (AQ) and the Dominating and Jealous Tactics Scale (DJTS), verifying the Construct Validity of the M-CTS to measure aggressive behaviors. Conclusion: the cultural adaptation of the M-CTS offered adequate reliability and validity scores in Mexican population expanding the possibilities of comparing prevalences of the problem between nations with a reliable instrument based on the same theoretical and methodological perspectives.

A clinical guide to assessing level of ego development using psychological testing

This article presents a clinical guide for relating psychological test findings from the Minnesota Multiphasic Personality Inventory-2 and Rorschach Technique to various levels of ego development. The original three validity and 10 clinical scales from the MMPI and a selected group of traditional determinants from the Rorschach are employed. Expected testing results from these instruments are derived from both the authors' clinical experience and the research literature. These results are presented along a continuum of nine levels of ego development and their associated disorders. The nine levels of ego development are "normal" neurotic, neurotic trait, and neurotic symptom organization; high-, mid-, and low-level borderline organization; and affective, cognitive-affective, and cognitive psychotic organization. The relationships between typical testing responses and indices of personality functioning at each level of ego development would hopefully facilitate accurate diagnosis, which in turn would result in more effective treatment planning.

The Adult Eating Behaviour Questionnaire in a bariatric surgery-seeking sample: Factor structure, convergent validity, and associations with BMI

The aim of this study was to validate the Adult Eating Behaviour Questionnaire (AEBQ), a measure of food approach and avoidant traits, for use in bariatric surgery candidates. Participants were 337 bariatric surgery candidates in the Mid-Atlantic United States. Confirmatory factor analysis suggested that one item did not load onto its original factor. A 34-item, eight-factor model had better fit than a seven-factor model; dropping the Hunger factor, as previously suggested, did not improve fit. The factors had good internal consistency and showed convergent/divergent validity with an existing measure of food approach traits. The emotional overeating scale was positively correlated with BMI at programme entry, whereas the slow eating scale was negatively correlated with baseline weight. The AEBQ scales had the same pattern of intercorrelations and similar means to those of two previously published samples. The AEBQ is a valid measure of appetitive traits in bariatric candidates.

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La catégorie de psychose débutante fait partie des classifications médicales usuelles, à la fois au seuil des savoirs qui constituent l'ossature du champ de la santé mentale, et catégorie normative, susceptible de donner une signification médicale à un ensemble de conduites d'abord identifiées comme bizarreries de comportements, propos, émotions et états mentaux étranges, puis requalifiées en tant que prodromes d'une maladie mentale. De plus, elle fait l'objet de nombreuses publications depuis les années 1990, sans que l'on sache quelles furent vraiment les pratiques de santé dans le passé, avant d'être un objet de protocoles standardisés de recherche, de prévention et de soin. En nous appuyant principalement sur les archives de l'Hôpital de Bonneval, et en établissant des rapprochements et des différences avec d'autres hôpitaux français et allemands dans les années 1950 à 1980, nous donnons des exemples de son maniement dans la clinique, à partir d'un type de sources encore peu utilisées dans l'histoire de la seconde moitié du 20e siècle, les dossiers médicaux. Ce cadre étant posé, nous procédons à l'analyse des enchaînements entre les certificats, les premiers entretiens cliniques, le récit d'anamnèse, la construction du diagnostic, les indications de traitement, le pronostic, etc., autant d'indices diachroniques qui offrent un lieu d'observation des savoirs et savoir-faire impliqués – ou pas. En effet, il ne s'agit pas tant ici d'évaluer l'impact de certaines doctrines que d'examiner quels sont les signes cliniques et les dichotomies conceptuelles sur lesquels les cliniciens s'appuient, et de questionner l'usage d'outils comme les tests psychologiques. On peut alors dégager le constat que la clinique n'est pas seulement une production de signes objectifs, mais que les symptômes subjectifs font aussi partie des pratiques de santé en psychiatrie, à partir du moment où elle en fait une catégorie normative, intermédiaire entre des conduites atypiques et un diagnostic caractérisé, comme la schizophrénie.

Tests, testing, and tested - we need to critically evaluate the meaning of tests in psychiatry

This article describes clinical pitfalls in our concepts of what it means for an illness, diagnosis, or evaluation and treatment methods to say that they have been "tested". This articles begins with the problems encountered in newborn testing for Krabbe Disease of the nervous system in New York State over the last few years as an example of a test that did not live up to its promise to help the society. Next, the article gives 3 examples of testing in psychiatry, 1. Psychological testing to make treatment decisions in children with depression, 2. Patient's and parents who have been told, or believe, that they have Asperger's disorder, and 3. The conclusions made about the efficacy of cognitive behavioral therapy based on clinical studies. The article's conclusion sums up these examples as reasons why we need to have a more practical and scientific approach to our understanding and implementation of tests used in our field.