A dog model for human psychopathology

The author reviews studies of the development and scientific exploitation of two true-breeding strains of pointer dogs, one of which is basically normal and one of which is nervous, particularly around people. Basic studies, which generally contrast the nervous dogs with the normal dogs, include studies of inheritance, early experience, conditioning, psychophysiology, neuropharmacology, and neurochemistry. The author suggests that the nervous line is an animal model of human psychopathology and probably of cardiac pathology.     

An explanatory model for Munchausen by proxy abuse

OBJECTIVE: In Munchausen by proxy (MBP) abuse, a caretaker fabricates or induces illness in another person to obtain emotional gratification. In representative cases, a mother is the perpetrator and her child is the victim. In view of the limits of current explanatory models, we use personal accounts of MBP perpetrators, physicians, and family members as a window into understanding this counterintuitive behavior. METHOD: As subspecialty clinicians and consultants, we supplemented our extensive direct experience with MBP with a review of published reports of MBP located via MEDLINE and PsycINFO (1980 onward). We also examined the books devoted to the subject and incorporated personal accounts of MBP perpetrators and of family members and professionals involved with them. RESULTS: Factors contributing to the onset and continuation of MBP are the perpetrator's experiencing a particular drive (e.g., intense anger or frustration); lacking or overcoming internal inhibitions against abusive actions; and overcoming external inhibitions, such as the potential intercession of a spouse or pediatrician. As a result, the MBP parent experiences release from unpleasant emotions and a sense of renewed control. MBP behavior gains "habit strength" each time it occurs. CONCLUSIONS: Psychodynamic explanations of MBP, while favored by some authors, are inherently speculative and tend to be low in predictive value. We suggest broadening these traditional explanations by emphasizing observable behaviors and verifiable background factors. The behavioral perspective we outline helps explain how MBP behavior is learned, why it is more prevalent among mothers, and why it is so difficult for perpetrators to stop.     

A dimensional model of psychopathology

The question of whether mental disorders are discrete clinical conditions or arbitrary distinctions along dimensions of functioning is a longstanding issue, but the importance of this question is escalating with the growing recognition of the frustrations and limitations engendered by the categorical model. Researchers are now focusing their attention on developing alternative dimensional models of classification. Concerns have been raised with regard to these dimensional models. Addressed in this brief commentary are two of these concerns: clinical utility and credibility.     

The development of valid subtypes for depression in primary care settings: a preliminary study using an explanatory model approach

A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an "injured self." The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored.     

The psychopathology of choice

The important, often neglected factor of choice, learned in childhood, is examined in detail and illustrated by clinical examples. The primary etiological factors in psychopathology of choice are: (1) Too much choice allowed before integration is possible; (2) Too little choice allowed and (3) Distortions of choice due to racial, sexual, and religious prejudices or cognitive distortions.     

Brain and self: toward a neuropsychodynamic model of ego autonomy and personality

Principles derived from neuropsychology can begin to be applied to the development of heuristic models of complex psychological processes and can thereby contribute to theories of personality and psychopathology. Applications of neuropsychological concepts to the problems of self-knowledge, ego autonomy, and personality integration are discussed. Special reference is made to the role of the frontal lobes in the recursive modulation of behavior and to the verbal functions of the left hemisphere in self-awareness and self-control. Caution against a narrow localizationist conceptualization of human behavior is urged, and suggestions for interdisciplinary rapproachment are offered.     

Measuring the hierarchical general factor model of psychopathology in young adults

There is evidence that models of psychopathology specifying a general factor and specific second‐order factors fit better than competing structural models. Nonetheless, additional tests are needed to examine the generality and boundaries of the general factor model. In a selected second wave of a cohort study, first‐order dimensions of psychopathology symptoms in 499 23‐ to 31‐year‐old twins were analyzed. Using confirmatory factor analysis, a bifactor model specifying a general factor and specific internalizing and externalizing factors fit better than competing models. Factor loadings in this model were sex invariant despite greater variances in the specific internalizing factor among females and greater variances in the general and specific externalizing factors among males. The bifactor structure was robust to the exclusion of any single first‐order dimension of psychopathology. Furthermore, the results were essentially unchanged when all overlapping symptoms that define multiple disorders were excluded from symptom dimensions. Furthermore, the best‐fitting bifactor model also emerged in exploratory structural equation modeling with freely estimated cross‐loadings. The general factor of psychopathology was robust across variations in measurement and analysis.     

The development of a new measure for the assessment of psychopathology in adults with intellectual disability

Background   People with intellectual disability (ID) and untreated psychiatric disorder lead unnecessarily difficult and unhappy lives. The prevalence of mental illness in children and adults with ID is greater than that found in the general population. A carer-completed checklist of psychopathology that could be used with both children and adults would help identify those individuals with ID most likely to have a mental health problem, help ensure that they receive the limited services that are usually available and also assist the process of clinical assessment, diagnosis and management.
Method   This research aimed to develop a reliable and valid carer-completed checklist of psychopathology for adults with ID by redeveloping an existing measure for children with ID, the Developmental Behaviour Checklist (DBC-P). The new checklist, The Developmental Behaviour Checklist for Adults (DBC-A) was devised by changing, deleting and adding to DBC-P items. Reliability studies were conducted with paid and family carers, and DBC-A scores were compared with the results from two other measures of psychopathology.
Results   One DBC-P item was deleted, seven items changed and 12 items added. The psychometric properties of this new checklist, the DBC for Adults with ID (DBC-A), were investigated and found to be satisfactory. Intraclass correlations for test-retest and inter-rater reliability ranged from 0.72 to 0.85, and concurrent validity with two measures of emotional and behavioural disturbance was satisfactory.
Conclusions   The carer-completed DBC-A provides a broad and comprehensive survey of the emotional and behavioural problems of adults with ID. It has satisfactory psychometric properties and therefore can be used with confidence in clinical, research and service settings, and its development allows continuous assessment of psychopathology across the lifespan for all people with ID.     

The psychopathology of 'late schizophrenia'

We investigated the clinical features of schizophrenic syndromes first manifested after the age of 50. By comparison with the schizophrenic syndromes first manifested before the 50th year of life we found: late schizophrenia is characterized by rich psychotic productive syndromes (delusions and hallucinations); disturbances of thought are rare; depression, euphoria and anxiety show no difference between the two groups; females are much more represented than males; social isolation is not more common in late schizophrenia than in non-late schizophrenia.