Current Psychiatry Reviews - Volume 13, Issue 3, 2017

Psicoanalisis Multifamiliar was created by Jorge Garcia Badaracco in Buenos Aires in the programme of some psychiatric hospitals in the middle of the last century (Badaracco, 2000): patients together with their families meet on a regular basis to foster their treatment. The author suggests the translation of «Psicoanalisis multifamiliar» into Multi Family Group Analysis. This kind of groups was introduced in Portugal by the author in 2001. They were added to the treatment programme of a psychiatric Day Hospital in Lisbon. This Day Hospital has got a psychoanalytic and group analytic framework, since 1977. The author and her team have found Group Analysis, its concepts and training, as a very much important tool to manage these complex groups. Therefore the author has proposed the concept of Multi Family Group Analysis. The author will describe the aims, characteristics and evolution of this kind of groups which have been run since 2001 on a fortnight basis. The basic concepts which underlie them will be referred as well as the results. The author and her team consider that this group is an important therapeutic and prophylactic tool as well as a way of a pre and post graduate training.

Despite its psychoanalytic origins, the author situates the emergence of the therapeutic community within divergent traditions. He theorizes the therapeutic community as both a ‘place’ and a space at the centre of which is an absence (the un-conscious). This absence is the foundation of the Symbolic. The culture of each community is embodied in specific rituals and customs which represent the Law (Oedipus). And the position the subject adopts in relation to the rules and boundaries in the community always refers us back to his or her singular history. It is here, for the subject of psychosis, that the spectre of the fragmented body emerges, within a psychic homelessness. In the therapeutic community, the boundary between the inside and the outside is inscribed not just in the spatial location but also by the relationships between members of the group.

Research has shown that hallucinations and delusions (characteristic of severe mental disorders) are relatively common. Many people in the general population will experience mild instances of such events at some point in their lives. However, for others, these are very disturbing events. Cognitive-behavioural models argue that these differences result from the interpretation of those same experiences. Therefore, cognitive behavioural therapy seeks to know the factors that contribute to the development (e.g. early traumatic experiences) and maintenance (e.g. selective attention, safety behaviours, disruptive control strategies) of psychotic processes, from the deep and isolated understanding of each patient's experience of specific symptoms (e.g. paranoid delusions) rather than their syndromal diagnosis (e.g. schizophrenia). The case formulation for each complex psychotic symptom results from the initial intake assessment at the start of a prospective intervention. This article reviews the cognitive behavioural conceptualization of psychotic symptoms (i.e. auditory hallucinations, delusions and negative symptoms), as well as the key areas of assessment and therapeutic interventions proposed by these models.

This article presents the emergent approach of personalized assessment in mental health care, which combines standardized patient reported outcome measures (PROMs) with individualized measures (I-PROMs). Each patient has a unique clinical condition, with a set of problems and presentations specific to his or her person and circumstances. I-PROMs inform clinicians about idiosyncratic problems that cannot be captured in pre-set standardized PROMs, thus tailoring assessment to the person, and accomplishing the requirements of patient-centred outcomes assessment. Implications for managed care systems are discussed.

Background: In recent years, there have been significant advancements in understanding the etiology, assessment, and treatment of borderline personality disorder [BPD]. However, the influence of culture has not been carefully considered. The present review is an attempt to identify cultural factors that may change the presentation, assessment, and response to treatment among adults and adolescents with BPD. Discussion: We discuss the relevance of examining the BPD diagnosis across cultures, define culture, and review studies on the prevalence of BPD across sociocultural groups. Conclusion: We provide a comprehensive list of assessments developed to capture BPD and the cultural adaptations and validations attempted thus far. We also summarize the evidence base for culturally sensitive treatments for BPD. Finally, we present suggestions for future research and clinical implications for our findings.

The number of people diagnosed with Alzheimer's disease (AD) is expected to increase substantially in the near future. In the recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the terminology related to AD has shifted from “dementia” to major or mild “neurocognitive disorder”, emphasizing the cognitive impairment that occurs relatively early in the disease process. The concept of “mild neurocognitive disorder” or “mild cognitive impairment” promotes early detection and diagnosis of AD, particularly by psychiatrists, who often consult the DSM-5. This narrative review describes the current and future role of psychiatrists in the diagnosis and management of AD, focusing on the DSM-5 criteria for mild and major neurocognitive disorder. We summarize some of the key instruments used to assess cognition and the neuropsychiatric and behavioral symptoms that often accompany early AD, neuroimaging diagnostic tools, and newly available AD-specific biomarkers that enhance the ability of clinicians to diagnose early AD. We also briefly describe current and emerging pharmacological treatments for AD that target amyloid and tau and that may modify disease progression. Finally, we provide our clinical opinion on the future role of psychiatrists in AD, the education and training necessary to fulfil this role, interactions between psychiatrists and other specialists as part of a multidisciplinary team, and the potential for routine screening of cognitive function among elderly people.