Assessing irritability in patients with stroke: psychometric properties of the Irritability Questionnaire

Objective: Irritability is a very common symptom after stroke and a source of a great deal of distress to patients and caretakers. We evaluated the psychometric properties of the Irritability Questionnaire (IQ) in a sample of patients with stroke.Methods: we recruited 94 participants (47 stroke patients and 47 healthy controls) that participated in a 6-month longitudinal observational study. The IQ includes three dimensions in the assessment: emotion, cognition, and behavior. IQ has two subscales: The Irritability Questionnaire (IRQ) and the Carer's Irritability Questionnaire (CIRQ). Internal consistency, convergent validity, and sensitivity to change were evaluated for both IRQ and CIRQ.Results: Cronbach's alpha for the IRQ was 0.91 (95% CI: 0.76 to 0.87), whereas for the CIRQ was 0.92 (95% CI: 0.89 to 0.94). Convergent validity was good for both subscales. IRQ did not show sensitivity to change at 6 months (p-value = 0.99), while CIRQ showed moderate changes (-0.29, p-value = 0.124).Conclusions: IQ presented good psychometric properties to assess irritability in stroke. The tool detected significant differences between groups (stroke and healthy controls) and can be considered a valid instrument for clinical and research purposes.

Trail Making Test in traumatic brain injury, schizophrenia, and normal ageing: sample comparisons and normative data

The Trail Making Test (TMT) has been a useful assessment tool to investigate executive function. Several studies have recently improved the existing TMT norms by mean of large samples of healthy individuals stratified by a number of demographic variables from different populations. In contrast, criticisms have been raised about the utility of norms from healthy samples to detect changes across time in clinical samples where TMT performance used to be altered. In addition, few studies have compared groups of patients with deficits in TMT performance, making it difficult to decide whether a single set of norms is sufficient to assess different clinical populations. We provide normative data from three large samples of patients with traumatic brain injury (TBI) (n=90), schizophrenia spectrum disorders (n=127), and healthy Spanish speakers (n=223). Differences between healthy participants and patients in all TMT direct (TMT-A, TMT-B) and derived (B-A, B:A, B-A/A) scores were found. TMT performance was poorer in TBI patients than in schizophrenia patients except for the B:A and B-A/A scores, suggesting a similar underlying executive deficit. Normal ageing impaired both direct and derived TMT indices, as revealed by lower scores in the healthy elderly group (55-80 years old) as compared with young (16-24) and middle-aged (25-54) healthy participants. Three different sets of norms stratified by age, education, or both are presented for clinical use. Recommendations on TMT scores are made for future research.

[Organic personality disorder: conceptual review and research strategies]

The historical review of "psychiatric personality disorders" reveals the lack of convergence of those disorders with the organic personality disorder (OPD). Only the psychopathy concept has been used as a psychopathological phenotype for one of the groups of OPD, the so-called "pseudopsychopaths". These patients have been described from the beginning of the XXth century under the heading of "frontal lobe syndrome". It was only with the development of the psychiatric nosologies, towards the middle of the XXth century, that the term "organic personality disorder" started to be used. The accumulation of knowledge about the different prefrontal areas and the development of neuropsychological models that try to explain social behavior have opened new ways of understanding this syndrome. The orbitofrontal cortex has been identified as one of the key structures in behavioral and emotional regulation. Recognition of emotions in voices and faces, empathy, appreciation of humor, tasks that show "theory of mind" are some of the dimensions included in the examination of the non-cognitive functions of the prefrontal cortex

[Organic personality disorder. Conceptual and diagnostic aspects]

INTRODUCTION

Probably the commonest neuropsychiatric sequela in persons who have had some type of cerebral lesion (of whatever origin) are the complaints of changes in the personality of the patient prior to the lesion which cause problems with the family, socially and at work. These problems have been grouped together under the same diagnosis in current psychiatric nosology called 'organic personality disorder'.

DEVELOPMENT

In this article we wish to point out the disadvantages due to this diagnosis which have a double origin. Firstly, it is based on the concept of personality, which has been shown to be inconsistent throughout the history of science. Secondly, because this group contains heterogeneous phenomena and conducts which are probably based on different neurobiological processes.

CONCLUSION

The development of strategies of investigation, and of effective therapeutic techniques for these patients make it necessary to separate the different phenomena which, in the author's opinion, are erroneously included in this nosological group.

Andre G. Ombredane and the psychiatry of multiple sclerosis: a conceptual and statistical history

By means of conceptual history and statistical analysis of historical data, this report shows that studies into the psychiatry of multiple sclerosis (MS) underwent a qualitative improvement between the Great War and the publication of A.G. Ombredane's great work. Analysis of his database, collected 60 years ago, shows that some of his conclusions (later to be influential) were unwarranted, but that, on the other hand, it enshrined hidden information showing a relative independence between euphoria (and other affective changes) and chronicity and illness duration. An earlier knowledge of this point might have had a corrective effect on later claims about the neuropsychiatry of MS.

Depressive illness in multiple sclerosis. Clinical and theoretical aspects of the association

The present state of knowledge of the possible relationship between depressive illness and multiple sclerosis is described. Problems of the research methodology are identified and suggestions made for useful areas of inquiry.