Udviklingspsykopatologien og den transaktionelle udviklingsmodel introduceret og diskuteret i relation til tidlig udvikling og risiko

Denne artikel giver en generel introduktion til basale begreber og antagelser fra udviklingspsykopatologien. Artiklen præsenterer også den transaktionelle udviklingsmodel, som er central for den forståelse af udviklingsprocesser – både sunde og patologiske, der gør sig gældende inden for udviklingspsykopatologien. Begreberne og modellen eksemplificeres og diskuteres primært i relation til undersøgelser og viden fra spæd- og småbørnsområdet vedrørende tidlig udvikling og risiko. Afslutningsvis belyser artiklen, hvordan udviklingspsykopatologien og den transaktionelle udviklingsmodel kan fungere som en konstruktiv forståelsesramme for tidlige forebyggende og sundhedsfremmende indsatser. Der peges på, at den kliniske forskning i behandling og forebyggelse kan give indsigter, som kan bidrage til nye teoretiske fremskridt og forståelse af psykiske lidelsers ætiologi og patogenese ad psykiske vanskeligheder

SPÆDBARNSPSYKOLOGIEN SOM TEMA

Spædbarnet og de psykiske grundfunktioners udvikling og risiko for fejludvikling i løbet af de første leveår er et forskningsfelt, der i disse år nyder en stærkt stigende interesse – ikke alene inden for den psykologiske videnskab, men også inden for en bred vifte af andre videnskabelige discipliner både empiriske og teoretiske. For eksempel inden for filosofien, sprogvidenskaben, biologien, lægevidenskaben, sociologien og flere andre og særlig aktuelt inden for det nyere tværvidenskabelige forskningsområde »cognitive neuroscience«, der har udforskningen af den menneskelige bevidsthed som genstand. Traditionelt har der været en tendens inden for videnskaberne til en primær fokusering på de »voksne« eller de færdige menneskelige funktioner, for så efterfølgende i et vist omfang at applicere denne viden på børnene – i hvert fald ofte med hensyn til behandlingsmetoder ved sygdom. I dag ses en stigende videnskabelig erkendelse af og nysgerrighed i forhold til, at en afdækning af netop udviklingen af de menneskelige psykologiske funktioner og karakteristika – herunder også den helt tidlige udvikling – udvider vores viden om disse. En viden, der også udvider vores muligheder for at forstå, hvordan disse forskellige funktioner faktisk fungerer – i et alment psykologisk og livslangt perspektiv. Dette vil forbedre vores muligheder for behandling og forebyggende intervention, når der ses patologiske tilstande eller risiko for udvikling af patologi. Idet vi ved (i hvert fald noget om), hvordan den normale udviklingsproces er, hvordan udviklingen kan komme på afveje, så øges også vores viden om, hvordan vi kan intervenere for igen at fremme sunde udviklingsprocesser hos barnet og såvel som hos den voksne

Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment

Background: Differentiating diagnostically between schizophrenia and emotional and personality disorders with psychotic or psychotic-like symptoms is a challenging task. It is especially difficult when working with adolescent patients, because their symptoms tend to manifest at lower levels as compared with adult patients. Thought disorder is a core symptom of schizophrenia, and the Rorschach Inkblot Method is widely used for the assessment of formal thought disorder. Objective: In this study, which is situated within ongoing clinical practice, we investigated whether the Rorschach test is helpful for assessing early-onset schizophrenia due to its ability to detect thought disorder. We also wanted to examine whether the Thought Disorder Index (TDI) is superior to the Comprehensive System (CS) for differentiating between patients with early-onset schizophrenia and non-psychotic patients experiencing auditory and visual hallucinations. An additional aim was to examine whether the TDI correlated with the Positive and Negative Syndrome Scale (PANSS). Methods: Twenty-three subjects between the ages of 12 and 18 years were examined with the use of the Rorschach test, and the protocols were scored according to both the TDI and the CS. All subjects were also assessed with the Positive and Negative Syndrome Scale. The sample included 14 subjects who fulfilled the criteria for schizophrenia and 9 subjects who were experiencing hallucinations that emanated from severe emotional and relational problems but who had different non-psychotic disorders. Results: Although the two groups could not be distinguished with regard to their total scores for thought disorder, the identification of specific thought disorder types proved useful for differential diagnosis. Verbalizations that were categorized by the TDI as “absurd responses,” “fluidity,” “contamination,” “autistic logic,” and “word-finding difficulty” were only given by patients who had been diagnosed with schizophrenia. When patients’ responses were scored with the use of the CS, the “contamination” score was the only one found to be specific to schizophrenia. Conclusions: Although the sample size limits the conclusions that can be drawn, the results indicate that the TDI may be superior to the CS for the identification of thought disorder specific to—but not always present in—adolescents with schizophrenia. In other words, the absence of severe thought disorder is not synonymous with the absence of severe psychopathology, but the presence of the most severe thought disorder types (i.e., “absurd responses,” “fluidity,” “incoherence,” “contamination,” and “autistic logic”) seems to be a strong indicator of schizophrenic psychopathology

Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment

Background: Differentiating diagnostically between schizophrenia and emotional and personality disorders with psychotic or psychotic-like symptoms is a challenging task. It is especially difficult when working with adolescent patients, because their symptoms tend to manifest at lower levels as compared with adult patients. Thought disorder is a core symptom of schizophrenia, and the Rorschach Inkblot Method is widely used for the assessment of formal thought disorder. Objective: In this study, which is situated within ongoing clinical practice, we investigated whether the Rorschach test is helpful for assessing early-onset schizophrenia due to its ability to detect thought disorder. We also wanted to examine whether the Thought Disorder Index (TDI) is superior to the Comprehensive System (CS) for differentiating between patients with early-onset schizophrenia and non-psychotic patients experiencing auditory and visual hallucinations. An additional aim was to examine whether the TDI correlated with the Positive and Negative Syndrome Scale (PANSS). Methods: Twenty-three subjects between the ages of 12 and 18 years were examined with the use of the Rorschach test, and the protocols were scored according to both the TDI and the CS. All subjects were also assessed with the Positive and Negative Syndrome Scale. The sample included 14 subjects who fulfilled the criteria for schizophrenia and 9 subjects who were experiencing hallucinations that emanated from severe emotional and relational problems but who had different non-psychotic disorders. Results: Although the two groups could not be distinguished with regard to their total scores for thought disorder, the identification of specific thought disorder types proved useful for differential diagnosis. Verbalizations that were categorized by the TDI as “absurd responses,” “fluidity,” “contamination,” “autistic logic,” and “word-finding difficulty” were only given by patients who had been diagnosed with schizophrenia. When patients’ responses were scored with the use of the CS, the “contamination” score was the only one found to be specific to schizophrenia. Conclusions: Although the sample size limits the conclusions that can be drawn, the results indicate that the TDI may be superior to the CS for the identification of thought disorder specific to—but not always present in—adolescents with schizophrenia. In other words, the absence of severe thought disorder is not synonymous with the absence of severe psychopathology, but the presence of the most severe thought disorder types (i.e., “absurd responses,” “fluidity,” “incoherence,” “contamination,” and “autistic logic”) seems to be a strong indicator of schizophrenic psychopathology

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BACKGROUND: Children in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent-child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being. METHODS: This is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4-17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists. DISCUSSION: This trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children. Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022

What factors are most important for the development of the maternal-fetal relationship? : A prospective study among pregnant women in Danish general practice

Acknowledgements The views expressed in this article are those of the authors and not necessarily those of the foundations. Funding Novo Nordisk Foundation, Region Zealand, Danish Research Foundation of General Practice, A.P. Moller Foundation, Lilly and Herbert Hansen’s Foundation and Jacob and Orla Madsen’s Foundation. We declare that the foundation had no input on the study design, collection, analysis, and interpretation of data and on writing the manuscript.Peer reviewedPublisher PD