The vulnerability model is prevalent in the current Theory of Psychiatry. Systematic reflection after reviewing the historical proposition of this model can enrich its contents.

Complete and deepen the meaning of the concept “vulnerability” in Psychiatry.

Review historical approaches to the concept of vulnerability in Psychopathology. The study starts with Zubin & Spring and reaches contemporary approaches especially in the writings of Giovanni Stanghellini.

Seek sources to deepen its meaning looking back to Karl Jaspers and Ludwig Binswanger's classical Psychiatry. They offer psychopathological notions that can be used to enrich a model of vulnerability.

This is research in the context of Theory of Psychiatry, its method implies a historical literature review and a systematic philosophical reflection.

Vulnerability is still revealed to be the best concept to organize a model of mental illness. This study proposes to avoid any simple identification of vulnerability with statistical or genetic risk. Vulnerability in psychopathology should always be confronted with the horizon of human subjectivity. To keep in view this horizon – a limit impossible to grasp – is indispensable for clinicians and researchers if they want to understand patients who suffer mental illness. This process is helpful to avoid any reductionism about the image of mental illness and about the human being who suffers that illness.

“Vulnerability” is shown as a concept that needs to be thought over thoroughly and to be present in psychopathology to overcome reductionism and to understand the very possibility of psychiatric illness.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

As a general problem in nosology, the moment when one becomes ill may be hard to define. In Psychiatry, the boundaries of disease may be more difficult to establish. In the last decade, we’ve been observing a growing interest in early diagnosis in this field, and the concept of “transition” to a mental illness became an important topic of discussion with implications in clinical practice.

To review different author's models of evolution of symptoms and transition to mental illness and discuss their advantages and limitations in the actual context of Psychiatry research and clinical practice.

To increase understanding on the different paradigms of becoming ill and their relevance to present and future psychiatric practice.

Non-systematic review of literature devoted to the creation of models that describe the establishment of a mental disorder.

One of the first accounts of becoming mentally ill was developed by K. Jaspers within a phenomenological life-history analysis. Nonetheless, a cross-sectional approach to diagnosis has dominated Psychiatry for most of the time. With the advent of early intervention studies, longitudinal models of disease have been emphasized. The concept of a transition to disease was then operationalized but also highly criticized. Recently, McGorry proposed a staging model for psychiatric disorders in continuum with the non-clinical population. Finally, a dynamic systems approach to diagnosis in Psychiatry will be discussed.

Driven by research in early phases of mental illnesses, current models of disease propose a longitudinal approach that emphasizes the complex and non-linear course of symptom clusters.

The authors have not supplied their declaration of competing interest.

Justice is one of the fundamental concepts of right ordering of human relationships. Justice is a regulative idea for the arrangement of society preceding the law and already seen in animals; the sense of justice is observed as early as in young children. The ability to altruistic behavior, sense of fairness, reciprocity and mutual help are probably genetically determined as a disposition, which may further develop or be deformed by education. Although justice issues are common in psychotherapy, they may not be reflected and processed in the course of therapy.

Review of psychotherapeutic text and reflection of experiences of the authors.

In psychotherapy, justice issues appear directly in what the client says (mostly about injustice), but more frequently, the issues are implicitly contained in complaints and stories against a background of conflicts and problems. They may be related to the client's story, his or her problems with other people, and the therapeutic process itself, including client's selection of therapy, therapeutic relationship, and therapeutic change strategies. Problems with justice between the therapist and the client may be revealed by honest therapist self-reflection or high-quality supervision.

Although justice issues are common in psychotherapy, they may not be reflected and processed in therapy. By increasing receptiveness to the issue of justice, the therapist may improve the therapeutic process.

The authors have not supplied their declaration of competing interest.

Phenomenology is a term borrowed from philosophy which refers to the study of the structures of experience and consciousness. Founded as a school by Edmund Husserl in the early 20th century, it was later expanded and modified by many others, including Martin Heidegger, to include the analysis of existence and hermeneutics.

To explain the clinic phenomenology of ADHD based on the historical bibliography regarding this term, making references to the heterogeneity of its phenomenological presentation depending on social context, age and gender.

To go over the historical considerations of phenomenology and its evolution, as well as its clinical applications, in order to use this knowledge in a clinical context based on the observation of different cases in clinical practice.

We try to apply the phenomenological method as first inaugurated by Karl Jaspers’ General Psychopathology (1913) to analyse the different clinical phenomena that can be observed in patients diagnosed with ADHD.

We think that watching the psychiatric conditions, in this case ADHD, through the phenomenological lens can lead to a better understanding of the heterogeneity of their appearance in the clinical practice.

The authors have not supplied their declaration of competing interest.

The private language argument was introduced by Ludwig Wittengstein in his Philosophical Investigations (1953). For Wittengstein, language is a rule-governed activity and a language in principle unintelligible to anyone but its originating user is impossible, as even the originator would fail to establish meanings for its putative signs. The private language argument is of paramount significance in modern debates about the nature of language and mind and continues to be disputed. Language disorder has been described since the first accounts of Schizophrenia. Multiple studies have reported anomalies at multiple levels of language processing, from lexical and syntactic particularities to the discourse field, as well as structural and functional abnormalities in brain regions that are involved with language perception and processing.

We aim to critically assess the Wittengstein's argument in the light of recent developments in neuroscience of language.

We conclude that in some patients diagnosed with schizophrenia, presenting a significant language impairment, one can infer a dysfunctional process, in which the language becomes progressively more private and the meaning of utterances harder to ascertain in the realm of interpersonal communication. The privatization of language might contribute to the social cognition deficits and the so-called negative symptomatology of these patients.

The authors have not supplied their declaration of competing interest.

The question what mental disorders are lies at the heart of the philosophy of psychiatry. In search of a valid taxonomy of mental disorders, it is a question that needs a proper answer. In recent work, Kenneth Kendler et al. (2011) have put forward the “mechanistic property cluster” (MPC) model of mental disorder. On this view, mental disorders are mechanistically mediated clusters of multi-level (bio-psycho-social) properties. Kendler et al. present the MPC-model as a non-reductionist form of realism – realist because it tries to account for mental disorders in terms of the causal structure of the natural world, non-reductionist because it views mental disorders as clusters of multi-level properties. For the project of psychiatric nosology, such non-reductionist realism would be a great step forward and indeed preferable to pragmatist and constructionist models of mental disorder.

To critically assess the MPC-model in light of arguments against realism about mental disorders presented in the philosophical literature.

To achieve a proper understanding of the ontology of mental disorders that can inform future psychiatric nosology.

Literature study and conceptual analysis.

Despite appearances, the MPC-view fails to take into account the various (societal, practical, scientific) values that determine the delineation of mental disorders. It ultimately faces philosophical problems similar to those of more reductionist forms of realism.

The MPC-model fails as a realist model of mental disorders. Its non-reductionism, however, is an important contribution to theories of explanation in psychiatry.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Risk and protective factors for PTSD can be grouped into pretraumatic, peritraumatic, and posttraumatic. Reported childhood abuse has predictive risk effects for PTSD than most other pretraumatic risk factors.

To examine childhood physical abuse history in war veterans.

To determine whether childhood physical abuse is risk factor for PTSD in war veterans.

Cross-sectional study of 205 war veterans tested by Harvard Trauma Questionnaire and sociobiographic Questionnaire (with data of childhood physical punishment).

A significant difference in reported childhood physical punishment between war veterans with and without PTSD was found. Veterans with PTSD were identified as recipients of childhood physical punishment.

Childhood physical punishment has positive correlation with development of PTSD in war veterans.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To identify the prevalence of the PTSD and associated events in adults victims of the displacement in the city of Montería.

Transversal and explorative study, 117 adults (M: 40,41; SD: 13,14). The PTSD was verified with the checklist for PTSD (Weathers, Litz, herman, Huska & Keane, 1993) and according to criteria of DSM-5 (APA, 2014). The 3 factors associated with the disorder were analyzed according to age groups. To evaluate the events associated to the disorder was used the checklist of events (Blake, Weathers & Nagy, 1990). Occurred and witnessed by the subject events were analyzed. Descriptive were used to determinate the existence of the PTSD and an ANOVA to contrast the symptomatology of the PTSD by age groups.

The 26,49% (n = 31) of the sample had the clinic criteria of PTSD. An ANOVA of a factor evidenced that the activation was present in a biggest proportion in the range of 53-59 years old (M = 18.73); intrusion and avoidance was shown mostly in the range of 60-71 years old (intrusion M = 14.00; avoidance M = 14.85). In relation to the associated events occurred to the subjects, there was found that the highest incidence were: natural disasters (42.7%) and unexpected death (35.9%); the witnessed events with higher percentage where: unexpected death (19.70%) and traffic accidents (15.4%).

References not available.

The authors have not supplied their declaration of competing interest.

In a globalized world, violence, present in all forms and in all places, is a public health problem with serious early or late consequences for the mental health of those who are direct or indirect victims. Violence is avoidable and preventable and is not evenly distributed by population groups or regions being among the top 20 causes worldwide of years lost due to disability and with a projected increase by 2030 according to the World Health Organization (Mathers, Fat & Boerma, 2008).

The search was made on ScienceDirect database, using the following keywords: posttraumatic stress disorder; violence and war. It was included documents in English published between 2004 and 2015; as well as textbooks and documents officers.

Violence is a risk factor for the disorder of post-traumatic stress disorder (PTSD) which, in turn, is also a risk factor for perpetrating violence. The PTSD can occur when a person faces or faces an unexpected traumatic stressor, such as war, violent personal assault, have been held hostage or kidnapped confinement as a prisoner of war, torture, terrorist attack, or serious car accidents (Javidi & Yadollahie, 2012). The costs of violence are high and its routinization for a living have important effects on mental health.

Studies in relation to PTSD and violence are necessary for us to have a better understanding of the phenomenon and its consequences for public health, as well as to promote the mental health of all.

References not available.

The authors have not supplied their declaration of competing interest.

Posttraumatic stress disorder (PTSD) has a high prevalence and severe impact in military populations. Cognitive behavioral therapy (CBT) is indicated in this condition but it is a structured therapy that requires patients’ motivation and doctors’ availability.

Assess feasibility and effectiveness of CBT in a military group with PTSD.

A group of six militaries that witnessed the same traumatic event (an armed attack) and were diagnosed with PTSD were involved in a structured individual session CBT with one therapist. An assessment using the PTSD checklist for DSM (PCL) was performed initially and in halfway therapy. The therapy included an education about PTSD, a cognitive restructuring, a behavioral approach via home tasks and relaxation techniques.

The initial PCL scores varied from 25 to 55. All patients were initially on sick leave. Five patients had adjunctive antidepressant medications and one patient was only on therapy. Three patients showed no motivation and were excluded after 3 sessions. Two patients have had 7 weekly sessions and were able to return to work in the same place. One patient with severe PTSD had 2 sessions monthly, he had slight clinical improvement and could not come back to military work. The three patients who are still in therapy have improved PCL scores.

CBT can be effective in PTSD. The outcome depends on initial severity of PTSD and assiduity.

The authors have not supplied their declaration of competing interest.

Complex trauma resulting from neglect and abuse in early childhood is frequently misdiagnosed.

This presentation shares emerging “best assessment practices” that help to differentiate complex trauma from Schizophrenia.

The case study demonstrates that a wide-ranging psychometric assessment and the application of Lacter & Lehmann (2008) guidelines provide accurate results while MCMI-III results can be spurious.

“Unbelievable” disclosures of an adult survivor prompted a search for scientific references, experiences in the survivor scene and historical examples. Work-related personality questionnaires, in-depth ability tests and Lacter & Lehmann (2008) guidelines were deployed to differentiate complex trauma from an erroneous diagnosis based largely on MCMI-III results.

The research identified measurement issues with the MCMI-III clinical personality questionnaire that generated spurious elevations on Narcissistic, Delusional and Paranoid scales. Work-related personality questionnaires provided much more useful information showing no “personality disorder” risks at all. WAIS results confirmed an earlier “Twice Exceptional” ability pattern with very high verbal IQ (95%ile) and extraordinarily poor auditory working memory (2nd%ile) i.e. a “Dyslexia” performance pattern. Lacter & Lehmann (2008) guidelines showed that none of the 42 schizophrenia indicators applied and only 1/3 of the complex trauma indicators.

Mental health professionals must remain cognizant to the chilling notion that extreme abusers may “frame” victims in order to make them “appear” schizophrenic. As MCMI-III was developed originally for those seeking therapy, its use in forensic settings with the general population should be avoided. Tests do not diagnose people – people do!

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Mental trauma may precede persistent changes in a person's mental health in the form of psychosis and dissociation. Presently, there are no subtypes to the diagnosis of PTSD. A psychotic subtype of PTSD has been proposed, and studies show that these patients differ as well in symptoms as biologically from patients with non-psychotic PTSD. Dissociation and psychosis are generally viewed as different phenomena. Where dissociation is understood as a disintegration of the mind, psychosis is viewed as a neurodegenerative disorder on a mainly biological/genetic basis. The delineation of psychotic and dissociative symptoms is not clear however.

Our objective is to clarify, whether psychologists and psychiatrists describe trauma-related changes of consciousness (TCC) differently as dissociative or psychotic. Furthermore, we wish to compare scientific journals, and look for differences in how psychiatrists’ and psychologists’ make use of the terms dissociation and psychosis in relation to TCC.

We aim to investigate whether TCC are interpreted differently among psychiatrists and psychologists.

This study is a systematic critical review of the literature. The databases PubMed, Embase and PsychInfo will be used. Articles involving PTSD with TCC will be included. Studies will be classified as viewing TCC's as either psychotic or dissociative, based on the terms the authors use to describe the observed phenomena.

The results will be presented at the EPA in March 2016 in Madrid.

The study will reveal differences in how psychiatrists and psychologists classify TCC's in PTSD.

The authors have not supplied their declaration of competing interest.

Despite the four factor model of PTSD proposed in the DSM-5 (APA, 2013) has received a better empirical support than three factor model of DSM-IV (APA, 1994), some alternative models proposed can provide a better representation of PTSD's latent structure.

The current study tested the fit of seven models, including the 3-factor DSM-IV model (APA, 1994), the 4-factor DSM-5 model (APA, 2000), the 4-factor dysphoria model (Simms, Watson & Doebbeling, 2002), the 5-factor dysphoric arousal model (Elhai et al., 2012), the 6-factor anhedonia model (Liu et al., 2014), the 6-factor externalizing behaviors model (Tsai et al., 2014) and the 7-factor hybrid model (Armour et al., 2015) that combines key features of the anhedonia and externalizing behaviors models.

It expected that the 7-factor hybrid model (Armour et al., 2015) would be the best fitting model.

PTSD symptoms were assessed using the Global Assessment of Posttraumatic Stress Disorder (EGEP-5; Crespo, Gómez & Soberón, 2016) in a sample of 165 victims of different traumatic events. Confirmatory Factor Analysis (CFAs) were conducted on each of the seven models using Maximum Likelihood (ML) estimation method.

All the models tested (except for DSM-IV model) yielded an adequate fit to the data. However, 7-factor hybrid model (Armour et al., 2015) provided a better fit than other competing models.

The current findings suggest that the dimensional structure of DSM-5 PTSD symptoms may be best represented by the 7 factors proposed in the hybrid model instead of 4 factors of DSM-5.

References not available.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The use of valid and practical screening scales might ease the burden for greatly needed universal testing for mental health, substance use and dual disorders, but do they work well with all populations? Do they miss correct identification of certain groups?

To understand discrepancies in diagnostic prediction using the AC-OK screen in conjunction with other standardized assessment scales.

Two hundred and twenty-six Latino participants were recruited from primary care and community clinics in Madrid, Barcelona and Boston and assessed with standardized mental health and substance abuse measures including the AC-OK screen and with a Computerized adaptive test for mental health (CAT-MH). A measure of frequency of discrepancies and an adjusted and unadjusted comparison of results and demographic characteristics or respondents were made for mental health, substance abuse or for discrepancies in both categories.

35.4% of cases were discrepant in mental health (AC-OK-Mental Health vs. Patient Health Questionnaire-9, Generalized Anxiety Disorder 7 or PTSD Checklist) and 14.2% in substance abuse (AC-OK-substance abuse vs. drug abuse screening test or Alcohol use disorders identification test). When CAT-MH scale was incorporated, discrepant results were found in 24.3% and 14.2%, respectively. No association was found between substance abuse discrepancies and patient demographics. In logit regressions being from Barcelona, of younger age and male were significant predictors of discrepancies.

Discrepancies were observed in the diagnostic prediction, with differences detected for site and sociodemographic characteristics of participants suggesting the importance of testing screeners for site and population differences. Evidence for the misclassification of young males is discussed. Caution is warranted in the implementation of screeners for at risk populations.

The authors have not supplied their declaration of competing interest.