The XXIII Annual Meeting of the Italian Society of Psychopathology will deal psychopathology in its 3 aspects of education, evidence and translation. These 3 topics are inspired by the need to deal with the growing amount of biological, medical, psychological and social knowledge, from the psychopathological viewpoint.
Professional training in psychiatry and mental health has become an increasingly complex challenge, combining professional areas such as physicians or psychologists and others with consolidated practice in mental health. All these must be kept up to date to deal with complex social and economic shifts.
Psychopathology, as a science and discipline that describes and assesses anomalies of subjective psychological experience, has seen levels of interest vary widely over the last century. Teaching and training in psychopathology need a more central place in clinical practice, as sometimes clinical manifestations are only judged superficially, using terms that do not convey the real characteristics of the suffering person.
Young psychiatrists are not satisfied with their formal and practical training in psychopathology, and some even consider it of little clinical utility. This attitude risks leading to excessive simplification of the description and analysis of symptoms, which can ‘dilute’ psychopathology down to plain psychiatry, hence to mental health, with little more than an ancillary role. The consequence of this tendency is that on the diagnostic level too psychological descriptors get lost in ‘nominalistic’ categories. Aspects like perplexity, autistic withdrawal, expansivity or impulsivity call for careful analysis of the subjective findings in a person with a mental disorder. The prophecy that then comes true is that hasty, generic descriptions serve no useful purpose.
One of the reasons for contradictions between clinical and neurobiological findings is often inadequate psychopathological evaluation. The clinical variable may not necessarily add up to a ‘diagnosis’, or a clear nosological entity, but may consist of psychopathological constructs or endophenotypes. The construct of ‘aberrant salience’ seems a useful definition or psychopathologic model to describe the passage from a high-risk condition on the one hand, to overt psychotic manifestations on the other. This construct is not necessarily associated with a single diagnosis, but may comprise more than one and may link phenomenology to neurobiology of delusion formation.
Evidence-based clinical practice and care must clearly be combined with practice based on experience and values. Social complexity, economic variables, religious diversity, sexual orientation, and technological innovation are all factors that can influence the interventions and outcomes in mental health. They have therefore to be managed with an approach integrating evidence-based medicine (EBM) and good clinical practice.
The MBE approach can help the clinician in making a decision, but in psychiatry it is harder to meld the different psychological, psychosocial and neurobiological disciplines involved in deciding the treatment. EBM has therefore to work alongside practice based on experience and values, and in this direction psychopathology is a pivotal, irreplaceable tool.
The translation heading refers to how, how much, and where to apply knowledge and evidence responding to the principles of clinical utility, ethical compatibility and – last but not least – the economic aspects and sustainability of the national health service. Scientific societies, universities, mental health departments and all others concerned must establish close contacts with national and local health agencies with a view to selecting the most appropriate interventions, but also to organize controlled trials of innovative interventions in order to verify the utility of the knowledge acquired.
The 23rd SOPSI Congress, 2019, will examine these questions, bearing in mind that training, evidence and translation are all increasingly ‘global’ issues, that need to be tackled from this viewpoint – critically but open to knowledge and innovation.
I hope you enjoy the Congress