Functional neurological disorder (FND) is an often-disabling condition characterized by neurological symptoms that are incongruent with recognized neurological or medical disease processes. Alongside the increased clinical interest in this condition, there remain diagnostic and conceptual challenges, with controversy pertaining to assessment methods, the notions of primary and secondary gain, and how testing should be used and interpreted. This is of particular importance for the pediatric population, where less work has been done and even less certainty exists around a codified understanding of FND mechanisms, subtypes, and frameworks. While the bulk of the literature to date on FND concerns adults, an emerging research-base is developing in children. Representing a meaningful proportion of pediatric neurology consultations, FND is a relevant condition for clinicians engaged in psychological and neuropsychological assessment. This commentary examines FND in children from a broader perspective, offering a preliminary view of FND, a review of primary and secondary gain constructs as they relate to FND, and diving in with a deeper perspective on psychological and neuropsychological assessment. Future directions for FND in children are offered and discussed.
Over-reporting is a form of response bias involving the exaggeration or fabrication of symptoms and impairment. Symptom validity tests (SVTs), including standalone measures and validity scales embedded within broadband personality inventories, are commonly used to assess over-reporting. Recent SVT development has increasingly emphasized symptom-domain specificity, including cognitive, somatic, and psychological presentations. This review examines current advances and challenges in symptom validity assessment, with particular attention to whether over-reporting indicators demonstrate meaningful domain-specific distinctions. Evidence regarding symptom-domain specificity remains mixed. Although some findings suggest that SVTs may differentially detect particular symptom presentations, other research indicates that these measures generally perform within a common range of over-reporting effects and do not consistently demonstrate the expected relationships between symptom domain and assessment context. To further evaluate these distinctions, we re-analyzed data from an independent meta-analysis of MMPI-2-RF over-reporting validity scales and conducted a random-effects meta-analysis of interscale correlations among MMPI-2-RF over-reporting indicators reported across the empirical literature. Across these complementary analyses, over-reporting indicators demonstrated substantial similarities in performance despite their proposed domain distinctions. Current evidence raises questions about the degree to which symptom-domain distinctions among over-reporting indicators reflect meaningfully separable constructs. Greater attention to construct definition, criterion selection, comparative scale performance, and multivariate patterns of responding is needed to determine when domain-specific interpretations are empirically warranted. Methodological and analytic improvements in these areas may strengthen the construct validity, clinical utility, and interpretive precision of symptom validity assessment.
This review examines the evidence accumulated over the past decade on the Inventory of Problems-29 (IOP-29) in order to provide an updated appraisal of its scientific status and clinical and forensic role. Particular attention is given to classification accuracy, comparative validity, cut scores, cross-cultural applicability, and related extensions. The IOP-29 literature now includes both simulation and criterion-group studies, independent replications, quantitative reviews, cross-cultural investigations, and comparative validity studies. Overall, findings across different symptom domains, research designs, countries, and language versions indicate that the IOP-29 discriminates credible from noncredible symptom presentations with very large mean effect sizes. In addition, updated pooled estimates showed that the standard cutoff of ≥ 0.50 yielded sensitivity and specificity estimates of 0.84 and 0.90, respectively. The IOP-29 should no longer be viewed primarily as a new or emerging symptom validity test. Rather, the evidence reviewed here supports its use as a brief, psychometrically sound measure in clinical, forensic, psychological, and psychiatric assessment. Future research should now focus less on whether the IOP-29 works and more on how, when, and under what conditions it is most effectively used within a multimethod assessment framework.
Suicidality is a devastating public health problem, yet effective interventions are still lacking. This commentary outlines the theoretical foundations for applying mindfulness- and compassion-based interventions for suicide prevention, through explaining how the therapeutic elements of these interventions address common psychological risk factors for suicide. Accumulating research data from the meditation research literature points to the safety, feasibility, accessibility, and cost-effectiveness of mindfulness- and compassion-based intervention programs. Emerging data on their application to suicide prevention in outpatient as well as inpatient settings has demonstrated the safety and feasibility of these programs. Developing trauma-sensitive suicide prevention programs based on mindfulness and compassion is a promising direction for clinical innovations. Based on the potentials demonstrated from emerging research data, it is possible to develop mindfulness- or compassion-based intervention programs that are versatile, scalable, cost-effective and easily accessible across multiple sectors of suicide prevention.
Antidepressant-induced mania constitutes one of the most relevant and controversial complications of psychopharmacology, with direct implications in the choice and monitoring of the treatment. The incidence of this adverse effect varies widely in the literature, influenced by multiple factors, clinical and pharmacological. The scientific evidence about it remains fragmented, justifying a comprehensive systematic review that integrates clinical and pharmacological data in a critical way. The objective of this review was to analyze and synthesize and the incidence and the risk factors of this antidepressant-induced mania and mood destabilization. With resource to PubMed/MEDLINE, Embase and Cochrane Library, several studies were extracted and analyzed. Among the analyzed studies, 29 were included, whose inclusion criteria were fulfilled. Amid the studies, a great variability was observed in the occurrence of mania induced by antidepressants, however, was noted a higher risk of switch among the individuals with bipolar disorder, being lower in the individuals with major depressive disorder. Additionally, pharmacological and clinical risk factors associated to an increased risk were identified, respectively, hypomanic episodes and previous hospitalizations, bipolar disorder type I, rapid cycling, more severe course of illness and the use of tricyclic antidepressants, venlafaxine, and antidepressant monotherapy. Antidepressant induced mania is a subject with great relevance, which requires a meticulous clinical approach for the identification of a latent bipolarity and a tight follow-up upon institution of antidepressant therapy.
