Psychopathology最新文献

Background: In recent times, adolescents with severe forms of psychopathology that do not unambiguously fit into a precise diagnostic category, have come to clinical observation. The diagnoses attributed to these young patients range from borderline personality disorder, to affective disorders, ADHD, and others. These diagnoses are mainly based on behavioural abnormalities (e.g., social withdrawal, aggressiveness, self-injuring behaviour), but fail to capture the experiential core of their suffering.

Summary: Research in psychopathology, particularly that with a phenomenological approach, has long been committed to identifying early markers of schizophrenia in clinical pictures that precede the full onset of this pathology. In this paper, two case studies in Transitional Age Youth (TAY) and additional material taken from our own clinical practice are presented where self-disorders and anomalies of common sense - originally developed to phenomenologically characterise the schizophrenic spectrum phenotype, and especially non-delusional forms of schizophrenia - are used to complement standard nosographic assessments. Key-message: We propose that using some of these phenomenological constructs can shed light on certain TAY pictures, in particular the most serious ones, helping us to grasp their psychopathological core and provide further elements for a fine-grained characterization and in-depth understanding. We propose as a work-in-progress a set of tentative criteria to differentiate such phenomena in TAY patients as compared to patients with a diagnosis of schizophrenia.

Objective: Due to the COVID-19 pandemic, psychosocial well-being of families and parents worldwide has been impaired. As part of a larger online survey, we analyzed maternal depressive symptoms and perceived stress.

Method: A total of 666 mothers from Germany with young children (mostly aged 0-3 years) filled out the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS) at 2 time points during the pandemic (T1: summer/fall 2020; T2: early spring 2021). We (1) calculated prevalence rates of a risk for depression and high perceived stress levels, (2) analyzed differences between time points via paired t tests, and (3) examined the reciprocal relation between the two constructs via cross-lagged panel modeling.

Results: Considering cut-off values of the EPDS (≥10) and PSS (≥27), 33.8% carried a risk for depression and 15.2% high levels of stress at T1, whereas, respectively, 55.1% and 26.0% did so at T2. Depressive symptom severity and perceived stress levels significantly differed between measurement points with higher values at T2 (p < 0.001). Our cross-lagged panel analysis revealed large correlations (p < 0.001) within as well as small to medium (i.e., [0.21, 0.47]) auto-regressive (p < 0.001) and reciprocal (p < 0.001) predictions across time points between the severity of depressive symptoms and perceived stress.

Conclusions: This work demonstrates how severely mothers of infants were affected by depressive symptoms and perceived stress in a time of pandemic crisis. Psychosocial support should focus on screening and treating mothers as early as possible to mitigate the risk for subsequent depressive symptoms and perceived stress. Aiming attention at both depressive symptom reduction and stress relief most successfully promotes maternal well-being.

Introduction: The construct of epistemic trust (ET) has gained wide acceptance and support in the field, although there is little empirical evidence to substantiate the theoretical assumed model. Studies of the assessment of ET were conducted in community samples only and the mediating role of attachment and mentalizing in addition to ET was not investigated. This study examines the theoretical assumed relationships between ET and attachment and mentalizing as well as the mediating role of attachment, mentalizing and ET in the association between childhood adversity and borderline personality disorder (BPD) in a heterogeneous sample containing also patients.

Methods: The associations between ET and attachment, mentalizing, childhood maltreatment and BPD were explored in a sample of 245 participants, including subjects from the community as well as patients diagnosed with anxiety and personality disorders from two clinical samples. Multiple mediation analysis was performed to explore the mediating role of attachment (ECR-R), mentalizing (RFQ), and ET within the relationship between childhood trauma (CTQ-SF) and BPD (MSI-BPD).

Results: Strong relationships between ET and attachment and mentalizing were found indicating that lower degrees of cET are associated with insecure attachment and lower reflective functioning. Attachment, mentalizing, and ET together accounted for 75% of the mediation between childhood adversity and BPD. Hypomentalizing and anxious attachment accounted for the largest share of the mediation.

Conclusion: Our findings provide preliminary evidence for the theoretical supposed model of ET and suggest relevance of ET in the mediation between childhood adversity and PDs, although the role of ET seems smaller than assumed by recent theories.

Purpose: Sex differences play an important role in depression prevalence, symptom profile, treatment response, and disease course. However, sex differences in factors associated with suicide attempts (SAs) in first-episode and drug-naïve (FEDN) patients with psychotic major depression (PMD) remain unclear.

Methods: In this study, 171 patients with FEDN PMD were recruited. Patients' symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale. In addition, metabolic parameters and thyroid hormone levels were measured.

Results: The prevalence of SA was remarkably high in both male and female PMD patients (53.19% vs. 50.81%), without significant differences between the two groups. In male PMD patients, the combination of marital status and thyroid-stimulating hormone (TSH) levels was found to effectively distinguish between SA and non-SA cases, with an AUC value of 0.87. In addition, the HAMD score and diastolic blood pressure (BP) were significantly associated with the frequency of SAs in this subgroup. For female PMD patients, the combination of positive score, diastolic BP, TSH, and antithyroglobulin was found to be an effective discriminator between SA and non-SA cases, with an AUC of 0.91. Furthermore, duration of illness, positive score, systolic BP, and thyroid peroxidase antibody were found to be significantly associated with the frequency of SAs in this subgroup.

Conclusions: Our results indicate a high incidence of SAs in both men and women with PMD. Several clinically relevant factors, metabolic parameters, and thyroid hormone function contribute to sex differences in SAs in FEDN PMD patients.

Introduction: This secondary analysis of quality control data assessed principal components of personality dysfunction and their relationship to mentalizing in a sample of treatment-seeking women with severe personality disorders.

Methods: The Schedule for Nonadaptive and Adaptive Personality (SNAP) and the Movie for the Assessment of Social Cognition (MASC) were administered to 37 females in routine quality assessments of a specialized residential treatment program. Principal component analysis (PCA) of SNAP scores was used to determine dimensions of personality most significantly contributing to overall maladaptive personality functioning. Bootstrapped stepwise regression tested the relationship of dimensional personality indices to hypermentalizing and hypomentalizing on the MASC controlling for general psychiatric severity.

Results: Four principal components (PCs) explained 71.4% of the variance in personality dysfunction, mapping onto antisocial, obsessive compulsive, borderline, and narcissistic personality constellations. The borderline and antisocial PCs were positively predictive of hypermentalizing. The obsessive-compulsive PC was positively predictive of hypomentalizing, while the antisocial PC was negatively predictive of hypomentalizing.

Conclusion: The study reiterates prior findings of a relationship between hypermentalizing and borderline and antisocial personality profiles. It also contributes evidence to the limited research on hypomentalizing as a clinical indicator and potential treatment target for obsessive-compulsive personality, and shows evidence of a negative relationship between antisocial personality disorder and hypomentalizing. These findings provide clinical indications for enhancing and regulating mentalizing via attention to and interpretations of internal and interpersonal events in individuals with personality disorders. Further research is needed to replicate these associations in larger, more representative clinical samples.

Introduction: The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB.

Methods: A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10-19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL.

Results: AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26-12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06-1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001).

Conclusions: AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal.

Introduction: Misophonia is an increasingly recognized disorder characterized by negative emotional and sensory reactions to specific noises. Although misophonia most often begins in childhood, there has been minimal research on its clinical presentation in youth. This qualitative study explored cognitive behavioral processes that are involved in misophonia and its associated functional impairment in young people and their families.

Methods: Focused interviews were conducted with 20 youth with misophonia (ages 10-17) and their parents. Thematic analyses of these interviews using a cognitive behavioral theoretical framework were conducted.

Results: A number of themes were identified, which included internalizing and externalizing cognitive behavioral processes at the individual level (e.g., hypervigilance, anticipatory anxiety, escape, automatic negative attributions), secondary emotional and functional consequences (e.g., negative perception of self, guilt, anxiety, depression, emotional exhaustion, concentration difficulties at school), as well as significant impacts to school, social life, and particularly to family life (e.g., conflict/tension, anger and resentment, family accommodation). These themes are integrated in a proposed theoretical model.

Discussion: Misophonia is characterized by several transdiagnostic cognitive behavioral processes, including avoidance, maladaptive cognitions, emotional reactivity, and family communication difficulties, as well as significant functional impairment. Developing treatments that target these processes has the potential to help youth overcome misophonia and improve the quality of life of youth and their families.

Introduction: Prominent eating disorders (EDs) theories identify a critical relationship between body and self. One of the ways to study this relationship is through autobiographical memories (AMs). The present review aimed to evaluate the studies that investigated AM in patients with EDs.

Methods: A search of PubMed, ScienceDirect, and Scopus databases was performed to identify relevant articles. Of the 57,113 studies found, 25,016 were not duplicated. After screening, 27 articles were included.

Results: The studies had some methodological flaws: none of the articles was a randomized control trial and the sample sizes were small. Nevertheless, important evidence emerged because all studies showed that patients with EDs have impaired AM function. This is because the way patients with EDs remember and define themselves is through an allocentric perspective associated with the gazes of others whose role has an impact on AM, body shape, and self.

Conclusion: To our knowledge, this is the first systematic review to examine AM in patients with EDs. Future research is needed in EDs to expand knowledge about the relationship between the body and the self.

Introduction: According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD.

Methods: An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale - Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 - Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test.

Results: A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = -0.38; p < 0.010) and anankastia (γ = -0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001).

Conclusion: Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD.

Background: Impairments in theory of mind (ToM) are highly prevalent among individuals with schizophrenia, resulting in substantial functional deficits. However, research on impairments in individuals with schizotypy has yielded inconsistent findings, with some studies finding ToM deficits in overall schizotypy, other studies finding ToM deficits in only specific schizotypy dimensions, and yet other studies finding no ToM deficits at all. One potential key factor that may account for this discrepancy is the use of schizotypy measures that do not adequately measure specific schizotypy dimensions. Additional limitations are employment of ToM measures that rely heavily on explicit cultural knowledge, verbal/reading comprehension, and/or other cognitive abilities.

Method: To address these discrepant findings, we used the Schizotypal Personality Questionnaire-Brief Revised (Updated; SPQ-BRU) and the Multidimensional Schizotypy Scale (MSS) to tap overall schizotypy and specific schizotypy dimensions. To measure ToM, we used the Frith-Happé animations (FHA) and Strange Stories Film Task (SSFT). We examined the hypothesized negative relationship between schizotypy and ToM in a sample of 233 nonclinical individuals.

Results: Regression analysis indicated no significant relationship between overall schizotypy and ToM on both the FHA (b = 0.01, t(196) = -0.75, p = 0.46) and SSFT (b = -0.20, t(195) = -1.69, p = 0.09). However, it did find that the negative schizotypy dimension was associated with poorer ToM performance on both the FHA (b = -0.11, t(194) = -2.7, p = 0.008) and SSFT (b = -0.12, t(193) = -3.22, p = 0.001). Also, exploratory analyses employing an extreme-group design approach indicated high schizotypy and high negative schizotypy groups displayed weaker ToM performance within all specific schizotypy dimensions.

Conclusion: These results indicate that ToM impairments are present in schizotypy, especially within the negative schizotypy dimension. The results suggest important methodological implication for studying ToM in schizotypy and conceptualizing the latent structure of schizotypy.