Psychopathology最新文献

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 ET 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 Depression Scale (HAMD), Hamilton Anxiety 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 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 TgAb was found to be a very effective discriminator between SA and non-SA cases, with an AUC of 0.91. Furthermore, duration of illness, positive score, systolic BP, and TPOAb were found to be significantly associated with the frequency of SAs in this subgroup.

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

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.

Introduction: Individuals with borderline personality disorder (BPD) are thought to experience specific biosocial vulnerabilities that give rise to a maladaptive negativity bias in the perception and expression of emotions. However, while this negative bias has been identified in adults with full threshold BPD or high BPD features, it is unclear whether it is evident earlier in the course of the disorder - that being, young persons with first-presentation BPD meeting three or more BPD features, as defined by early intervention models.

Methods: The current study compared patterns of facial responding in individuals aged 15-25 years first presenting to a specialist outpatient service with three or more BPD features (n = 32) to age-matched healthy controls (n = 46). Facial electromyography was used to assess muscle activity associated with positive (zygomaticus major) and negative (corrugator supercilii) expression while participants viewed happy, angry, and neutral facial expressions.

Results: The data revealed that negative facial emotional reactivity for the BPD group did not significantly differ from the control group. However, the results for positive emotional reactivity were more nuanced, indicating that while there was not an overall between-group difference, there might be an effect of time suggestive of a slower positive emotional reaction to happy faces by the BPD group.

Conclusions: These data provide initial evidence that negatively biased emotional expression, when responding with negative facial expressions to neutral, happy, or angry faces, is not evident in young persons first presenting to a specialist outpatient service for treatment of BPD. However, a bias may be demonstrated by what appears to be a slower positive affective response to happy faces. The implications of these findings are discussed, particularly in relation to factors associated with chronicity of illness that might potentially contribute to the development of a more pronounced negativity bias later in the course of the illness. We encourage further examination of negativity biases in the developmental sequelae of BPD via longitudinal design or cross-sectional designs that include BPD participants across the course of illness, as well as further research to explore the possibility that positive affective reactions in this group might not be grossly blunted but rather delayed.

Background: Cannibalism is a practice based on the assimilation of the enemy, characterized by different ritual phases. The cultural anthropologist Francesco Remotti provides insight into this practice, stating that the Tupinamba tribes - an ethnic group living along the Eastern Atlantic coast of Brazil - use it to demonstrate their superiority over the defeated group. After capturing a prisoner, the assimilation process begins, which prepares the prisoner for the cannibalistic act through a specific sequence of steps.

Summary: Remotti's research on cannibalism is applicable to the world of narcissism. The way a narcissistic individual relates to others is a paradigmatic example of cannibalistic rituals. This study aimed to catch the structural components of the narcissistic relationship, rooted in Remotti's anthropological perspective, and to explore the associated phenomenological and psychopathological characteristics.

Key message: We present a new perspective for understanding the interpersonal relationship characteristic of a narcissistic person, which we have termed "identity cannibalism."

Background: The question of the role of personal values in the constitution of and recovery from mental illness is a divisive subject discussed in contemporary psychopathology. This article critically examines the psychopathological theories and contributions of Antoni Kępiński - a seminal yet internationally under-recognized Polish psychiatrist.

Summary: Drawing upon a multilayered framework incorporating biological, affective-emotional, and sociocultural dimensions, Kępiński posited mental disorders as disturbances in the energy and information metabolism with the environment leading to an increase in entropy. Kępiński's work also contributes to a richer understanding of schizophrenia (whose essence he metaphorically described as the plasma membrane rupture) and the complexities inherent in the decision-making processes of patients. In a quasi-phenomenological vein, Kępiński encouraged to re-evaluate delusions and hallucinations as opportunities to access unfiltered insights into reality. He also argued for the potential for moral growth within psychiatric treatment.

Key messages: Kępiński's theories anticipated many concepts now foundational in neuroscientific research and clinical psychiatry, showcasing his role as a forward-thinking figure in the history of the profession.

Background: Differences in subjective stress perception and acute response of the hypothalamic-pituitary-adrenal axis have been reported in internet gaming disorder (IGD). The present study aimed to further investigate alterations in diurnal profiles of the endocrine stress response system in IGD compared to healthy controls (HCs).

Methods: The diurnal course of endocrine markers (salivary cortisol and α-amylase) was investigated in a clinical sample of n = 29 adolescents with IGD compared to n = 26 HC. Further, the effect of unrestricted gaming versus restricted gaming was examined within the IGD group.

Results: No significant differences in salivary cortisol and α-amylase were observed comparing adolescents with IGD and HC. In addition, in the IGD group, there were no significant differences in salivary cortisol and α-amylase between conditions of unrestricted gaming versus restricted gaming. Compared to the HC group, the IGD group showed a significantly higher body mass index.

Conclusions: Our results indicate no alteration in diurnal profiles of the endocrine stress response in IGD.

Introduction: Beyond the memory deficits classically observed in individuals with alcohol use disorder (IwAUD), research has recently focused on the study of autobiographical memory (AM) processes in IwAUD by analysing the content of AM narratives, and the implications for self-conception have been discussed. However, little is known about how IwAUD subjectively experience autobiographical recall.

Methods: Thirty-seven IwAUD and 37 control participants were invited to perform an AM task that involved recalling memories for 4 life periods (2 important memories per period). Then, they assessed their subjective experience during AM recall using 6 phenomenological scales evaluating emotional valence, emotional intensity, sensory details, distancing, sharing, and vividness. Anxiety and depression symptoms, interoceptive sensibility, and difficulties in emotion regulation were also measured.

Results: The IwAUD experienced greater distancing during AM recall, except during childhood AM recall, indicating that IwAUD are more prone to feeling that the person they are today is different from the person in their retrieved AMs. Very few intergroup differences were observed for AMs from childhood, adolescence-young adulthood, and adulthood, and a greater number of differences were observed for AMs from the last year: the IwAUD experienced AMs with a more negative valence, greater emotional intensity, fewer sensory details, greater distancing, and less sharing. A positive correlation was observed between distancing and interoceptive sensibility in the IwAUD group.

Conclusion: Although these results suggest good preservation of autonoetic consciousness in IwAUD, except for more recent AMs, it is insufficient for IwAUD to experience a sense of self-continuity. This difficulty in maintaining a continuous sense of self may constitute a risk for AUD relapse.

Introduction: Epistemic trust (ET), the authenticity and personal relevance we assign to interpersonally transmitted knowledge, is considered an essential component of any effective therapy. Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change. Consequently, unlike other critical components, a clear distinction between its aspects - the patient's attributes, the therapist's contribution, and their unique therapeutic relationship - remains elusive, leaving our understanding incomplete. The current study examines the constituents of ET in therapy and its related effects through three distinct lenses: a blended snapshot lens, a prognostic lens, and a lens focusing on state-like changes. The constituents of ET were measured as follows: patient attributes were measured using attachment orientation and interpersonal functioning scales; therapist contribution was evaluated through scales assessing the therapist's use of techniques; and the patient-therapist therapeutic relationship was gauged using the working alliance scale.

Methods: We collected and analyzed data from 116 patients who participated in manualized psychodynamic psychotherapy sessions to investigate the trait-like and state-like components of ET.

Results: The results offer a comprehensive panoramic view with small to medium, but meaningful, correlations between ET and patients' attributes (ranging from 0.18 to -0.26); therapists' contributions (ranging between 0.15 and 0.28); and the patient-therapist therapeutic relationship (ranging between 0.17 and 0.23).

Conclusion: While some findings were consistent with our expectations, others were contrary, highlighting the necessity of considering the variations between and within patients as they have distinct theoretical, clinical, and empirical implications. Employing these three distinct lenses helps therapists gain a better understanding of the clinical picture reflected by the patient over different treatment periods. This broad perspective is of prognostic importance and encourages clinicians to adjust the treatment focus to meet the evolving needs of their patients.