Psychopathology最新文献

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.

Background: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions.

Methods: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed.

Results: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels.

Discussion: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.

Introduction: Phenomenological qualitative research delves into the essence and meaning of phenomena through subjects' lived experiences. Despite its widespread use in humanities disciplines, its integration with psychopathology is rare in China.

Methods: We systematically reviewed phenomenological studies on schizophrenia in China to assess their content and quality and offer insights for future research. Following PRISMA guidelines, we reviewed 28 articles. Quality assessment focused on adherence to theoretical principles, transparency, coherence, and evidence.

Results: Topics covered various illness-related experiences, including treatment seeking, medication, hospitalization, rehabilitation, relapse, sexuality, and reproduction. Some studies also explored caregiver experiences. However, only 5 articles were rated excellent, with most lacking theoretical depth.

Conclusion: Phenomenological research related to schizophrenia in China is mostly peripheral to the psychopathology of schizophrenia, and the qualification rate is low. Researchers should keep in mind the nature of phenomenological attitudes, delving into the essence and meaning of phenomena.

Introduction: Repetitive transcranial magnetic stimulation (rTMS) alleviates symptoms of major depressive disorder, but its neurobiological mechanisms remain to be fully understood. Growing evidence from proton magnetic resonance spectroscopy (1HMRS) studies suggests that rTMS alters excitatory and inhibitory neurometabolites. This preliminary meta-analysis aims to quantify current trends in the literature and identify future directions for the field.

Methods: Ten eligible studies that quantified Glutamate (Glu), Glu+Glutamine (Glx), or GABA before and after an rTMS intervention in depressed samples were sourced from PubMed, MEDLINE, PsychInfo, Google Scholar, and primary literature following PRISMA guidelines. Data were pooled using a random-effects model, Cohen's d effect sizes were calculated, and moderators, such as neurometabolite and 1HMRS sequence, were assessed. It was hypothesized that rTMS would increase cortical neurometabolites.

Results: Within-subjects data from 224 cases encompassing 31 neurometabolite effects (k) were analyzed. Active rTMS in clinical responders (n = 128; k = 22) nominally increased glutamatergic neurometabolites (d = 0.15 [95% CI: -0.01, 0.30], p = 0.06). No change was found in clinical nonresponders (p = 0.8) or sham rTMS participants (p = 0.4). A significant increase was identified in Glx (p = 0.01), but not Glu (p = 0.6). Importantly, effect size across conditions were associated with the number of rTMS pulses patients received (p = 0.05), suggesting dose dependence.

Conclusions: Clinical rTMS is associated with a nominal, dose-dependent increase in glutamatergic neurometabolites, suggesting rTMS may induce Glu-dependent neuroplasticity and upregulate neurometabolism. More, larger scale studies adhering to established acquisition and reporting standards are needed to further elucidate the neurometabolic mechanisms of rTMS.

Introduction: Pathological narcissism (PN) can be defined as the compromised and fluctuating ability to regulate self-esteem, the latter depending on external validation, admiration, or enhancement, all resulting in grandiose (e.g., self-enhancement, aggressiveness, manipulation) or vulnerable (e.g., depression, anxiety, self-criticism, avoidance) dysfunctional reactions when confronting with self-esteem threats. A link has been suggested between PN and emotion dysregulation (ED), but to date, no systematic review has been conducted.

Methods: We conducted a systematic review of the literature published until February 2024 studying the association between PN (with or without a diagnosis of narcissistic personality disorder) and ED, divided in two domains: emotion regulation difficulties and strategies.

Results: Twenty-two studies were included in our analysis. Altogether, the available data are insufficient to conclude on the link between grandiose narcissism and emotion regulation difficulties in non-clinical population (notably due to different patterns of associations depending on the scale used to assess narcissism). However, the small number of studies conducted in clinical population seems to indicate a possible absence of association between the two constructs. On the other side, there is considerable evidence for the existence of a positive association between vulnerable narcissism and emotion regulation difficulties, regardless of the scale used to assess narcissism and the type of population considered. Finally, regarding emotion regulation strategies, data are too scarce to draw any conclusion, even though there seems to be a trend toward positive association between narcissistic vulnerability and expressive suppression.

Conclusion: ED seems to be highly associated with narcissistic vulnerability. Given that every patient suffering from PN may experience vulnerable states, we believe that ED should be considered as an important part of psychoeducation programs and psychotherapeutic treatments designed for this population.