Psychopathology最新文献

Background: Self-injury has become increasingly prevalent among adolescents and young adults over the past decades, reflecting the intersection between individual vulnerability and sociocultural transformations. Understanding this phenomenon requires not only a clinical perspective but also a broader reflection on how current social dynamics - such as digital hyperconnectivity and weakened interpersonal bonds - shape subjectivity and emotional regulation.

Summary: This article offers an integrative and interpretive study based on the authors' previous empirical research conducted in 2022, which included semi-structured clinical interviews with 20 young people (19 females and 1 male) aged between 13 and 28 years who engaged in skin-cutting. The analysis considered four dimensions: family dynamics, identity, symptom onset and context, and the function of the symptom. The findings revealed that self-injury is associated with difficulties in identity formation, emotional regulation, and family relationships, which were interpreted in light of contemporary sociocultural changes. To enrich this perspective, theoretical contributions from sociology and philosophy were incorporated to link individual experience with the broader cultural framework.

Key messages: Self-injury reflects not only intrapsychic conflict but also the impact of sociocultural transformations characteristic of postmodernity. Understanding its meaning requires integrating clinical, familial, and sociocultural levels of analysis. The proposed therapeutic approach combines evidence-based strategies for emotion regulation with interventions that address the patient's identity and social context. This work aims to provide clinicians with conceptual and practical tools to better understand and treat self-injury as a phenomenon rooted in contemporary culture.

Introduction: The current definition of hallucinations as perception-like experiences has been criticized for neglecting their experiential character and context. This study examined the phenomenology of auditory verbal hallucinations (AVHs) and visual hallucinations (VHs) in schizophrenia and their relation to other psychopathology, particularly basic self-disorders.

Methods: Twenty patients with schizophrenia-spectrum psychosis and hallucinations participated in phenomenologically oriented, semi-structured interviews exploring the experiential characteristics and context of AVH and VH as well as a comprehensive psychopathological examination, including the Examination of Anomalous Self-Experience (EASE).

Results: The far majority of participants considered their hallucinations distinct from perceptual experience and described alterations of the ordinary experiential structure of sensory experience. Generally, both AVH and persistent VH were experientially intertwined with self-disorders and other subjective pathological phenomena. Moreover, AVHs were characterized by alterations of spatiality and experienced as private, i.e., not being accessible to others. Compared to a control group, the participants with hallucinations had significantly higher levels of self-disorders, earlier onset of psychopathology, and lower IQ.

Conclusion: The findings align with prior research proposing that most AVHs in schizophrenia reflect an underlying alteration of the structure of subjectivity (i.e., disorder of basic self). We report novel findings suggesting that a similar link between self-disorders and VH should be further investigated. Our study highlights the importance of assessing hallucinations within the broader context of the patient's psychopathology for adequate differential diagnostic evaluation and understanding of lived experience.

Background: Depressive disorders are among the most common mental illnesses. Many approaches to treatment using psychotherapy or psychotropic drugs exist, but the proportion of non-responders should not be ignored. The consideration of existential, so-called "meaningful questions" of life, although their significance is well known, has so far been used little or not at all in the diagnosis and treatment of mental illnesses like depressive disorders. The aim of this study was, therefore, to examine the significance of existential questions in the context of depressive disorders and to shed light on the attitudes of affected patients.

Method: This exploratory cross-sectional study used semi-structured interviews and questionnaires to examine 30 inpatients with a diagnosed depression and 30 mentally healthy individuals as a comparison group. Clinical parameters were collected from all study participants. The psychometrics included the recording of depression (BDI-II), anxiety (STAI-I/II), loneliness (UCLA Loneliness Scale), and life meaning (LeBe/SoMe). The BOFRETTA scale was also used to assess the subjects' fear of death and attitudes toward death. The Bochum Questionnaire on the Importance of Existential Questions (BOFBEX), newly designed for this study, was used to assess attitudes to existential issues.

Results: For the depressed patients, there were unfavourable and significantly different values compared to the mentally healthy subjects with regard to meaningfulness and crisis of meaning. Most depressives (66.7%) stated they suffered subjectively from experience of meaninglessness at most, whereas this did not occur in any of the healthy subjects. However, the level of depressiveness correlated significantly positively with loneliness in both groups and with the perception of a crisis in meaning.

Conclusions: Depressed patients had a need and desire to be able to address existential questions, which mainly concerned their loneliness, the feeling of autonomy, and having meaning in life, more strongly and more frequently with reference therapists as part of psychiatric-psychotherapeutic treatment.

Introduction: A recent empirical benchmark study designed to assess real-world diagnostic accuracy and reliability among 30 internationally renowned psychiatrists specializing in the schizophrenia spectrum found that only 33.3% of the psychiatrists correctly diagnosed two vignettes that included typical descriptions of disorders in the schizophrenia spectrum. The present study aimed to identify clinician-related factors that might account for this poor diagnostic performance, such as clinical versus research focus, years of clinical experience, and perceived usefulness of psychopathological concepts.

Methods: The study employed secondary analyses of data collected in in-depth online interviews with a group of 30 top-tier international psychiatrists specializing in schizophrenia spectrum disorders (SSDs). Participants were asked to make their best clinical diagnostic estimate for two written clinical vignettes developed on the basis of real-world SSD cases.

Results: We found that diagnostic accuracy was nearly significantly related to length of clinical experience, greater emphasis on practice versus research (estimated by low H-index), a proclivity to engage in psychotherapy, a nuanced view of psychosis as a spectrum concept, and acknowledgment of the relevance of self-disorders (i.e., subtle, enduring, nonpsychotic phenomenological anomalies of subjective experience) for SSD diagnosis.

Conclusion: Taken together, these findings suggest that continuous clinical activity and nuanced knowledge of psychopathology that goes beyond the guidelines of DSM and ICD are crucial for accurate diagnostic performance in real-world diagnostic encounters.

Background: Healthcare professionals encounter challenges in discerning endogenous and exogenous, drug-related, psychopathological phenomena. This study aimed to explore qualitative differences between hallucinations in schizophrenia and two forms of substance-related psychosis. These are substance-induced psychosis (SIP), which has an acute onset and is usually transient, and substance-related persistent psychosis (PP).

Summary: To explore phenomenological differences, we use an ideal-typical method (which Jaspers borrowed in psychopathology from Weber), together with classic and contemporary phenomenological reflections. After a historical overview of the main issues concerning this topic, we consider the qualitative differences between the different types of hallucinations at the following levels: formal features of the phenomenon, contents, state of consciousness, temporal experience, and position-taking.

Key messages: Our results indicate that while schizophrenic hallucinations typically occur in clear consciousness with variable sensory vividness, SIP hallucinations manifest in an oneiroid state with increased vividness and multisensory integration. In contrast, PP hallucinations occur in a twilight state of consciousness, often presenting as simpler but intrusive phenomena. Furthermore, the discussion includes a brief phenomenological analysis starting from Husserlian conceptions of perception to clarify the basic structural difference underlying the qualitative distinctions previously analysed. By identifying distinctive phenomenological characteristics of hallucinations across these conditions, this study provides clinicians with a conceptual framework for developing more effective diagnostic approaches and therapeutic strategies, particularly in the complex context of substance-induced psychopathologies.

Background: The co-occurrence of schizophrenia and substance use disorders (SUDs), referred to as dual diagnosis, represents a significant challenge in psychiatric research and clinical practice. The interplay between these conditions complicates symptomatology, diagnosis, and treatment, necessitating an integrated approach to care.

Summary: This scoping review systematically examines the available literature on the psychopathological characteristics of individuals with dual diagnosis, emphasizing symptomatologic clusters associated with different substances. A systematic search was conducted in Medline and Scopus databases to identify original research articles published in the last 20 years. Studies examining psychosis-related symptoms in individuals with SUDs were included, excluding non-original research, non-English articles, and studies not focusing on dual diagnosis. A total of 129 studies were included, with cannabis being the most frequently studied substance, followed by alcohol, stimulants, and opioids. The most commonly reported symptoms were positive symptoms (hallucinations, delusions, paranoia, disorganized thinking), cognitive impairments, and negative symptoms (social withdrawal, anhedonia). Emotional dysregulation, impulsivity, and aggression were also frequently documented. Substance-induced psychosis was found to differ from primary psychotic disorders in symptom severity, age of onset, and associated comorbidities.

Key messages: The psychopathology of dual diagnosis is multifaceted, with overlapping and complex symptom presentations. Substance use can exacerbate or trigger psychotic symptoms, making differential diagnosis challenging. These findings highlight the need for integrative treatment strategies that address both psychotic and substance-related symptoms. Further research is needed to develop standardized diagnostic criteria and targeted interventions for dual diagnosis patients.

Background: Dynamical systems theory (DST) has recently gained traction as a framework to describe and predict the progression of psychopathology. However, a number of challenges to the application of DST to psychopathology have arisen, including the heterogeneity of symptom measures and the lack of theoretical underpinnings to describe the temporal unfolding of psychiatric illnesses.

Summary: In this article, we aim to show how the integration of methods from phenomenology may strengthen the application of DST in psychopathology research. We explore how phenomenological psychopathology can improve DST-based investigations in two key ways: (1) by specifying the core symptoms of interest in psychopathological states in a more precise manner by focusing on subjective experiences, and (2) by deepening our theoretical understanding of how these symptoms evolve in severity over time. We show how incorporating phenomenologically informed measures of experience can complement DST using clinical high risk (CHR) for psychosis as a test case, and we demonstrate the utility of combining phenomenologically informed theory and DST by examining the ipseity-disturbance model (IDM) of psychosis development. We close by offering a vision for the broader integration of DST and phenomenological research methods within psychopathological research.

Key messages: Phenomenological investigations can synergize with and advance the use of DST to better understand and predict psychiatric disorders and transitions in states of mental health.

Introduction: The psychopathology of schizophrenia is a complex amalgamation of features that span across different dimensions. These dimensions range from the experience of altered time and space through self-disorders to perceptual, positive, and negative symptoms. The relationship between these different psychopathological dimensions remains unclear. Addressing this gap was the aim of our study.

Methods: We collected data on schizophrenia spectrum disorder at three medical expert centers, via semi-structured phenomenological interviews, consisting of the Scale for Space and Time Experience in Psychosis (STEP), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and, for a subset of these data, the Examination of Anomalous Self-Experience (EASE), and the perceptual domain of the Bonn Scale for the Assessment of Basic Symptoms (BSABS or BONN). Various state-of-the-art statistical methods, including network and mediation analyses, were used to investigate the relationships between these psychopathological dimensions.

Results: We found a relationship between altered time and space experiences (STEP) and both general symptoms (PANSS) and the basic self-disorders (EASE).

Conclusion: Our various network and mediation analyses show that the basic self-disturbance is a key node in mediating the impact of the more fundamental time and space disturbances on both perceptual changes, and negative, positive, and general symptoms.

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.