Psychopathology最新文献

Dis-sociality (DS) reflects the impairment of social experience in people with schizophrenia; it encompasses both negative features (disorder of attunement, inability to grasp the meaning of social contexts, the vanishing of social shared knowledge) and positive features (a peculiar set of values, ruminations not oriented to reality), reflecting the existential arrangement of people with schizophrenia. DS is grounded on the notion of schizophrenic autism as depicted by continental psychopathology. A rating scale has been developed, providing an experiential phenotype. Here we present the Autism Rating Scale for Schizophrenia - Revised English version (ARSS-Rev), developed on the Italian version of the scale. The scale is provided by a structured interview to facilitate the assessment of the phenomena investigated here. ARSS-Rev is composed of 16 distinctive items grouped into 6 categories: hypo-attunement, invasiveness, emotional flooding, algorithmic conception of sociality, antithetical attitude toward sociality, and idionomia. For each item and category, an accurate description is provided. Different intensities of phenomena are assessed through a Likert scale by rating each item according to its quantitative features (frequency, intensity, impairment, and need for coping). The ARSS-Rev has been able to discriminate patients with remitted schizophrenia from euthymic patients with psychotic bipolar disorder. This instrument may be useful in clinical/research settings to demarcate the boundaries of schizophrenia spectrum disorders from affective psychoses.

Introduction: Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews.

Methods: To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method.

Results: Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one's self, and (3) losing control on one's self.

Conclusion: Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself - which is the core of depressive experiences - ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.

Introduction: Psychiatric diagnoses are descriptive in nature, but the lay public commonly misconceives them as causal explanations. It is not known whether this logical error, a form of circular reasoning, can sometimes be mistakenly reinforced by health authorities themselves. In this study, we investigated the prevalence of misleading causal descriptions of depression in the information provided by authoritative mental health organizations on widely accessed internet sites.

Methods: We searched for popular websites managed by leading mental health organizations and conducted a content analysis to evaluate whether they presented depression accurately as a description of symptoms, or inaccurately as a causal explanation.

Results: Most websites used language that inaccurately described depression as a causal explanation to depressive symptoms.

Conclusion: Leading professional medical and psychiatric organizations commonly confound depression, a descriptive diagnostic label, with a causal explanation on their most prominently accessed informational websites. We argue that the scientifically inaccurate causal language in depictions of psychiatric diagnoses is potentially harmful because it leads the public to misunderstand the nature of mental health problems. Mental health authorities providing psychoeducation should clearly state that psychiatric diagnoses are purely descriptive to avoid misleading the public.

The term "dissociation" encompasses a wide array of symptoms and phenomena, all sharing the common characteristic of involving altered states of consciousness where an individual temporarily loses the sense of continuity of their own identity. In the context of addiction pathology, however, the dissociative paradigm remains a topic of ongoing debate. It fluctuates between the description of individual dissociative symptoms and the notion of post-traumatic dissociation as a structural process. This process involves fragmentation that extends beyond the confines of perception and experience within a singular moment, instead ensuring a persistent discontinuity of the self throughout one's existence. Pathological addiction stresses the question of the donation of sense in this deep and dramatic experience; it situates individuals within a compressed and constricted realm of vital space, alongside a frozen perception of time. Within this context, every emotion, sensation, and comprehension becomes impaired. Consequently, we have embarked on a journey starting with a historical analysis: the aim was to construct an elucidative framework for the dissociative paradigm in the context of addiction. This involves an in-depth exploration of the fundamental constructs of trauma and temporality, examined through the lens of phenomenological perspective.

Introduction: Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing performance in terms of correct scores and types of errors in adolescents and young adults with ADHD.

Methods: Forty-nine adolescents and adults with ADHD and 49 healthy controls matched for age and gender completed a computerized naturalistic mentalizing task, the Movie for Assessment of Social Cognition (MASC). Repeated measures analyses of variance examined the effects of age group and ADHD diagnosis on MASC performance. Additionally, associations between mentalizing scores, the severity of attention problems, and the presence of comorbidity were explored in the ADHD group.

Results: Results showed an increased prevalence of hypomentalizing errors in adolescents with ADHD. Lower mentalizing scores in adolescents with ADHD were correlated with indices of inattentiveness, impulsivity, and vigilance problems. Hypomentalizing errors in adolescents showed to be particularly associated with inattentiveness, after controlling for age and comorbidity. In contrast, adults with ADHD performed similarly to controls and their scores on the mentalizing task were not correlated to attention problems.

Conclusion: These findings highlight potential developmental differences in mentalizing abilities in ADHD youths and their association with attentional impairments.

Introduction: Considering the importance of neuroinflammation and neurodegeneration in the pathophysiology of major depressive disorder (MDD), peripheral blood biomarkers are promising for the prediction of diagnosis and treatment outcomes. We aimed to elucidate the neuroinflammatory pathophysiology of depression by evaluating serum levels of FAM19A5 as a new biomarker of inflammatory activation, proinflammatory cytokines, brain-derived neurotrophic factor (BDNF), and oxidative stress parameters.

Methods: Adolescents diagnosed with first-episode drug-naive MDD (n = 35) were compared neurobiologically healthy control group (n = 33). Serum FAM19A5 levels, cytokine levels, BDNF and oxidative stress parameters were evaluated using the enzyme-linked immunoassay method. All participants were assessed with the Level-2 Depression Severity Scale, Sleep Disturbance Scale, Somatic Symptom Scale.

Results: BDNF levels were significantly higher in the patient group compared to the control group. While BDNF showed a positive correlation with all scale scores; BDNF was significantly higher in the suicide risk groups than the control group. IL-1β levels displayed a negative correlation with the severity of sleep disturbances.

Conclusions: In adolescents with MDD, inflammatory and oxidative stress markers were not raised in peripheral blood, unlike in adults. However, BDNF levels, which typically decrease in neurodegenerative conditions, were higher in those with MDD.

Background: Identifying suicidal risk based on clinical assessment is challenging. Suicidal ideation fluctuates, can be downplayed or denied, and seems stigmatizing if divulged. In contrast, vitality is foundational to subjectivity in being immediately conscious before reflection. Including its assessment may improve detection of suicidal risk compared to relying on suicidal ideation alone. We hypothesized that objective motility measures would be associated with vitality and enhance assessment of suicidal risk.

Methods: We evaluated 83 adult-psychiatric outpatients with a DSM-5 bipolar (BD) or major depressive disorder (MDD): BD-I (n = 48), BD-II (20), and MDD (15) during a major depressive episode. They were actigraphically monitored continuously over 3 weekdays and self-rated their subjective states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective psychopathology measures with circadian activity parameters.

Results: Actigraphic circadian mesor, amplitude, day- and nighttime activity were lower with BD versus MDD. Self-rated vitality (wish-to-live) was significantly lower, self-rated suicidality (wish-to-die) was higher, and their difference was lower, with BD versus MDD. There were no other significant diagnostic differences in actigraphic sleep parameters or in self-rated depression, dysphoria, or anxiety. By linear regression, the difference between vitality and passive suicidal ideation was strongly positively correlated with mesor (p < 0.0001), daytime activity (p < 0.0001), and amplitude (p = 0.001).

Conclusions: Higher circadian activity measures reflected enhanced levels of subjective vitality and were associated with lesser suicidal ideation. Current suicidal-risk assessment might usefully include monitoring of motility and vitality in addition to examining negative affects and suicidal thinking.

Introduction: Non-suicidal self-injury (NSSI) is a large phenomenon among adolescents, and adverse childhood experiences (ACEs) are a major risk factor in its development. Malfunctioning of the hypothalamus-pituitary-adrenal (HPA) axis has been repeatedly reported for ACE as well as for NSSI. The glucocorticoid receptor (GR) is essential for the correct functioning of the HPA axis, thus alterations in the expression of the GR through altered methylation of the GR gene (NR3C1) (and more specifically exon 1F) might contribute to the development of NSSI in individuals with a history of ACEs, as has been reported for different other mental disorders.

Methods: In this case-control study, we compared the methylation levels of exon 1F of the GR gene (NR3C1-1F) in adolescents with engagement in NSSI (n = 67) and a healthy control group (HC; n = 47). We preserved buccal swabs and used a mass spectrometry-based method called EpiTYPER for analyzing mean methylation of NR3C1-1F.

Results: Adolescents in the NSSI group reported significantly more ACEs. The mean methylation level was about 3% in both groups with no significant group differences. Furthermore, no significant relation was found between ACE and methylation of NR3C1-1F, neither in the overall sample nor in the NSSI or HC group.

Conclusion: Our results are contradictory to previous research showing an increased methylation in individuals with ACE. Regarding relations between methylation of NR3C1-1F and mental disorders, previous studies reported inconsistent findings. Our study points to NSSI being either unrelated to methylation of NR3C1-1F or to yet not identified moderators on relations between methylation of NR3C1-1F and engagement in NSSI during adolescence.

Introduction: This study investigated the structure of the borderline personality features (BPFs) network and the most central BPF in adolescence.

Methods: Cross-sectional self-report data from 4,866 Chinese adolescents (M = 13.96, SD = 1.64; 61.3% girls) were included in the network analysis models. BPFs were assessed with the McLean Screening Instrument for Borderline Personality Disorder.

Results: Identity disturbance and affective instability emerged as the most central BPF in the current adolescent sample. In addition, chronic emptiness was also found with high centrality. The general networks of BPF were very similar between adolescent boys and girls, although some differences were detected.

Discussion: This study further supports the necessity of BPD assessment and diagnosis in adolescence and identifies the distinctive importance of identity and affective dysregulation in the early development of BPD. The findings provide empirical insights into the interconnections of BPF, which resonate with therapeutic mechanisms of evidence-based treatments for BPD. However, the research was limited in its use of a screening measurement rather than a diagnostic tool. Future studies can further explore BPD psychopathology in adolescence with longitudinal data and clinical interviews.

Background: The exploration of metacognition in relation to anxiety has received considerable attention in recent decades. Research indicates that it plays a role in the development and maintenance of anxiety disorders while also providing benefits, including the ability to assess situations, modify behaviors, and make informed decisions.

Summary: We propose that having an awareness of a disorder, also known as insight, is related to metacognition in anxiety. This relationship stems from the ability it provides individuals to recognize their mental state through reflection on personal experiences. We discuss the impact of insight and metacognition on decision-making, treatment-seeking behaviors, and coping strategy selection.

Key messages: Understanding the concept of insight in anxiety disorders, as compared to other mental disorders like psychosis, requires exploring its complexities while carefully considering the balance of harms and benefits. While the medicalization of symptoms in psychosis is widely regarded as clearly beneficial, evaluating the role of insight in anxiety disorders demands a more nuanced understanding. Gaining a fuller perspective on patients' beliefs can impact their behaviors and decision-making. Clinicians can achieve this by encouraging active self-reflection to increase awareness, which includes evaluating both severity and impact on daily functioning. This also involves expressing experiences and exploring attributions of anxiety. This practical approach enables clinicians to understand engagement and treatment-seeking behaviors, allowing them to tailor treatment plans and develop effective coping and management strategies. Ultimately, this knowledge promotes a deeper comprehension of insight into anxiety disorders.