Clinical Neuropsychiatry最新文献

Recent developments driven by people with attention-deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) have highlighted that far from being disorders, ADHD and/or ASD can be seen as natural variations in neurodevelopment. The neurodiversity movement acknowledges that people with ADHD and/or ASD have specific strengths, that can help them outperform neurotypical individuals in certain situations and that these conditions should therefore not be seen as disorders. This view is supported by evolutionary science, which can be used as a framework to understand ADHD and/or ASD as natural variations that were not eliminated by natural selection due to their benefit to the individual and group in certain situations. The evolutionary perspective supports neurodiversity as relevant and important in helping our species thrive.

Objective: it is well known that during an intentional behavior, the final goal of the action shapes the entire sequence of motor acts. This chained organization has been previously demonstrated to be altered in school-age autistic children, who modulate only the final motor act according to the action goal. Here, we investigate the temporal modulation during the intentional action in three groups of preschoolers: neurotypical, autistic, and non-autistic siblings of autistic children.

Method: the participants engaged in a simple task of reaching and grasping an object and placing it into two containers of different sizes.

Results: neurotypical children adjusted both reaching and placing times according to the width of the containers, indicating an action-chained organization. In contrast, both autistic children and non-autistic siblings adapted only the placing - but not the reaching- time according to the container size, exhibiting an unchained organization of intentional actions.

Conclusions: despite not being included among the diagnostic criteria, motor alterations are present in a large number of autistic individuals, detectable from an early age. Being motor signs also expressed by non-autistic siblings, our findings suggest a potential link between motor abnormalities and the pathogenesis of autism. Thereby, tasks similar to the one employed here could be valuable for screening children with an increased likelihood of atypical neurodevelopment.

Objective: The Self-Discrepancies Scale (S-DS) is a multiple-subscore instrument designed to assess discrepancies between mental representations of the self: the actual self on one hand, and the ideal and socially prescribed selves on the other. Its idiographic subscores rely on the endorsement of self-descriptive traits, while its abstract subscores form an overall judgement of felt self-discrepancies. The objectives of the present study were to (i) evaluate the S-DS in a new non-clinical population, (ii) expand the body of data on the S-DS's convergent validity, (iii) study the idiographic data for the S-DS, and (iv) establish a nomothetic list of traits with a better choice of unwanted traits.

Method: We administered the S-DS to a non-clinical sample (N= 422, mean age = 23.26, 90% female), along with a questionnaire measuring personality traits.

Results: Two internal reliability results were different to those observed in the primary research. The wanted ideal self (WIT%) was weakly linked to overall measures of discrepancy and distress. The correlations between the two indices of ideal self (WIT% and ideal discrepancy) were weak. One result differs from the literature findings (moderate correlation between the two discrepancy indices). Neuroticism was found to be the highest predictor of ideal discrepancy. The abstract discrepancy subscores (ideal and socially prescribed discrepancies) were better correlated with personality traits than the idiographic subscores (wanted ideal (or socially prescribed) traits). Our present results suggest that the ideal and socially prescribed selves encompassed the same categories of wanted and unwanted traits.

Conclusions: There were small quantitative differences (in the number of traits cited) between the two selves. In general, the two types of traits (wanted and unwanted) belonged to different categories. The wanted traits were more strongly endorsed in the ideal self. In conclusion, the present data provided a better assessment of the idiographic aspects of self-discrepancy and add to a grow body of evidence on the convergent validity of the S-DS.

Objective: Self-criticism (SC) is a central transdiagnostic factor in several psychopathological conditions, influencing the development and maintenance of symptomatology. The importance of this construct has stimulated quantitative and qualitative research about it. The main purpose of this systematic review is to highlight which qualitative methods have been used most frequently and which are most suitable for studying SC.

Method: We conducted a systematic search by searching the following databases to identify publications: PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and ERIC (all years up to and including January 2024). We aggregated search terms into two concepts for all databases: "self-criticism" and "qualitative analysis".

Results: After removing duplicates, we screened a total of 852 records, resulting in the identification of 28 full-text articles that we assessed for eligibility. Upon closer examination, there was consensus that 16 of those studies met the inclusion criteria. Data extracted from the included studies revealed the lack of a shared approach regarding qualitative analysis of SC. Some studies employed a top-down coding approach, others used a bottom-up coding approach, and a few combined both methods. Consensual qualitative research and thematic analysis have been used most widely in the field. Furthermore, the data revealed no consensus among researchers on the conceptualization of SC. SC categories identified through qualitative analysis frequently do not align with existing theoretical models, and these categories are rarely re-examined in subsequent studies.

Conclusions: There is a need to test existing theoretical models of SC through qualitative analysis and to develop new models that should be examined with qualitative and quantitative methods in different clinical populations to fully capture the complexity and multidimensionality of SC.

Objective: To describe the relationship between executive functions (EF) and symptom's severity, behavioral problems, and adaptive functioning in autistic preschoolers.

Method: Seventy-six autistic preschoolers (age-range: 37-72 months; SD: 8.67 months) without intellectual disability were assessed. Executive functions were measured by both performance-based (Battery for Assessment of Executive Functions -BAFE-) and indirect measures (Behaviour Rating Inventory of Executive Function - Preschool Version -BRIEF-P); adaptive skills were assessed using the Vineland Adaptive Behavior Scales Second Edition (VABS-II); ASD severity was evaluated through the ADOS-2 and the SCQ; the Child Behavior Checklist (CBCL ½-5) questionnaire was used to describe the emotional/behavioral profile.

Results: A considerable rate of autistic preschoolers showed weaknesses in one or more measures of EF, in particular in inhibition and working memory at both performance-based and parent report measures. EF measures explained a significant proportion of variance in the emotional/behavioral profile, and in the adaptive skills, particularly in the socialization domain. Specifically, the most relevant EF predictors are Inhibition, Emotional Control and Cognitive Flexibility subscales of the BRIEF-P.

Conclusions: Assessment of EF in autistic preschoolers may identify those children at higher risk for emotional/behavioral problems and adaptive difficulties. EF are a crucial target for early intervention in preschoolers with autism with the potential to improve child outcomes.

Objective: Even though the COVID-19 emergency has concluded, its consequences are still relevant. Recent evidence suggests that a significant proportion of individuals experience persistent symptoms long after the initial infection has resolved, classified as "Long COVID" condition. Fear of COVID-19 increases anxiety and stress levels in healthy individuals and exacerbates the symptoms of those with pre-existing psychiatric disorders; therefore understanding the impact of the pandemic on psychiatric disorders remains of utmost importance. The present study aimed at assessing the prevalence and predictive factors of fear of COVID-19 in a sample of patients with different psychiatric conditions.

Method: A sample of 269 psychiatric patients were recruited from two different tertiary clinics in Italy and assessed with the Fear of COVID-19 Scale (FCV-19S). In order to compare patients with a significant fear of COVID-19 or without (Fear+ vs. Fear-) and to identify the main features in terms of clinical dimension, exploratory and predictive analysis were performed.

Results: Female gender, age at illness onset, and insight levels emerged as positive predictors of FCV-19S. Conversely, current substance abuse emerged as a negative predictor of fear levels. Moreover, significantly lower FCV-19S scores were observed in patients with a diagnosis of schizophrenia spectrum disorders.

Conclusions: Specific sociodemographic and clinical factors predicted higher levels of fear of COVID-19 in psychiatric patients. Further studies are warranted to determine the potential long-term consequences of the COVID-19 impact on mental health.

Objective: Obsessive-compulsive and related disorders (OCRDs) and disorders due to addictive behavior (DABs) are prevalent conditions that share common neurobiological and behavioral characteristics. This scoping review aims to identify and map the range of subjective assessment tools (e.g., interviews and self-report instruments) for assessing Research Domain Criteria (RDoC) and related constructs underlying DABs and OCRDs, such as impaired response inhibition, habit formation, and compulsivity.

Method: A scoping review was performed following the PRISMA Extension for Scoping Reviews (PRISMA ScR). The search was conducted in Medline, Web of Science, PsycINFO, and EMBASE databases. No constraints of data or document type were adopted.

Results: The search yielded 615 instruments, of which 79 were deemed transdiagnostic and capable of assessing at least one of the target constructs. Noteworthy tools included are the Cambridge-Chicago Compulsivity Trait Scale, the Self-report Habit Index, the Reward Probability Index, the Threat-Related Reassurance-Seeking Scale, and the recent Positive Valence Systems Scale.

Conclusions: Despite the growing body of literature on OCRDs and DABs as new diagnostic chapters and the number of tools with the potential to assess their transdiagnostic constructs clinically, most instruments were designed to capture dimensions or psychopathology not directly (or primarily) related to OCRDs, DABs and the concepts of impaired response inhibition, habit formation, and compulsivity in the context of these conditions. Further studies exploring the correlation between subjective assessments, corresponding behavior paradigms, and neuroimaging data would be of great value in the translation of RDoC constructs and domains into clinical settings.

Is Attention Deficit Hyperactivity Disorder (ADHD) a "brain disorder"? Should it be managed regularly with stimulant drugs? This article critically examines the evolving biomedical discourse surrounding these questions through a close inspection of the latest edition of the influential psychiatric manual - the DSM-5-TR - as well as additional authoritative sources (e.g., previous DSM editions, consensus statements, FDA communications). The DSM-5-TR acknowledges that "no biological marker is diagnostic for ADHD" and that "meta-analyses of all neuroimaging studies do not show differences between individuals with ADHD and control subjects." The authors of the DSM-5-TR, therefore, conclude that "until these issues are resolved, no form of neuroimaging can be used for diagnosis of ADHD." These statements, along with biases in the neuroimaging literature and additional empirical evidence presented in the article, challenge popular myths about the neurobiological basis of ADHD. Similarly, common beliefs about the first-line treatment of ADHD with stimulant drugs are being increasingly questioned today. For instance, the DSM-5-TR's section on Stimulant-Related Disorders introduces a new diagnostic entity named: Stimulant-Induced Mild Neurocognitive Disorder. This addition aligns with a recent FDA Drug Safety Communication for "all prescription stimulants," which highlights longstanding concerns regarding the safety of medications prescribed to millions of diagnosed individuals, primarily children. The FDA now mandates that "the Boxed Warning, FDA's most prominent warning, will describe the risks of misuse, abuse, addiction, and overdose," emphasizing that such "misuse and abuse of prescription stimulants can result in overdose and death." In light of these challenges to the biomedical discourse, this article offers a neurodiversity-oriented alternative. Using evolutionary principles and historical context, it argues that most cases of ADHD fall under the DSM's socio-philosophical category of "conflicts that are primarily between the individual and society" (similar to homosexuality, which was removed from the DSM in 1973), and are therefore "not mental disorders".