Clinical Neuropsychiatry最新文献

Objective: Virtual Reality (VR) is gaining increasing attention for its ability to support psychological interventions by offering immersive, interactive, and emotionally rich environments. While VR has been widely adopted in cognitive-behavioral treatments, especially for conditions like anxiety disorders, post-traumatic stress disorders, and phobias, its use within psychodynamic and insight-oriented therapies is still in its early stages. This paper explores how VR may serve as a valuable complement to psychodynamic work by enabling patients to connect with unconscious processes, relational patterns, and emotional experiences in new and innovative ways.

Method: Building on foundational psychoanalytic concepts, such as reality testing, unconscious fantasy, transference, and transitional objects, the paper examines how VR experiences can activate symbolic and affective dimensions of the psyche.

Results: In virtual immersive environments, patients can project inner conflicts, interact with avatars that represent aspects of the self or significant others, and engage in emotionally charged narratives that support insight and self-reflection. VR's embodied qualities, like avatar identification and real-time bodily synchronization, further support this process by offering new modalities for exploring identity, body image, and dissociated self-states. However, realizing VR's full therapeutic potential requires addressing a set of practical and theoretical challenges These include variability in individual responses, risks of disorientation or cybersickness, and the possibility that excessive environmental control could inhibit spontaneity and symbolic elaboration. Additionally, technical and financial barriers can also make the integration difficult. Along this line, VR should not be seen as a replacement for traditional psychotherapeutic methods, but rather as a flexible tool that, when thoughtfully embedded within a psychodynamic framework, can deepen the therapeutic encounter.

Conclusions: By offering new routes to emotional and symbolic exploration, VR expands the analytic setting into a dynamic and embodied space, inviting clinicians to engage with emerging modalities while preserving the depth and specificity of their practice.

Objective: Personality disorders (PDs) are chronic and pervasive mental health conditions associated with significant functional impairment and high psychiatric comorbidity. Although psychotherapeutic interventions are the primary treatment approach, pharmacotherapy is frequently prescribed to manage specific symptoms. However, adherence to pharmacological treatment in PDs remains a critical challenge, influenced by both personality traits and clinical factors. The present study aims to assess adherence rates in a large cohort of patients with PDs and explore potential sociodemographic and clinical factors associated with compliance.

Method: This observational study included 200 patients diagnosed with PDs according to DSM-5 criteria, recruited from different psychiatric services in Milan, Italy. Adherence was assessed using the Clinician Rating Scale (CRS), with positive adherence defined as CRS ≥ 5 and poor adherence as CRS < 5. Sociodemographic and clinical data were collected and analyzed across adherence groups and PD clusters.

Results: Positive adherence was observed in 64.5% of the sample. Cluster C PDs exhibited significantly higher adherence rates (83.3%) compared to Cluster B (61.3%), mixed-feature (60%), and Cluster A (73.3%; p<.05). A positive family history of psychiatric disorders was associated with greater adherence (60.3% vs. 45.5%, p<.05). A trend toward lower adherence was observed in patients with lifetime and current substance use.

Conclusions: Higher adherence in Cluster C PDs may be linked to anxiety-driven behavioral patterns, while lower adherence in Cluster B and mixed-feature PDs suggests impulsivity and mistrust contribute to non-compliance. Additionally, a positive family history of psychiatric disorders emerged as a potential protective factor, possibly enhancing treatment engagement through greater awareness and support networks. Future research should focus on developing tailored interventions to the specific needs of different PD clusters to improve long-term treatment outcomes.

Objective: Increasing attention on the correlation between pet-ownership and mental health or well-being in general population and those affected by psychiatric and cognitive disorders is currently arising. It has been proposed that emotional attachment to pets moderates the relationship between pet-ownership and mental health. Most data highlight the benefits that pet-owner relationships may lead to the individual. Notwithstanding, there are evidence of presence of some psychological features in pets' owners that may belong to several psychopathological spectra. These features may have important implication for individual well-being, and, in the pet relationship which tends to compensate owners' potential abnormal traits. However, the presence of abnormal traits may, in turn predispose the individual to the worsening of psychopathological features in stressful circumstances, especially when the relationship with the animal is hampered. This review aims to highlight relevant data from the literature on this issue and advance hypotheses for future research and clinical implications.

Method: A narrative review of the available literature on the topic was carried in three main databases (PubMed, Scopus, Web of Science), between September 2024 and December 2024, using the following string: ((pet attachment) OR (pet owner relationship) OR (pet owner personality) AND/OR (mental health) AND/OR (quality of life) AND/OR (autism) AND/OR (separation anxiety)).

Results: Personality traits, such as neuroticism, empathy, and consciousness play in shaping the bond between pets and their owners. While traits like empathy often enhance emotional bonding and quality of life, the literature also acknowledge that they may overlap with psychological distress or disorders, complicating the interpretation of these relationship. Interestingly, even traits typically considered negative such as narcissism, may manifest positively in pet care, further complicating the dynamics of pet attachment. While pet provide emotional security, especially for individuals with anxiety disorder or neuroatypical traits, excessive attachment can introduce emotional vulnerabilities and worsen psychological issue.

Conclusions: This review call for future research to better understand the psychological implications of pet attachment and suggest potential clinical applications for fostering healthy bonds and improving mental health well-being.

Objective: Psychotic disorders are heterogeneous in their clinical presentation and outcome. While early research focused on poor prognoses in schizophrenia, recent longitudinal studies tracking first-episode psychosis (FEP) have identified more favourable outcome trajectories. This study investigates the stability and predictive value of metacognitive and social cognitive impairments-Jumping to Conclusions (JTC) bias and Facial Emotion Recognition (FER) deficits-as intermediate phenotypes of psychosis over a 5-year follow-up period.

Method: A total of 134 FEP patients and 105 population-based controls from the GAP and EU-GEI follow-up study in London were reassessed after an average of 4.8 years. JTC was measured using the 60:40 Beads task, while FER was assessed through the Degraded Facial Affect Recognition (DFAR) task. Clinical, functional, and social outcomes-including hospital admissions, symptom severity, and employment status-were evaluated. Mixed models and regression modeling examined the stability of these cognitive traits and their association with long-term outcomes.

Results: JTC and FER impairments remain stable over time, supporting their classification as intermediate phenotypes. However, neither JTC nor FER was associated with clinical outcomes (hospitalization rates, symptom severity) or social functioning (employment, independent living, relationships). A weak correlation was found between global FER impairment and negative symptoms at follow-up, but no associations emerged with real-world functional measures. Additionally, while patients demonstrated greater impairments than controls, the differences were more quantitative than qualitative, aligning with the psychosis continuum hypothesis.

Conclusions: These findings demonstrate that JTC and FER are stable in people with psychosis and controls. Therefore, they may serve as important treatment targets for early intervention in psychosis. Future research should integrate the potential role of environmental factors as well as genetic influence to deepen our understanding of cognitive impairments in psychotic disorders.

Does Attention Deficit Hyperactivity Disorder (ADHD) increase the risk of suicidality among children? This article critically examines a notable study by Shahnovsky et al. (2024), which identifies hyperactivity as a significant predictor of suicide attempts. A detailed analysis of the study reveals three critical gaps: (1) oversight of key risk factors, such as ADHD medications and comorbid disorders - some of which were examined in a related study by the same authors, showing no significant association between ADHD and suicidality; (2) misinterpretation of prior research, inaccurately presenting ADHD medications as protective despite evidence indicating a significantly elevated suicide risk among users; and (3) misrepresentation of the study's findings, which largely suggested that ADHD was unrelated to suicide risk based on both parent and child reports and the two examined components of ADHD. Drawing on an extensive body of research, it is argued that depressive symptoms and suicidal ideation are more likely attributable to the first-line treatments for ADHD than to the diagnosis itself. By situating the study within the broader literature, this article cautions against potential real-life implications arising from its conclusions, such as clinicians prescribing ADHD medications to suppress the allegedly dangerous hyperactivity - medications that may paradoxically increase the risk of suicide. This critique is offered with the utmost respect for the authors' lifelong dedication to advancing suicide prevention, with the sincere aim of fostering a constructive dialogue to deepen our understanding of the tragic phenomenon of childhood suicide.

Polyvagal Theory proposes an evolutionarily informed neurophysiological framework for understanding how the autonomic nervous system supports social engagement, emotional resilience, and adaptive physiological responses. At its core, the theory emphasizes a hierarchical organization of autonomic states mediated by the vagus nerve, highlighting the unique role of the ventral vagal complex in facilitating social behavior and physiological flexibility through mechanisms such as neuroception, co-regulation, and dissolution. This paper reviews the empirical foundations of Polyvagal Theory, addresses methodological critiques - particularly regarding anatomical specificity and respiratory sinus arrhythmia (RSA) - and consolidates recent advances in autonomic measurement. Furthermore, it explores wide-ranging clinical implications across diverse conditions including trauma, chronic pain, autism, developmental disorders, and mood disorders. Finally, the paper advocates for applying a "science of safety" in clinical practice, education, and public health, offering future directions for research, clinical practice, and the systemic design of institutions that support physiological safety at scale.

Objective: This study aims to characterize the developmental, cognitive, and behavioral profiles of children and adolescents with autism spectrum disorder (ASD) without intellectual disability (ID).

Method: A cross-sectional observational study was conducted, including children and adolescents with ASD and an intelligence quotient (IQ) of 75 or higher. Parents completed the CBCL, and SNAP-IV 26 Parent Rating Scale to assess developmental milestones, cognitive abilities, and behavioral symptoms.

Results: The study included 74 participants, with a mean age of 9.8 ± 2.9 years, of whom 64 (86.5%) were male. Mothers and fathers had a mean age of 33.4 ± 5.5 and 30.2 ± 5.7 years, respectively, with 64.9% of mothers and 47.9% of fathers having completed higher education. Generalized anxiety and depression were the most frequent psychiatric histories reported by parents. Median IQ scores were: total 100 (88-113), verbal 102 (85-117), and performance 97 (90-108). While 82.5% of children spoke their first words before 24 months, only 40% were able to form phrases by age 2. Prosody, pragmatic difficulties, and echolalia were present in over 40% of cases. Moderate or severe symptoms of inattention, hyperactivity, and oppositional behaviors were observed in 33.8%, 16.2%, and 16.2% of participants, respectively. Internalizing symptoms were present in 27%, and externalizing symptoms in 15% of the sample. Learning challenges included difficulties with text interpretation (31%), text production (24%), reading, and math (19% each).

Conclusions: Children and adolescents with ASD without ID exhibit significant behavioral and cognitive challenges, including language delays, inattention, internalizing symptoms, and learning difficulties. These findings emphasize the need for targeted educational and therapeutic strategies to address their unique developmental and behavioral profiles.

Objective: Catatonia is a complex neuropsychiatric syndrome characterized by motor, cognitive, and emotional disturbances, affecting approximately 7-38% of psychiatric inpatients. Despite its prevalence, it is frequently underrecognized in clinical practice. The objective of this narrative review is to explore the hypothesis that dysfunction of the basal ganglia's indirect pathway-mediated by neurotransmitter imbalances-plays a central role in the pathophysiology of catatonia.

Method: This narrative review synthesized clinical, neuroimaging, and preclinical studies identified through PubMed, Embase, and PsycINFO (1980-April 2025) using terms related to catatonia, basal ganglia pathways, and neurotransmitters. Studies on GABA, dopamine, glutamate, serotonin, and acetylcholine in catatonia or indirect pathway function were included. Findings were conceptually integrated to link neurotransmitter dysregulation with catatonic features, considering age-related effects and circuit models.

Results: Evidence indicates that impaired inhibitory control within the indirect pathway is a core mechanism underlying catatonia. Key findings include reduced GABAergic tone, dopamine D2 receptor dysfunction, glutamatergic hyperactivity, and altered serotonergic and cholinergic modulation. These disruptions collectively contribute to clinical features such as stupor, rigidity, and stereotypies. While benzodiazepines, which enhance GABA-A receptor activity, remain the first-line treatment, preliminary evidence suggests that NMDA antagonists, dopamine agonists, and serotonergic/cholinergic modulators may also offer therapeutic benefits, though these are not yet widely implemented.

Conclusions: By integrating neurocircuit-based models with observed clinical phenomena, this review proposes a unifying framework to understand the neural basis of catatonia. Clarifying the role of indirect pathway dysfunction could support the development of targeted, mechanism-based interventions, ultimately improving recognition and treatment outcomes for this often-debilitating syndrome.

Objective: Several studies have demonstrated an increase in body dissatisfaction following the use of photo filters; however, the role of intervening factors such as critical thinking has often been overlooked. The aim of this research was to investigate the relationships between photographic manipulation, body dissatisfaction, and critical thinking, taking into account the mediating role of critical thinking.

Method: A convenience sample of 500 Italian-speaking subjects (44% male; 56% female) aged between 18 and 60 years (Mage = 25.7; SD = 17.8) participated at the study. The instruments used were: (1) the Revised Photo Manipulation Scale; (2) the Body Uneasiness Test; (3) the Fake Subscale of the Critical Processing of Beauty Images Scale; (4) a specifically constructed task for recognizing photographic manipulation (5) three control questions.

Results: The results obtained show a positive relationship between the use of photo manipulation and body image dissatisfaction. Critical thinking has a partial mediating role in the relationship between body image dissatisfaction and photo manipulation.

Conclusions: To delve deeper into the findings, the participants' ability to correctly classify natural and filtered photos have been described. Clinical and research implications are discussed.

Objective: Autism Spectrum Disorders are neurodevelopmental disorders characterized by persistent communication and social interaction challenges, restricted and repetitive behaviours and interests. The severity of ASD symptoms varies widely, influencing an individual's functioning throughout their lifespan. Various external contextual factors can further modulate these symptoms and their impact on overall functioning. The primary purpose of this study is to investigate global functioning as well as the types of services, interventions and therapies that subjects with ASD in adulthood have experienced throughout their lives. Additionally, we collected data to analyze and identify factors that impact outcomes for subjects with ASD.

Method: A total of 503 subjects with ASD in adulthood, along with their families and clinicians, were interviewed to collect comprehensive data on demographic, clinical, and functional variables. Data were analyzed using regression models to identify factors independently associated with global functioning, measured through the Global Assessment of Functioning (GAF) scale.

Results: We identified internal and external factors that significantly impacted the global functioning of ASD people.The analysis identified multiple factors significantly affecting global functioning, including levels of communication, psychiatric comorbidities, social relationships, use of interventions, and living and employment status. The study highlights the critical role of both individual and contextual elements in shaping outcomes.

Conclusions: Our study represents an exploratory investigation of outcomes for ASD adults. It underscores the importance of personalized and targeted interventions to improve the quality of life and overall functioning of subjects with ASD in adulthood. The findings advocate for further research to address gaps in understanding and to design interventions tailored to diverse needs.