Clinical Neuropsychiatry最新文献

Objective: Systemic comorbidities are common in Alzheimer's disease (AD) and may influence disease progression, severity, and management. Aim of the study was to assess the prevalence of comorbid medical conditions in a large cohort of AD patients, focusing on sex differences.

Method: AD patients from the NIMH Alzheimer Disease Genetics Initiative were enrolled. Data on multimorbidity, demographics, disease characteristics, and clinical assessments were collected from interviews, medical records, and examinations. Univariate and multivariate logistic regression models were performed to identify possible associations between comorbidities and sex. Subgroup analysis was performed for patients with autopsy-confirmed AD.

Results: Four hundred and twenty-four AD patients (295 women; mean age: 78.4±8.3 years) were included. Men had a higher prevalence of heart disease, diabetes, chronic obstructive pulmonary disease and smoking, whereas thyroid disease, hypertension and depression were more common in women (all p<0.05). Except for hypertension, all associations found in the univariate analysis were confirmed in the multivariate analysis after adjustment for age. Subgroup analysis of autopsy-confirmed cases confirmed these findings.

Conclusions: Our findings support the importance of considering sex-specific comorbidities in AD for precision medicine and emphasize the need for comprehensive assessment of comorbidities to improve clinical outcomes, treatment strategies and health equity.nt.

Objective: Inflammatory Bowel Disease (IBD) is a gastrointestinal condition that significantly impacts individuals' psychosocial functioning. Accumulating evidence from psychosomatic research shows how self-conscious emotions may influence various levels of adaptation to the condition. The current systematic review aims to encompass studies that have already assessed the role of Shame and Guilt in individuals with IBD.

Method: Academic databases were screened to collect studies that met the criteria coded by the authors. 15 studies met the inclusion criteria, and their quality was assessed. Data were categorized as follows: (1) general description of methodology and measures; (2) characteristics of the study samples; (3) shame and guilt in individuals with IBD.

Results: Findings from the current systematic review emphasize that Shame and Guilt are prevalent among individuals suffering from IBD and that they may contribute to the development of maladaptive behavioral and cognitive patterns.

Conclusions: Clinical interventions should assess the presence of these self-conscious emotions and target them to improve clinical efficacy.

Objective: The diagnosis of autism is considered more longitudinally stable compared to other diagnoses for children and adolescents, although significant heterogeneity in longitudinal outcomes emerges between studies based on temporal intervals and diagnostic instruments. The introduction of the concept of Autism Spectrum Disorder (ASD) by DSM-5 may have impacted diagnostic stability. The current study aimed to investigate the longitudinal diagnostic stability of different diagnoses of autism according to the ICD-10 diagnostic system before the institutional move towards the utilization of a unique ASD diagnosis according to DSM-5.

Method: A retrospective study based on medical records and the ELEA electronic database was performed on children attending the Autism Center of the Child and Adolescent Mental Health Service of the Azienda USL-IRCCS, Reggio Emilia, Italy, from January 1, 2005, to December 31, 2015. Diagnostic stability was evaluated according to the diagnosis at follow-up, which was set at 10 years from baseline or December 31, 2020.

Results: A total of 380 children were included at baseline, and 341 were included at follow-up (with a mean temporal interval of 8.74 ± 2.7 years). Among them, 251 individuals maintained a diagnosis within the F84 spectrum, resulting in a diagnostic stability of 73.6%. Specifically, diagnostic stability was 79.8% for the F84.0 diagnosis and 68.2% for the F84.9 diagnosis.

Conclusions: Before the adoption of DSM-5 diagnostic criteria for ASD, ICD-10 diagnoses related to autism were relatively stable in the long run, with an 8-year follow-up. The next step is to assess the longitudinal diagnostic stability of ASD after the adoption of DSM-5 criteria.

Objective: This study investigates the role of metacognition and personality functioning levels as mediators in the relationship between maladaptive personality traits and the risk of problematic gambling (PG) within a non-clinical adult sample.

Method: A cross-sectional design was employed with 619 participants who completed self-report questionnaires assessing maladaptive personality traits, metacognitive abilities, personality functioning levels, and gambling-related behaviors. Instruments included the South Oaks Gambling Screen, the Assessment of DSM-IV Personality Disorders, the Metacognition Self-Assessment Scale, and the Levels of Personality Functioning Scale-Self Report. Data were analyzed using linear regression and serial mediation analyses.

Results: The findings revealed that the risk of PG was positively associated with maladaptive personality traits, particularly Antisocial, Narcissistic, and Borderline traits, and negatively associated with metacognitive abilities and personality functioning levels. Serial mediation analyses demonstrated that metacognitive functions, especially Critical Distance and Self-Reflexivity, along with personality functioning levels, mediated the relationship between maladaptive personality traits and PG risk. Notably, in individuals with pronounced Cluster B traits, metacognition alone served as the primary mediator, while in those with Cluster C traits, the mediation effect involved both metacognitive abilities and personality functioning levels, indicating a dual mediation pathway. These findings highlight distinct mechanisms across personality profiles.

Conclusions: The results underscore the critical role of metacognition and personality functioning in linking maladaptive personality traits to the risk of PG. Clinically, these findings suggest that interventions enhancing specific metacognitive abilities, such as perspective-taking and self-reflection, along with addressing impairments in personality functioning, could mitigate the risk of problematic gambling. These insights contribute to the development of tailored therapeutic strategies for preventing and managing gambling-related behaviors in at-risk populations.

Objective: The Narcissistic Personality Inventory (NPI) is the most commonly used psychometric instrument for assessing narcissistic traits in the general population. Despite its widespread adoption, various factorial structures have been proposed. The present study aimed to provide new evidence for the NPI factorial solution using the not-yet-explored Exploratory Structural Equation Modeling (ESEM) approach and to improve understanding of its relationship with other variables.Method:We administered the NPI along with measures of anxiety, depression, stress, self-esteem, and loneliness to 583 participants (50.8% male, M age = 30.96, SD = 12.12) in a survey online. We compared confirmatory factor analyses and ESEMs for both the long and brief versions.

Results: The NPI-13 ESEM model was the optimal fitting model (ꭓ2=72.060, df = 42, CFI = 0.979, TLI = 0.961, RMSEA = .035 [.021-.049]) also for its bifactorial solution. Moreover, our findings supported the evidence based on relations to other variables for the NPI-13.

Conclusions: In conclusion, our results argued the use of a multidimensional brief version of the NPI and supported the ESEM's advantages for explaining the factorial structure of complex psychological constructs.

Objective: Functional somatic disorders (FSD) are extremely common amongst neuropsychiatric and other specialty medicine referrals. Intensive Short-term Dynamic Psychotherapy (ISTDP) is an emotionally focused form of brief therapy that has been researched and developed specifically for the diagnostic assessment and treatment of FSD, amongst other conditions.

Method: In this publication, we review the ISTDP theoretical underpinnings, the diagnostic assessment, treatment approach and evidence base.

Results: There are now over 50 publications evaluating ISTDP and its effect and processes in FSD. It has been demonstrated efficacious for the spectrum of functional somatic disorders, including chronic pain, functional gastrointestinal disorders, and functional neurological disorders among others. It has further been found more effective than cognitive behavioral therapy in the treatment of chronic pain. Further there is evidence that it is cost-effective in treating these conditions.

Conclusions: ISTDP is a broadly useful clinical tool in the assessment and treatment of FSD.

Objective: An increasing body of literature suggests that autism spectrum disorder (ASD) exists along a continuum, with higher prevalence among individuals affected by other mental disorders.Vincent van Gogh, one of the most universally celebrated artists and a timeless icon, may provide a compelling case for exploring the role of autism spectrum in the development of psychopathological trajectory throughout life. The present report debates the possibility that van Gogh's ASD contributed both to his frenetic artistic production and his severe mental illness, ultimately complicated by catatonia and to his premature death.

Method: The analysis is based on a review of scientific papers, biographies, artwork, and van Gogh's extensive correspondence (902 letters, including 820 to his brother Theo), along with numerous contemporary eye-witness accounts. Throughout the psychobiographical exploration of van Gogh's life, we reference a series of historical elements that align with DSM-5-TR ASD criteria (APA, 2022). Rather than imposing a rigid categorical diagnosis, we use these criteria to highlight the transdiagnostic nature of his symptoms, acknowledging the limitations of modern nosology when applied to historical figures.

Results: This study reconstructs a hypothetical illness trajectory for van Gogh, originating from ASD and culminating in severe catatonia, followed by his premature death whose cause remains unclear. We also address potential comorbidities (e.g., bipolar disorder, substance use), emphasizing the non-specific, transdiagnostic features of many psychopathological symptoms.

Conclusions: We propose Vincent van Gogh as a potential prototypical case of ASD with catatonia, as described in DSM-5-TR (2022), in an adult without intellectual impairment or language developmental delays. This retrospective hypothesis underscores the complexities of retrospective diagnosis and the possible weaknesses of strictly categorical models, given the overlapping nature of neurodevelopmental, affective, and psychotic symptoms in real-world clinical practice.

Objective: To date, the literature on repetitive negative thinking (RNT), rumination and worry, in students with Specific Learning Disorder (SLD) is still scant. This study seeks to deeply examine those variables in university students with and without SLD, focusing on the differences between males and females.

Method: A survey was administered to 107 university students between 18 and 31 years (mean age=21,56; SD=2,60). Of these, 65 were typically developing (TD) and 42 had a diagnosis of SLD. Participants responded to the Ruminative Response Scale (RRS) and the Penn-State Worry Questionnaire (PSWQ). Anxious and depressive symptoms were also assessed.

Results: Significant differences were found between university students with and without SLD on all the scales except for PSWQ. Regression analyses reported that rumination significantly affected depression and anxiety whereas worry seemed to have a role only in anxiety. Finally, female students with SLD showed higher levels of internalizing symptoms among all the subjects.

Conclusions: The results give psychologists a greater understanding of RNT in university students with SLD, suggesting the importance of including those psychological processes in the clinical assessment.

This review of reviews aims to investigate the effectiveness of non-invasive brain stimulation (NIBS) methods, i.e., transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), in reducing elevated body mass index (BMI) and overeating behavior (food cravings, binge eating, increased food consumption). Systematic reviews and meta-analyses in the English language were included. A search was conducted in PubMed and EMBASE until January 2024. The quality of all included reviews was assessed using the "A Measurement Tool to Assess Systematic Reviews" (AMSTAR-2). Quality assessment and data extraction were conducted by two independent reviewers, while all reviewers participated equally in article synthesis. Twenty-four systematic reviews were included, most of which show promising results regarding the effectiveness of NIBS on overeating and increased BMI . For weight reduction, rTMS is more effective, and tDCS can improve food cravings and food consumption. However, the critically low quality of most included studies and the heterogeneity of the intervention parameters are strong limitations against drawing any safe conclusions. More studies are needed with stable NIBS parameters.