Clinical Neuropsychiatry最新文献

Objective: The clinical and empirical investigation of the role of investment in goals and anti-goals is limited by the lack of an easy-to-use tool. This is critical, as psychopathology, and specifically pathological personality, is characterized by an overinvestment in goals and anti-goals, rigidity in these investments and, consequently, by a poor existential plan that generates suffering and resistance to change. To develop a preliminary version of a self-report questionnaire measuring investment levels in goals and anti-goals, described as core features of the most common psychopathological conditions. To test the factorial structure of the tool and examine preliminary data on its construct validity.

Method: The Inventory of Goals and Anti-Goals (IGAG) was developed. A total of 572 participants (Mage= 33.05 years; SD= 10.01; 61.62 % females), including community participants (n =424) and patients (n =148), was asked to complete a battery of questionnaires including the IGAG, the Personality Inventory for DSM-5 and the Symptom-Checklist-90-Revised. Exploratory factor analysis, Mann-Whitney U tests and correlations were computed.

Results: Analyses identified an eight-factor structure and significant differences between groups on several factors. IGAG scores were largely significantly and positively correlated with the PID-5 and SCL-90-R in the expected directions.

Conclusions: The IGAG appears to be a promising instrument for both research and clinical practice. Results suggest a strong relationship between overinvestment in goals and anti-goals and psychopathology. Several limitations necessitate future modifications of its content and additional efforts for validation.

Objective: Within the realm of international diagnostic systems, the Psychodynamic Diagnostic Manual - 2nd edition (PDM-2) stands out as a particularly effective instrument for evaluating mental functioning based on a psychodynamic perspective. This research aimed to explore the psychometric properties of the M Axis and to investigate the dynamics among its 12 capacities for individuals with Cluster B personality disorders.

Method: A sample of 285 psychotherapists who regularly use the PDM-2 in their professional practice was involved in this research. The collected data were analysed using an integrated approach combining factor and network analyses.

Results: The factor analytic approach supported the strong psychometric properties of the M Axis for the 4-factor model. Good indications of internal consistency emerged, along with evidence of both convergent and divergent validity. The network analysis approach suggested that the psychotherapists perceived the capacity for mentalization and reflective functioning as the most influential one within the network of capacities in Cluster B personality disorders.

Conclusions: The M Axis emerged as a psychometrically solid assessment measure with strong theoretical and empirical bases, which can provide valuable support for enhancing both research and clinical practice.

Objective: Attention deficit/hyperactivity disorder (ADHD) is among the most prevalent neurodevelopmental disorders in children, often persisting into adulthood. It is characterized by two symptom domains: impulsivity and inattention, both associated with underlying neural and cognitive deficiencies. This study is the first toinvestigate the potential effects of transcranial direct current stimulation (tDCS) targeting the left DLPFC on cognitive functions related to both symptom domains in adults with ADHD compared to typically developed controls.

Method: This pre-registered clinical trial enrolled 55 participants, 25 of whom were diagnosed with ADHD. Participants completed a series of cognitive tasks before and after receiving either tDCS or sham treatment.

Results: In the ADHD group, tDCS treatment improved measures associated with inattention,but not measures related to impulsivity. In the control group, tDCS treatment had no benefits.

Conclusions: The discrepancy in treatment response observed between inattentive and impulsivesymptoms has implications for understanding the neurobiological mechanisms of ADHD. Our findings offer new evidence supporting the positive impact of tDCS on cognitive functions linked to inattention.

Objective: Objective of this review is to summarize current knowledge on Cognitive Behavioural Therapy (CBT), as treatment for depression in coronary artery disease (CAD).

Method: A systematic search was conducted on the PUBMED database for the last ten years, in accordance with the PRISMA guidelines, following PICOS criteria, and applying specific queries in the 'PubMed Advanced Search Builder'.

Results: Twenty-one studies were selected and included in the systematic review, with a total number of 2498 patients enrolled, excluding patient samples analysed multiple times, with results published in different papers. The mean/SD age of the enrolled patients was 56.9±7.7 years (range: 30.3-63.0). The mean/SD number of scales used was 4.2±2.0 (range: 2-9). The psychological intervention included CBT in 8/21 (38.1%) studies, Internet-Delivered CBT (I-CBT) in 8/21 (38.1%), and CBT + Activity in 1/21 (4.8%) Monitor (AM), 1/21 (4.8%) Stress Management CBT-based, 1/21 (4.8%) CBT-WBT Sequential Approach, 1/21 (4.8%) e-IMPACT CBT (CBT delivered via internet o' by phone'), 1/21 (4.8%) Group-CBT. The control groups underwent 'treatment as usual' (TAU) in 5/21 (23.8%) studies, 'online discussion forum' (ODF) in 5/21 (23.8%) studies, 'clinical management' (CM) in 4/21 (19.0%) studies, pharmacological treatment with SSRIs (2/21; 9.5%), 'waiting list condition' (WLC), 'educational support' or 'simple monitoring' in the remaining 4/21 (19.0%) studies; in one study (4.8%), this information was not available.

Conclusions: Efficacy of CBT as a treatment for depressive syndromes in patients with CD is still under discussion, partly due to the heterogeneity of the outcome measures, partly due to methodological issues, such as therapist supervision and allegiance. CBT seems to be irrelevant to biological variables, such as inflammatory markers and heart rate variability and not ever superior to other interventions, in the treatment of depressive symptoms.

The human, species-typical reproductive system is distinctive and unique among the great apes. It involves pair-bonding and long-term mating as well as male investment in both mate and offspring. Studies have demonstrated that this mating system produces the lowest male reproductive skew known in primates as well as in mammals generally which entails the lowest level of reproductive failure among human males compared to other primate/mammalian species. It is argued that this low reproductive skew leads to an increase in the effective population size and to a greater diversification/variation in personality and behavioural traits in the population compared to other species. The implications of this Reproductive Egalitarian Model for human mating are discussed with regard to the emergence of human personality traits, social complexity, division of labour and risk of mental disorder.

When advocating to fight stigma and promote acceptance of neurodivergent individuals, the current debate on neurodiversity does not present a major challenge to psychiatric theory and research. The controversy arises when neurodiversity is taken to its extreme, denying the existence of neurodevelopmental disorders. Evolutionary psychiatry has recently contributed to the neurodiversity debate by providing adaptive explanations. These explanations are based on the unproven assumption that neurodiversity has been shaped by natural selection, as some atypical neurocognitive profiles increased inclusive fitness in the ancestral environment. Evolutionary psychiatry recognizes the heterogeneity of neurodiversity, acknowledges the existence of neurodevelopmental disorders, and establishes fitness disadvantage as the criterion of morbidity. The evolutionary definition of pathological neurodiversity is based on an objective criterion but it has limited utility in clinical practice. Cultural relativism has always played a role in the history of medicine and psychiatry, often overshadowing scientific analysis. Therapeutic concerns are influenced by cultural trends that can lean towards either medicalization or diagnostic nihilism.

Objective: Traumatic brain injury (TBI) significantly increases the risk of suicidal ideation (SI) and behaviors due to neurobiological changes, cognitive impairments, and emotional dysregulation. This review consolidates current evidence on the relationship between TBI and suicide, identifying key risk factors and underlying mechanisms, and highlights the need for further research, especially in civilian populations.

Method: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases with studies published from 2014 to 2024. This review has been registered on Prospero (number CRD42024574643).

Results: Factors indicated such as external causes of injury, comorbidities like depression and substance use disorders, and post-TBI symptoms consistently influence suicide risk. Advanced predictive models emphasize the role of psychological symptoms, particularly depressive features, in forecasting SI post-TBI, underscoring the need for targeted interventions and early symptom management.

Conclusions: The seriousness of TBI significantly impacts the probability of SI and suicide attempts (SA). Research consistently shows that patients with more severe TBIs tend to have higher rates of SI and SA. Psychological disorders, such as depression and substance abuse disorders, greatly increase the likelihood of suicidal actions after a TBI. These conditions not only raise the occurrence of SI but also lead to earlier and more regular SA.

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.