Clinical Neuropsychiatry最新文献

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".

Objective: Atypical depression (AD) is a clinical subtype of depression characterised by mood reactivity and at least two of the following features: significant weight gain/increased appetite, hypersomnia, leaden paralysis, and/or interpersonal rejection sensitivity. The role of genetics in the development of depression remains a considerable level of interest among individuals. Due to the large number of breakthrough studies in genetics, there is currently a wealth of heterogeneous data on the existence of genetic markers for depression, including AD. However, it appears that there is a gap in the literature, as we were unable to identify any systematic reviews or meta-analyses that comprehensively describe these data. Therefore, our research aims to provide high-quality, solid evidence for further studies in this area.

Method: Electronic bibliographic databases (Scopus, MEDLINE) were systematically searched from inception to September 2023. We searched for any specific genetic markers that could be retrieved associated with AD. The quality of studies has been assessed by means of the Q-genie tool.

Results: Nine studies meeting the inclusion criteria were selected, which appeared to link genetic polymorphisms to atypical depression. Four studies examined genetic polymorphisms associated with the serotonin transporter gene (5-HTT), three studies examined genetic polymorphisms associated with endocrine regulation, two studies considered genetic polymorphisms associated with immune and/or cellular regulation, specifically the melanin-concentrating hormone receptor 2 (MCHR2), mineralocorticoid receptor (MR), and fat mass and obesity-associated protein (FTO) genes involved in the regulation of energy balance.

Conclusions: The extracted data confirm that the atypical type of major depressive disorder is heritable to a certain extent. Individual risk markers for developing this type of depression may be identified in the future.

Objective: The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent.

Method: We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships.

Results: The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client's way of functioning, regulate major changes that disrupt and alter the client's way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather safe enough, adaptive, and dynamic, leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client's resilience and adaptation.

Conclusions: Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research.

Objective: The growth of videoconferencing psychotherapy (VP) requires a closer conceptualization of the therapeutic relationship in VP. Therefore, we investigated the therapeutic relationship in VP from the clinicians' perspective.

Method: We conducted three focus groups with 27 Italian VP professional psychotherapists of different theoretical orientations, focusing on their experience of the therapeutic relationship in VP. Data analysis was conducted through inductive thematic analysis.

Results: The following themes emerged: (a) construction and management of the online setting (regarding the complexity of the therapeutic boundaries in VP and the efforts to manage this); (b) meaning construction of the request for help and the therapeutic process (regarding how patients and therapist represent the meaning of the therapeutic space and work in VP); (c) patient and therapist involvement in the online relationship (addressing the depth of the therapeutic relationship in VP in terms of intimacy, openness/closure, distance/closeness, and involvement); (d) new elements of the therapeutic relationship introduced by VP (regarding the source and nature of information about the patient and the effects of the technical environment on the relationship); (e) nonverbal aspects and corporeality in VP (dealing with how different aspects of para- and extralinguistic communication may impact the therapeutic relationship in VP); (f) differences in the quality of the emotional and relational level of VP (regarding the emotional attitudes and reactions of patients and therapists and the overall quality of the therapeutic relationship); (g) treatment satisfaction and drop-out (regarding ease of leaving the session, patient satisfaction, and dificulties in terminating therapy); and (h) personal characteristics of patient and therapist that influence VP (regarding the impact of patients personality and therapists training/approach on the progress of VP).

Conclusions: Results suggest that the therapeutic relationship in VP has specific features that distinguish it from face-to-face psychotherapy. Implications for practice, training, and research are discussed.