Clinical Neuropsychiatry最新文献

Objective: Insomnia can be a contributing factor, a comorbid disorder, or a transdiagnostic element to several mental disorders, including mood disorders (MDs). A recent meta-analysis has already shown the effectiveness of cognitive behavioral treatment (CBT) for insomnia that is comorbid with MDs. This work aimed to systematically review data on pharmacological insomnia treatment in the context of MDS. In agreement with the current guidelines, pharmacological interventions for insomnia include gamma-aminobutyric acid (GABA)A receptor agonists such as short-medium acting benzodiazepines and benzodiazepine receptor agonists - Z-drugs, melatonergic receptors agonists, specifically melatonin 2 mg Prolonged Release (PR) and ramelteon, and dual orexin receptors antagonists (DORA) such as daridorexant, lemborexant, and suvorexant.

Method: A systematic search was carried out on PUBMED database, according to the PRISMA Guidelines.

Results: Thirty-three papers, 15 on gabaergic receptor agonists, 14 on melatonergic receptor agonists and 4 on DORA, were selected.

Conclusions: Available data suggests that the treatment of insomnia symptoms with specific pharmacological options can improve both insomnia and comorbid conditions. Specifically, eszopiclone and melatonin 2 mg PR have demonstrated promising outcomes. Moreover, daridorexant and suvorexant, both belonging to the DORA class, have demonstrated efficacy in treating insomnia and mood symptoms. To summarize, current literature would suggest that targeting insomnia could potentially regulate the sleep system and, as such, improve mood symptoms.

Objective: Syncope is defined as a spontaneous and transient loss of consciousness and postural tone due to brief and reversible cerebral hypoperfusion. This review aimed to summarize the research findings regarding the psychological correlates associated with pediatric syncope. Moreover, the study aimed to deepen the understanding of the relationship between psychological disorders and the onset of syncopal episodes in childhood, focusing on clinical features and different clinical classifications.

Method: A systematic review was carried out from inception to January 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the CINAHL Plus, APA PsycArticles, APA PsycInfo, MEDLINE, and Psychology and Behavioral Sciences Collection databases. The study search and selection were based on the Population Intervention Comparison Outcome Study Design (PICOS) strategy and the Quality Assessment was carried out using Critical Appraisal Skills Programme (CASP) scales. A combination of keywords related to a) syncope; b) psycho*; and c) child* (Subjects) was used. Studies concerning epilepsy-related syncope were excluded.

Results: Overall, 912 records were identified. After excluding non-English, non-original, and duplicate studies, 579 records were selected for the title screening, 88 for the abstract screening, 37 full-text articles were assessed for eligibility and a total of 14 were included. The Risk of Bias in the included studies was assessed and 78,6% of the studies satisfied robustness quality criteria. The findings highlighted that children and adolescents with syncope showed a higher rate of psychopathology as compared to the healthy and clinical controls. Furthermore, patients reported social withdrawal and poor quality of life.

Conclusions: The findings suggest that there is a robust relationship between psychopathology and syncope. Children and adolescents with syncope frequently report clinical symptoms related to emotional, relational, and psychosomatic dysregulation. Psychological assessment should be routinely included in the integrated care to identify potential targets for treatment and improve early differential diagnosis.

Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement.

Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity.

Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies.

Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model.

Objective: Objective: The aim of this study was to investigate if psychache and hopelessness may serve as reliable predictors of suicidal ideation among female fibromyalgia (FM) patients.

Method: This was a cross-sectional study of 50 women with FM, examining the relationship between psychological pain, hopelessness, depressive symptoms, and suicidal ideation. FM diagnosis was confirmed by the American College of Rheumatology (ACR) criteria. Demographic data, the Mini International Neuropsychiatric Interview (MINI 7.0.2), the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), the Pittsburgh Sleep Quality Index (PSQI) and the Psychache Scale were utilized to assess these relationships and their predictive value for suicidality.

Results: The mean age of the participants was 50.2 years (±8.7). Thirty-two (64%) patients had current major depression, 11 (22%) had bipolar disorder, 20 (40%) presented passive suicidal ideation and 14 (28%) presented active suicidal ideation. Psychological pain correlated with both depressive symptoms (p<0.01; r= 0.648) and hopelessness (p=0.029; r=0.312) but did not predict suicidal ideation. Logistic regression analyses revealed depressive symptom severity as a predictor of passive suicidal ideation (odds ratio = 1.486; 95% CI: 1.017 - 2.170), while hopelessness predicted active suicidal ideation (odd ratio = 1.356; 95% CI, 1.049 - 1.753).

Conclusions: FM female patients showed increased prevalence of suicidal ideation. Hopelessness predicts active suicidal ideation but psychological pain did not serve as predictive factor for suicide ideation among female FM patients.

Objective: Emotional Dysregulation (ED) is characterized by the inability to manage emotions effectively, leading to maladaptive behaviors, and often co-occurs with psychiatric conditions carrying significant long-term consequences. Early diagnosis of ED is thus essential for targeted interventions. To address this need, we developed and validated the "Reactivity of Emotions in Adolescents: Caregivers' Tool" (REACT), a novel parent-rated questionnaire designed to assess ED in adolescents.

Method: The present study involved two samples, one drawn from the general population (n = 89 healthy controls from local schools) and the other composed of clinical patients (n = 76 adolescents with different psychiatric and/or neurodevelopmental conditions). Patients' diagnoses were confirmed through the clinical interview K-SADS-PL to explore the presence of any psychopathological conditions. Participants from both groups completed the RIPoSt-Y questionnaire, providing a measure of ED, while their parents filled out the ARI, measuring affective reactivity in youth. Confirmatory and exploratory factor analyses were performed to refine the questionnaire's internal structure.

Results: The final REACT questionnaire consists of 55 items distributed across three subscales, namely Negative Emotionality, Irritability, and Excitability. Psychometric evaluation showed that these subscales demonstrated excellent internal consistency and strong construct validity, with clinical patients scoring higher on all subscales compared to healthy controls. The REACT questionnaire showed also high convergent validity by exhibiting significant positive correlations with established measures of ED.

Conclusions: This novel tool represents a valuable improvement in the assessment of ED in adolescence as it may facilitate tailored interventions to provide emotional well-being and long-term outcomes.

Objective: This systematic review summarises the studies that have investigated the relationship between dimensions of social cognition (i.e., Theory of Mind - ToM, emotion recognition, and empathy) and alexithymia in the general adult non-clinical population.

Method: PubMed, PsycINFO, and Scopus databases were screened, using the following strings: ("alexithymi*") AND ("theory of mind" OR "ToM"); ("alexithymi*") AND ("empath*"); ("alexithymi*") AND ("emotion recognition"); ("alexithymi*") AND ("social cognition").

Results: A total of 117 studies met the inclusion criteria and were included in this review. The total number of participants included in the reviewed studies was 40,231. Mixed results were found for alexithymia and ToM, while the relationship between emotion recognition or empathy and alexithymia was more homogeneous. Alexithymia was found to be significantly associated with both a reduced ability to recognise emotions and empathy.

Conclusions: These results support the existence of significant relationships between alexithymia and altered social cognitive abilities. Future research is needed to confirm the present findings and further elucidate the complex relationship between these processes. Suggestions are made on how to overcome some of the theoretical and methodological problems in the literature.

Objective: Although gender-specific evidence on Gambling Disorder (GD) is still limited, some studies reported specific differences, mainly in psychopathological profiles, gambling behavior patterns, and pathogenesis. In order to further examine the role of gender in GD, we conducted a multicenter investigation in a sample of Italian outpatients.

Method: One hundred-four outpatients with a diagnosis of GD based on DSM-5 criteria were consecutively recruited at two clinics based in Milan. Socio-demographic and clinical variables were collected for the whole sample and analyzed for the effect of gender. The severity of illness was assessed using the Canadian Problem Gambling Index and the Gambling Attitudes and Beliefs (GABS).

Results: Among females, a significantly higher mean age (52.23 ± 10.95 vs. 40.96 ± 15.76; p=0.005) and older age at illness onset emerged (43.5 ± 11.92 vs. 29.22 ± 14.26; p<0.001). Females showed a significantly higher rate of psychiatric comorbidities, lifetime suicide ideation, stressful events at GD onset, and positive family history for GD compared to males. A predictive effect of male gender was found for the GABS questionnaires by performing a linear regression model, with males showing a higher risk to reach higher scores compared to females (B= 11.833; t=2.177; p=0.034).

Conclusions: Our study seems to confirm the hypotheses that gender in GD may influence psychopathological profiles, course, and comorbidity. GD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to males. Identifying specific clinical factors by gender may prompt more focus on the public health of women in relation to gambling, while still recognizing that males are at-risk of earlier gambling problems. These findings should be considered in therapeutic perspectives.

Objective: Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings.

Method: The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5).

Results: The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction.

Conclusions: Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals' euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.

Objective: Research so far has investigated the bivariate relationships between psychopathic traits, romantic attachment, and emotion dysregulation. However, no research thus far has examined these concepts in their interrelatedness. The aim of the present study was therefore to shed light on the possible linking mechanisms among these concepts, examining the mediating role of emotion dysregulation in the psychopathic traits-romantic attachment link.

Method: The present study was based on an undergraduate (N = 238, M age = 20.36 years) and a community sample (N = 521, M age = 35.27 years) from the Dutch population. Participants were administered self-report measures of psychopathic traits (measured with both the Self-Report Psychopathy Short-Form and the Triarchic Psychopathy Measure), emotion dysregulation (Difficulties in Emotion Regulation Scale - Brief Version) and romantic attachment (Experiences in Close Relationships-Revised). Correlation analyses and mediation analyses using a bootstrapping approach were conducted.

Results: Results showed that all the dimensions of psychopathic traits were related to both romantic attachment avoidance and anxiety, and that emotion dysregulation mediated all these associations (with only few exceptions). Except for boldness, all other dimensions of psychopathic traits were related to greater emotion dysregulation and, in turn, to insecure romantic attachment.

Conclusions: It is argued that the role of emotion regulation processes deserves more attention for the theoretical and clinical understanding of psychopathic traits and their correlates in the interpersonal domain, such as romantic attachment (in)security. When their interrelationships will be better understood, emotion regulation and attachment could represent relevant targets for intervention with individuals presenting psychopathic traits.