Clinical Neuropsychiatry最新文献

Objective: During and after the lockdowns of the COVID-19 pandemic period, a strain was put on young adults who have taken refuge in the problematic use of internet, social media, gaming, and gambling. This paper aims to investigate possible correlates of Internet Addiction Disorder (IAD), hypothesizing anxiety, depression and perceived stress would promote addiction, while mindfulness skills, resilience and socialization would, conversely, hamper IAD, and promote, consequently, a more functional internet use.

Method: A pilot study was carried out with a sample of 31 young adults, recruited through a snowball sampling using social networks. Participants filled out an online questionnaire including the following measures: Internet Use, Abuse and Addiction (UADI), Beck Depression Inventory (BDI-II); State-Trait Anxiety Inventory (STAI-Y); Perceived Stress Scale (PSS); Five Facet Mindfulness Questionnaire (FFMQ); Mindfulness Attention and Awareness Scale (MAAS); Resilience Scale (RS-14). It was also administered an ad hoc questionnaire for the assessment of socialization behaviour (6 items) and gambling (2 items).

Results: All the measures, but socialization, showed adequate reliability. Our sample showed high levels of anxiety, stress, IA and gambling, while presenting low levels of resilience, the mindful skill of no-reactivity and socialization. The first hypothesis was confirmed, finding positive and significant correlations between Internet Addiction on one side and PSS, STAI-Y1, STAY-2, and BDI II on the other side. We also partially confirmed the second hypothesis about UADI negatively correlated with both RS-14 and Mindful Acting. Finally, no correlations were found between Gambling and IA.

Conclusions: In conclusion, the more one perceives an emotional overload with less stress-control, high anxiety, and depression, and the less one can leverage on the skills of mindful acting and resilience, the more one uses the internet as a strategy to escape from a threatening reality.

Objective: Depression represents one of the most severe psychiatric disorders, characterized by low mood episodes, as well as loss of interest. Major Depressive Episodes (MDE) treatment relies primarily on monoaminergic prescriptions. However, although the presence of many antidepressant medications, their efficacy is still partial. A promising intervention to improve antidepressant treatment may be the use of adjunctive nutraceuticals. Aim of the present study was to assess the efficacy of a N-Acetyl-cysteine, S-Adenosyl-L-Methionine and Folic acid's combination for the treatment of depressive symptoms in a sample of MDE patients.

Method: Fifty outpatients with a MDE diagnosis in the context of different psychiatric disorders such as Major Depression, Bipolar Disorder, Anxiety disorders, and Personality disorders were recruited. The sample was divided into different groups based on the nutraceutical administration: a) concurrently with an AD (starter group); b) add-on to an already prescribed treatment; c) single treatment.

Results: A significant reduction of CGI-Severity and Improvement scores from baseline to the end of treatment was found. Moreover, the starter group showed a significantly greater CGI-Improvement score compared to the other groups. Ninety-four percent of patients did not show any side effects.

Conclusions: The present study showed promising results for the use of nutraceuticals in the add-on treatment of MDE. Those compounds may be considered a versatile, tolerable, and effective add-on treatment for the reduction of depressive symptoms impact and for improving the functioning of patients affected by MDE.

Objective: There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the diferent functions of safety in psychotherapy on a theoretical basis.

Method: We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations.

Results: Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases.

Conclusions: Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy.

Objective: Research has shown the importance of delving into the variables associated with externalizing and internalizing behaviors in adolescence, highlighting gender-related differences in their presentations. This two-wave longitudinal study aims to address gaps in understanding the concurrent contribution of borderline and narcissistic personality traits to the presence and maintenance of internalizing and externalizing problems in adolescence.

Method: We recruited 705 adolescents (65% females; age range 13-19 years old; Mage = 15.84, SD = 1.31) to self-report on behavioral problems (YSR-112), borderline (BPFSC-11) and narcissistic traits (PNI) at baseline and again on behavioral problems after 12 months.

Results: Data highlighted significant differences between males and females for all variables except externalizing problems. Hierarchical regression models showed that borderline traits are a prominent risk factor for all behavioral problems in males and females at baseline and after 12 months. Moreover, regardless of gender, higher grandiose narcissism contributes to lower internalizing problems only when the direct contribution of vulnerable presentations of narcissism is considered. Grandiose narcissism is also a risk factor for externalizing problems after 12 months in females, whereas vulnerable narcissism significantly increases the likelihood of internalizing trajectories improving over 12 months.

Conclusions: This study provides more evidence of the associations between maladaptive personality traits and adolescent internalizing and externalizing problems: (1) confirming that borderline traits are crucial beyond gender, (2) stressing the importance of considering both grandiose and vulnerable narcissistic traits, and (3) highlighting the adaptive value of narcissistic vulnerability in capturing the adolescent crisis. The implications for clinical practice and intervention are also discussed.

Objective: The purpose of this paper was to contribute to the psychometric properties and dimensionality of the IGD-20.

Method: An online survey was completed by 392 Italian online gamers (M_age = 29.2, SD = 11.3; 45.2% males). A battery of self-report questionnaires was administered to assess internet gaming disorder, internet addiction, loneliness, anxiety, depression, stress, social-interaction anxiety, self-esteem, and perceived social support. To test the factor structure of IGD-20, both traditional (i.e., EFA and CFA) and innovative (i.e., ESEM) techniques were applied. Convergent, concurrent, discriminant, and criterion-related validity were evaluated.

Results: Our study revealed the outperforming 3-factor ESEM model (χ²=39.951, p = 0.0021; RMSEA = 0.056, 90% C.I. [0.032 - 0.079]; CFI = 0.986; TLI = 0.965; and SRMR = 0.017; ω = .76, .77, and .79, respectively) as a new short version (IGD-10SV) for the IGD-20. The validity of the IGD-10SV was supported by significant associations with theoretically related measures.

Conclusions: The current findings support the adoption of the analytic ESEM approach for complex multidimensional measures and the use of the IGD-10SV for the assessment of internet gaming disorder.

Major depressive disorder (MDD) constitutes a challenge in the field of mental disorders, given its high prevalence in the general population and its impact on the quality of life, while representing a major burden of health worldwide. Currently, much interest in the pathophysiology of MMD ìs also directed towards disentangling the possible biological mechanisms shared with that medical condition known as metabolic syndrome (MeS) that is frequent in the general population and often comorbid with MDD. Therefore, the aim of this paper was to summarize the evidence on the relationships between depression and MeS, and to comment on the common factors and mediators present in these two conditions. For this reason, some of the main databases of scientific literature were accessed, and all the papers fulfilling the goal of this review were selected. The results demonstrated the existence of common pathways between depression and metabolic syndrome involving several mediators, such as inflammation, the hypothalamus-pituitary-adrenal axis, oxidative stress, platelet functions, coronary heart disease and peripheral hormones, thus requiring strict attention from the scientific community. Indeed, such pathways may be targeted in the near future in order to pave the way to new treatment options for these disorders.

Objective: The hip and knee arthroplasties are reliable and suitable surgical procedures aimed at restoring the patients' functioning. The most representative age range for these replacement surgeries is between 65 and 84 years for females. With aging, the likelihood of developing cognitive deficits increases, and there is evidence that elderly patients undergoing surgery orthopedic are at higher risk of developing cognitive problems in the postoperative phase. The Montreal Cognitive Assessment (MoCA) is often used for cognitive evaluation, but different cut-offs and validations are available in the literature. Given the importance of the problem, in this work we studied a hospitalized population candidate for orthopedic surgery to determine a new specific validation of the MoCA to assess the risk of MCI.

Method: We applied MoCA and Mini-Mental State Examination (MMSE) to a sample of 492 (333 women) hospitalized patients for knee (74%) or hip surgery. A non-parametric receiver operating characteristic (ROC) curve analysis was conducted to investigate the predictive accuracy of the MoCA to assess cognitive impairment, using MMSE as the gold standard.

Results: A score of 22.52 gives a sensitivity of 70% and a specificity of 78%. This value is providing a more coherent diagnosis with the MMSE as compared to the other cut-offs presented in the other available validations. No differences were found between patients in terms of age and gender, suggesting a general uniformity of the selected sample.

Conclusions: Deepening the coherence in MCI diagnosis between MMSE and the other MoCA's scoring considered, our new cut-off seems reasonably better than previous Italian validation on an elderly population in matching MMSE classification.

Objective: Child maltreatment (CM) is a recognized public health problem, and epidemiologic data suggest that it is a widespread phenomenon, albeit with widely varying estimates. Indeed, CM as well as child abuse (CA) and neglect (CN) are complex phenomena that are difficult to study for several reasons, including terminological and definitional problems that pose a hurdle to estimating epidemiological rates. Therefore, the main aim of this umbrella review is to revise recent review data on the epidemiology of CM, CA, and CN. A second aim was to revise the definitions used.

Method: A systematic search of three databases was performed in March 2022. Recent reviews (published in the last 5 years: 2017-March 2022) addressing the epidemiological rates of CM, CA, and/or CN were included.

Results: Of the 314 documents retrieved by the selected search strategy, the eligibility assessment yielded a total of 29 eligible documents. Because of the great heterogeneity among them, a qualitative rather than a quantitative synthesis was performed.

Conclusions: The data from this umbrella review show that the different age groups, methods, and instruments used in the literature to collect the data on the epidemiology of CM make it difficult to compare the results. Although definitions appear to be quite homogeneous, CM categorization varies widely across studies. Furthermore, this umbrella review shows that the CM reviews considered do not examine some particular forms of CM such as parental overprotection. The results are discussed in detail throughout the paper.