1,721,174 research outputs found
Impulsività e abilità di inibizione della risposta motoria: teorie, strumenti ed evidenze sperimentali in gruppi clinici
No full textImpulsivity is a dimensional construct which is crucial in defining the overt symptomatology of several psychopathological disorders. From a neuropsychological perspective, motor inhibition ability is conceptualized as an executive function involved in self-regulation; its impairment may cause the execution of impulsive behaviours. Aim of this paper is to review the main studies that investigated this ability in four clinical groups: Obsessive-compulsive disorder, trichotillomania, pathological gambling,substance use disorders. To date, existing behavioural data do not allow to support the presence of inhibitory problems in these disorders; nonetheless, neuroimaging studies have found several abnormalities in frontal lobe's activity
Criteri e classificazione diagnostica della tricotillomania nell'ottica del DSM V.
No full textLa tricotillomania consiste nello strappo cronico di capelli o peli ed è attualmente classificata dal DSM-IV-TR all’interno della categoria dei “disturbi del controllo degli impulsi non altrove classificati”. Studi recenti suggeriscono l’inadeguatezza dei criteri diagnostici; in particolare, i criteri B e C sono stati considerati eccessivamente rigidi e restrittivi, nonché scarsamente predittivi della gravità dei sintomi e della compromissione funzionale generalmente associate a questo disturbo. Gli attuali criteri diagnostici rappresentano pertanto un ostacolo al lavoro del clinico a livello sia diagnostico sia terapeutico. Nella presente rassegna sono state prese in considerazione le principali evidenze che supportano la necessità di riconsiderare i criteri diagnostici adottati in ambito clinico. Sono state inoltre esaminate le più accreditate classificazioni diagnostiche alternative proposte fino ad ora alla luce dei risultati di recenti ricerche. Infine, particolare attenzione è stata rivolta alle proposte tuttora in fase di valutazione per il DSM-V, le quali riguardano una serie di variazioni nei criteri diagnostici e la possibilità di includere il disturbo all’interno della categoria dei “disturbi comportamentali ripetitivi focalizzati sul corpo”, che andrebbero a costituire il sottotipo motorio dei “disturbi dello spettro ossessivo compulsivo”
Pathological Gambling: Compulsive-Impulsive Spectrum Disorder, Behavioural Addiction, or Both?
Full text linkPathological gambling (PG) is a chronic and progressive condition, defined as “persistent and recurrent maladaptive gambling behaviour”; it is currently classified among the Impulse control disorders (Not Elsewhere Classified) in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition - Text Revision (DSM-IV-TR). The diagnostic criteria for PG resemble those of both Substance use disorders (SUDs) and Compulsive disorders (in particular, Obsessive compulsive disorder [OCD]).
The terms compulsivity and impulsivity are interchangeably used to describe difficulties in self-control leading to repetitive psychopathological behaviours; nonetheless, they represent two distinct constructs. Compulsive behaviours are driven by “a tendency to perform unpleasantly repetitive acts in a habitual or stereotyped manner to prevent perceived negative consequences, leading to functional impairment”, whereas impulsivity has been described as “a predisposition toward rapid, unplanned reactions to internal or external stimuli with diminished regard to the negative consequences of these reactions to the impulsive individual or others”. Features of both compulsivity and impulsivity are involved in PG phenomenology, and a large body of literature investigated these aspects mainly making use of clinical observation and results obtained through self-report questionnaires. PG can be conceptualized as a compulsive-impulsive spectrum disorder or as a behavioural addiction: these two theoretical frameworks have been proposed for PG categorization in DSM-5, thus and understanding which of them is better suited to PG symptoms is relevant for diagnostic classification issues. Although these two approaches are not mutually exclusive, adopting one rather than the other has important clinical implications.
Recently, the importance of integrating phenotypic (i.e. phenomenological) and endophenotypic (i.e. behavioural/physiological) indicators in psychodiagnostic assessment has been highlighted. Endophenotypes are measures of the individual neuropsychological, neurophysiological and biochemical functioning, and consequently anomalies in endophenotypes are supposed to reflect impairments in the underlying neurocognitive processes. Impairments in motor inhibition ability and difficulties in delaying gratification and decision making, which are prefrontally-mediated cognitive functions, have been suggested to underlie problems in behavioural regulation (i.e. compulsive and impulsive behaviours). From this perspective, both compulsive and impulsive behaviours would represent: a. the performance of an action before its complete processing or the failure of interrupting already activated actions; b. a dysfunction in behavioural choices, which are perpetrated despite bad consequences for the individual. Therefore, cognitive measures of motor inhibition and decision making abilities may represent promising endophenotipic indicators of behavioural regulation, and deficits in these functions are hypothesized to underpin PG, OCD, and SUDs.
The present dissertation was conducted in the light of these considerations, and following the recommendation that directly comparing PGs with OCD patients and individuals with SUDs can represent a viable way to identify the most suitable classification for PG.
A group of treatment-seeking PGs was compared with patients with OCD, Alcohol dependents (ADs) and healthy controls (HCs) on both self-report questionnaires and cognitive measures of compulsivity and impulsivity. The main aims were to investigate similarities and differences between clinical groups in such measures, as well as potentially different patterns of response in cognitive tasks. The Go/Nogo task was used to assess motor inhibition ability, whereas the Iowa Gambling Task (IGT) was administered to evaluate decision making processes.
A preliminary comparison between small groups of PGs and croupiers on the same measures was also conducted; croupiers were chosen as gambling represents a relevant activity for both groups of individuals, and also in the light of the higher risks of developing problem or pathological gambling observed in casino employees than in general population. Consequently, the study of compulsivity and impulsivity in croupiers may be helpful in identifying the factors potentially involved in the development of PG.
The main results showed that PGs reported higher levels of both self-reported compulsivity and impulsivity than healthy individuals. Furthermore, a number of similarities between PGs, OCD patients and ADs in the phenotypic measures of both dimensions was observed. No evidence of impaired motor inhibition ability in PGs, OCD patients or ADs emerged. In regards to decision making processes, deficits in the IGT performance were found in PGs and ADs, whereas OCD patients did as good as HCs. Both PGs and ADs were characterized by a decline of their performance towards the end of the task, which indicated difficulties in the maintenance of learning to shift from disadvantageous to advantageous decisions.
The comparison between PGs and croupiers revealed that the former obtained higher scores on measures of compulsivity, whereas the latter did not differ from HCs. However, both PGs and croupiers reported similar and higher self-reported impulsivity than HCs. As regards the cognitive tasks, no significant difference between groups emerged; nonetheless, IGT profiles of learning showed that PGs had a poor performance and croupiers differed from HCs in that they did not improve in the last block of the task.
Several conclusions may be drawn from present results.
First of all, data from self-report measures suggest that both the compulsive-impulsive spectrum hypothesis and the behavioural addiction one might be adequate for PG categorization, as compulsivity and impulsivity co-occur in PGs. Furthermore, the numerous analogies emerged between PGs, OCD patients and ADs further support to include the three of them in a common spectrum of disorders.
On the other hand, IGT findings highlighted the presence of similar deficits in PGs and ADs. This result is in line with literature reporting dysfunctions in the brain circuitry underlying decision making ability, and therefore it supports the conceptualization of PG as an addictive disorder. Data emerged from the comparison between PGs and croupiers seem also to be consistent with this hypothesis, as probable vulnerability factors for addictions (i.e. impulsivity personality trait and potentially altered decision making processes) have been observed also in healthy individuals at risk for the development of PG. However, given the small samples sizes further studies are recommended.
To conclude, results from the present dissertation indicate that both classifications are equally appropriate for PG, depending on the adopted indicators. Other studies are required to further clarify which is the best diagnostic category for PG
Il disturbo da accumulo:studio di un campione tratto dalla popolazione generale
No full textIl disturbo da accumulo con ogni probabilità entrerà a far parte della prossima edizione del DSM
come categoria a sé stante. Obiettivo del nostro studio è stato quello di indagare il comportamento
di accumulo in un campione tratto dalla popolazione generale italiana, sia per quanto riguarda le
caratteristiche demografiche sia rispetto alle sovrapposizioni tra costrutti clinici. A tal fine, sono stati
somministrati diversi questionari di autovalutazione (SI-R, OCI-R, BAI, WDQ, BDI-II, FIS e PDQ-4+) a
un gruppo di 90 individui. I risultati non hanno messo in evidenza differenze legate al genere, mentre
sembra che gli individui più giovani siano maggiormente tendenti all’acquisizione. In linea con la
letteratura, le caratteristiche di accumulo sono risultate associate a comportamenti legati all’ordine e
alla simmetria e a caratteristiche disforiche, ma solo lievemente a preoccupazioni. Sono inoltre emerse
delle associazioni tra comportamenti di accumulo e tratti di tipo paranoide, schizotipico, narcisistico,
borderline, dipendente e ossessivo-compulsivo. Infine, i nostri risultati sembrano confermare
l’indipendenza tra comportamenti di accumulo e altri costrutti ossessivo-compulsivi e suggeriscono
l’assenza di una relazione tra accumulo e impulsività concettualizzata come difficoltà nella presa di
decisioni
Pathological Gambling: Compulsive-Impulsive Spectrum Disorder, Behavioural Addiction or Both? Phenotypic and Endophenotypic Evidence
No full textFeatures of impulsivity and compulsivity are involved in PG phenomenology, and a large body of literature investigated these aspects primarily using clinical observations and self-report questionnaires. Moreover, cognitive measures of motor inhibition and decision-making abilities may represent promising endophenotypic indicators of behavioural regulation, and deficits in these functions are hypothesised to be implicated in PG. In light of the importance of integrating subjective and objective indicators in psychodiagnostic assessment, the present review will consider findings on phenotypic and endophenotypic indicators of impulsivity and compulsivity in PG. Furthermore, the two main theoretical models proposed for PG will be discussed. An in-depth understanding of the role played by impulsivity and compulsivity within PG is indeed necessary to address diagnostic and treatment issues
La valutazione dell'orientamento negativo al problema: Validazione Italiana del Negative Problem Orientation Questionnaire
No full textL’orientamento negativo al problema riflette un atteggiamento negativo nei confronti dei problemi. Tale costrutto include: interpretazione degli eventi problematici come minacciosi; percezione di
scarsa auto-efficacia e di possedere capacità di problem solving carenti; pessimismo circa gli esiti del problem solving; bassa tolleranza alla frustrazione. Numerosi studi hanno evidenziato come
l’orientamento negativo al problema costituisca un fattore di vulnerabilità e mantenimento nel disturbo d’ansia generalizzata e nella depressione. Il Negative Problem Orientation Questionnaire
(NPOQ) è un questionario self-report che valuta la componente cognitiva dell’orientamento negativo al problema e che ha dimostrato ottime proprietà psicometriche nelle versioni in lingua francese, inglese
e spagnola. Obiettivo del presente studio è la validazione italiana di tale questionario. Hanno preso parte allo studio 590 individui non clinici e 76 pazienti con disturbi d’ansia e/o
depressivi, che hanno compilato una batteria di questionari somministrati in ordine controbilanciato. I risultati hanno evidenziato che il NPOQ possiede una struttura monofattoriale e un’ottima coerenza
interna nel campione sia non clinico, sia clinico, oltre che buone stabilità temporale, validità di costrutto e validità discriminante. L’associazione tra orientamento negativo al problema e worry
è risultata più forte di quella tra tale costrutto e i sintomi ansiosi, depressivi e legati al distress generale. Infine, i punteggi al NPOQ non sono risultati influenzati da genere, età e livello di
istruzione. In conclusione, quanto emerso supporta l’utilizzo del NPOQ come valido strumento di autovalutazione da impiegare nel contesto italiano sia non clinico che clinico
An examination of construct of Intolerance of Uncertainty with groups of typically developing young people of different ages.
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Struttura fattoriale e ulteriori evidenze delle proprietà psicometriche dell’Obsessive Beliefs Questionnaire-20 (OBQ-20) in campioni clinici e non clinici
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