1,720,985 research outputs found
La supervisione. Teoria e pratica psicoanalitiche
No full textAttingendo dall’esperienza di una vita e dal suo straordinario bagaglio di conoscenze teoriche e di ricerca, Nancy McWilliams ci offre una prospettiva nuova sulla supervisione. Il suo libro prende in esame non solo il modo in cui la supervisione può promuovere le competenze cliniche della terapeuta o del terapeuta, ma anche come può fornire loro un vero sostegno nella formulazione e nella verifica degli obiettivi terapeutici, e offrire chiavi di lettura brillanti e soluzioni efficaci a problemi etici complessi. Ricco di esempi clinici e dedicato alla supervisione sia individuale sia di gruppo, questo libro affronta con sensibilità anche i temi delle dinamiche personali, degli equilibri di potere e delle forme di diversità nel rapporto di supervisione. A chi la fornisce e a chi la riceve, McWilliams insegna il valore della supervisione come relazione unica, risorsa fondamentale di apprendimento e crescita che ci accompagna per tutta la vita professionale
Eating Disorders in Clinical High-Risk for Psychosis Samples: a Study Protocol for a Systematic Review and Meta-analysis
No full textBackground: Many research and meta-analytic studies have shown that individuals at high clinical
risk for psychosis (CHR-P) often exhibit complex clinical conditions characterized by the co-
occurrence of multiple psychopathological syndromes. Currently, evidence about the presence of
eating disorders (EDs) in this population is limited. Here we present a research protocol for a
systematic review and meta-analysis with the objectives of estimating the impact of
sociodemographic and study variables on the ED diagnosis in CHR-P individuals and of resuming
the available knowledge on the features of EDs in CHR-P samples.
Methods: PubMed, EBSCO/APA PsycINFO, and Web of Science will be searched for articles
published from 1 January 2018 to 31 December 2022. Original research assessing EDs in CHR-P
samples with validated measures will be included. Two independent researchers will screen the
articles and evaluate their quality using a modified version of the Newcastle-Ottawa Scale–potential
disagreements will be solved by contacting a third judge. A narrative synthesis will be performed.
Moreover, whenever applicable, random-effect models (proportions) and meta-regressions will be
applied to extracted data. The study will be conducted using the PRISMA guidelines.
Discussion: Since the empirical literature regarding EDs in CHR-P samples is limited, this study
intends to increase knowledge on the topic and inform preventive interventions aimed at addressing
clinical challenges of CHR-P patients with ED
Do sociodemographic and study variables impact eating disorder diagnosis in clinical high-risk for psychosis youth? A study protocol for a Systematic Review and Meta-analysis
No full textIntroduction: Many studies have shown that youth at clinical high risk for psychosis (CHR-P) suffer from
multiple psychopathological syndromes. Currently, evidence about eating disorders (EDs) in this clinical
population is limited. Here we present a research protocol for a systematic review and meta-analysis
aiming at estimating the impact of sociodemographic and study variables on the ED diagnosis in CHRP youth and of summarizing the available knowledge on clinical characteristics of CHR-P patients with
EDs. Methods: PubMed, EBSCO/APA PsycINFO, and Web of Science will be searched for studies
published from 1 January 2018 to 31 December 2022. Original research evaluating EDs in CHR-P
samples with reliables instruments will be considered. Two independent reviewers will screen the studies
and assess their quality with a modified version of the Newcastle-Ottawa Scale. Disagreements will be
solved by contacting a third judge. A narrative synthesis will be conducted. Whenever applicable, randomeffect models (proportions) and meta-regressions will be run to extracted data. This research will comply
with the PRISMA guidelines. Results: We expect to retrieve more cross-sectional than longitudinal studies.
Meta-regression will examine the role of potential moderators. The narrative synthesis will focus on
clinical characteristics of EDs in CHR-P youth, especially regarding functioning, symptoms, and bodily
sensations. Discussion: Since the empirical literature regarding EDs in CHR-P samples is limited, this study
aims to add knowledge on the field and inform preventive interventions aimed at addressing EDs in
CHR-P patients
Diagnostic validity and clinical utility of the psychosis-risk state: A multidimensional network analysis
No full textIntroduction: The clinical high-risk for psychosis (CHR-P) paradigm was developed to identify individuals at substantial risk of developing full-blown psychotic disorders (Fusar-Poli et al., 2020; Nelson & McGorry, 2020). Despite the establishment of specialized clinics aimed at preventing psychosis and improving general functioning in CHR-P individuals, there are significant challenges to the relevance and utility of this paradigm in healthcare systems (van Os & Guloksuz, 2017). These include the small proportion of CHR-P individuals who transition to psychosis and the difficulty in distinguishing CHR-P from common mental disorders due to high comorbidity rates. This study aimed to evaluate the clinical specificities of CHR-P youth compared to general help-seekers and non-CHR-P youth. By employing network analyses (Borsboom, 2017), the study sought to identify unique clinical characteristics of CHR-P individuals that could guide the development of tailored interventions, thereby supporting the diagnostic validity and clinical utility of the CHR-P concept. Methods: A total of 146 CHR-P and 103 non-CHR-P help-seeking youth were recruited from a neuropsychiatric unit. Participants were assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS), Children’s Depression Inventory (CDI), Multidimensional Anxiety Scale for Children (MASC), Global Functioning: Social (GF: Social), Global Functioning: Role (GF: Role), and Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale (WISC/WAIS). Three network structures were analyzed: the entire help-seeking sample (help-seekers network), only CHR-P patients (CHR-P network), and only non-CHR-P patients (non-CHR-P network). Results: In the help-seekers network, each variable presented at least one edge, indicating interconnectedness among clinical variables. The CHR-P network revealed two isolated subgraphs: one including functioning, anxiety, depressive, negative, disorganization, and general symptoms; the other including positive symptoms and IQ. In the non-CHR-P network, positive symptoms were negatively connected to functioning, disorganization, and negative symptoms. Conclusion: The findings highlight specific clinical characteristics of CHR-P youth that support the need for tailored interventions addressing comorbid disorders alongside positivde psychotic symptoms. The isolation of positive symptoms in the CHR-P network suggests that these symptoms may not interact with other psychopathology domains, necessitating distinct treatment strategies. The study supports the diagnostic validity and clinical utility of the CHR-P concept, advocating for specialized clinical approaches for CHR-P individuals. This study underscores the importance of specific clinical strategies for CHR-P youth, reinforcing the need for specialized clinics and tailored interventions (Yung et al., 2021). The network analysis approach provides a comprehensive understanding of the complex interactions among clinical variables in CHR-P individuals, which can inform future research and clinical practices aimed at preventing psychosis and improving outcomes for at-risk youth
Borderline Personality Disorder and High-Risk for Psychosis Research: a Scoping Review
No full textIntroduction: People at greatest risk for developing psychosis are characterized by a high prevalence of personality disorders (Boldrini et al., 2019). This research is aimed at mapping the literature on individuals presenting with borderline personality disorder (BPD) and at-risk for psychosis state and posing relevant research questions.
Methods: Web of Science, Pubmed, and EBSO/APA PsycInfo databases were systematically searched from inception up to December 31st, 2022, including both original published research and grey literature for studies assessing at-risk for psychosis state (e.g., CHR-P, UHR, BS) or attenuated psychotic symptoms not meeting at-risk for psychosis inclusion criteria and BPD (e.g., employing the SCID) or subthreshold borderline personality pathology (e.g., using the SWAP). The study was conducted in accordance with the PRISMA extension guidelines for scoping reviews (Tricco et al., 2018).
Results: Most retrieved studies were conducted in Western countries and Australia and focused on BPD in high-risk for psychosis samples. Topics explored included assessment, outcomes and transition to psychosis, transdiagnostic risk identification, mental health services for youth, and stress and trauma.
Discussion: Future research should better define criteria for access to both at-risk for psychosis and personality disorders specialized clinical services. Moreover, randomized control trials aimed at evaluating need-based and psychological interventions for young CHR-P individuals with comorbid BPD are needed–in compliance with evidence-based recommendations. Finally, studies conducted with a transdiagnostic risk identification approach (Hartmann et al., 2021) could generate insight into additional early detection and intervention strategies
A multidimensional network analysis in clinical high-risk for psychosis and help-seeking youth
No full textIntroduction: Children and adolescents at clinical-high risk for psychosis (CHR-P) represent a subsample
of help-seeking individuals attending early intervention services. However, knowledge about differences
between help-seeking and CHR-P youth is limited. This study aims to (a) to build two network
architectures: the first including both CHR-P and non-CHR-P help-seeking youth and the second
including only CHR-P youth, and (b) to explore differences between the two network structures. Methods:
We recruited 146 CHR-P and 103 non-CHR-P help-seeking youth in a specialized Child and Adolescence
Neuropsychiatric Unit. They were assessed with the Structured Interview for Psychosis-Risk Syndromes,
Children Depression Inventory, Multidimensional Anxiety Scale for Children, Global Functioning:
Social, Global Functioning: Role, and Wechsler Intelligence Scale for Children/Wechsler Adult
Intelligence Scale. Network analysis was applied to both help-seeking and CHR-P patients. Central nodes,
relevant edges, and correlation stability coefficients were examined. Results: In the first network structure,
depressive symptoms displayed the greatest number of connections. In the second network, two isolated
“archipelagos of symptoms” were observed: (a) a component including subclinical psychotic symptoms
(positive symptoms excluded), functioning and comorbid symptoms, and (b) a sub-graph including only subclinical positive symptoms and IQ. Subclinical negative and disorganization symptoms were the most
central nodes, and functioning played a key role in bridging subclinical psychotic and non-psychotic
symptoms. The correlation stability coefficient of the second network was above .50. Discussion:
Depressive symptoms were crucial in maintaining and spreading psychopathological manifestation in
help-seeking youth. Findings suggest that preventive interventions focusing on negative and
disorganization symptoms and impaired functioning in CHR-P youth are needed. Further research
exploring longitudinal course of symptom co-occurrence is warranted
Defense mechanisms in individuals with depressive and anxiety symptoms: a network analysis
Full text linkBackgroundDefense mechanisms play a crucial role in depression and anxiety. The current study aimed at estimating the network structure of defense mechanisms in individuals with symptoms of depression and anxiety to understand the most central defenses and relevant connections. Moreover, we aimed at examining the associations between defense mechanisms and symptoms.MethodsWe employed the Symptom Checklist-90 to recruit 655 individuals with depressive and anxiety symptoms during the first wave of the COVID-2019 Pandemic in Italy. Defense mechanisms were assessed with the DMRS-SR-30.ResultsResults showed a main component in the network graph featuring 16 defense mechanisms. Self-assertion was the most central node in the network, displaying positive and negative connections with an array of mature and immature defenses, respectively. Among immature defenses, passive aggression was the most interconnected node. Some mature defenses (i.e., humor, affiliation, and sublimation) were not connected to other nodes. A range of defense mechanisms were associated with anxiety and depressive symptoms.ConclusionsThis is the first research effort supporting the conceptualization of defense mechanisms as a complex system. Results suggest that defense mechanisms of the same cluster (e.g., mature defenses) play different roles in the network. Central defenses (i.e., self-assertion and passive aggression) detected in this study may be promising intervention targets
Involuntary Celibacy (Incel) Identity: A Thematic Analysis of an Online Community’s Beliefs and Emotional Experiences
No full textThe term incel is a neologism combining “involuntary” and “celibate”, describing men who experience involuntary absence from sexual and romantic relationships. Incels frequently espouse conspiratorial and misogynistic ideologies, often engaging in verbal aggression. The present study aimed at qualitatively exploring the emotional experiences and beliefs articulated within an online incel community, contributing to the formation of its collective identity. A thread (453 comments) sampled from an Italian “incel” forum was analyzed by two independent raters, using thematic analysis. Four themes emerged: (a) “non-persons (i.e., women) are not like us” revealed perceived gender inequality and misogynistic beliefs, (b) “without experiences in adolescence you are ruined” reflected the belief that early romantic and sexual experiences are crucial for later relationship satisfaction, (c) “I have no life” captured expressions of profound distress and life dissatisfaction, and (d) “only ours is true suffering” highlighted a sense of unique victimhood. Incel group identity was shaped by gender role stress, primarily stemming from the perceived failure to meet socially constructed expectations of hegemonic masculinity. Suffering emerged as the dominant emotional experience, seemingly exacerbated by feelings of hopelessness regarding romantic and sexual prospects. The perceived subordinate status of men and male suffering were exploited to rationalize and perpetuate misogyny. The observed incels’ openness in discussing experiences of suffering and trauma may present an opportunity for the development of preventive interventions aimed at increasing help-seeking behavior in this population
Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder
Full text linkAims: To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations.
Methods: We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023.
Results: 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting “clinical high at risk mental state” (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders.
Conclusion: The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries
Mental Health Literacy about Personality Disorders:A Multicultural Study
Full text linkMental health literacy (MHL) refers to lay people's knowledge and beliefs about the diagnosis and treatment of mental illness. The current study aimed at investigating MHL regarding personality disorders (PDs) multiculturally, comparing Turkish and Italian populations. In total, 262 participants responded to an online vignette identification task that required them to label the PDs of seven hypothetical subjects and rate various dimensions of their disorders. Narcissistic (25%), obsessive-compulsive (13%), and paranoid (12%) PDs were the most correctly labeled, while the average accuracy values for other PDs were below 0.04%. Compared to Turkish participants, Italian participants were more accurate in labeling narcissistic PD. Additionally, of the seven PDs, narcissistic PD was associated with the most happiness and success at work. Subjects with borderline and avoidant PDs were the most recognized as having psychological problems (>90%), yet their PDs were among the least correctly identified. Overall, participants from both cultures were generally successful at recognizing the presence of a mental illness, but they rarely labeled it correctly. Only limited cultural differences emerged. The present findings may inform the design of outreach programs to promote MHL regarding PDs, thereby facilitating early recognition of PDs and help-seeking behaviors for affected individuals
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