Psychiatry and Psychopathology

Aim  The World Health Organization’s International Classification of Functioning, Disability and Health adapted for children and young people (ICF-CY) is a framework for describing and classifying health and health-related states. The aim of the present study was to review literature on neurofibromatosis type 1 (NF1) using ICF-CY guidelines and to highlight findings about the quality of life of children with NF1.Method  Electronic databases were searched to identify studies involving children with NF1. Eligible studies were classified according to ICF-CY categories.Results  Children with NF1 have a variety of cognitive and other deficits. However, very little information is available on the impact of these deficits on their daily life.Interpretation  Despite the broad range of functional and structural deficits in children with NF1, the functional assessment of these children remains largely unexplored. Future studies should aim at evaluating the participation of children with NF1 in various situations, using tools with high real-world validity.

Evidence from imaging and anatomical studies suggests that the midcingulate cortex (MCC) is a dynamic hub lying at the interface of affect and cognition. In particular, this neural system appears to integrate information about conflict and punishment in order to optimize behavior in the face of action-outcome uncertainty. In a series of meta-analyses, we show how recent human electrophysiological research provides compelling evidence that frontal-midline theta signals reflecting MCC activity are moderated by anxiety and predict adaptive behavioral adjustments. These findings underscore the importance of frontal theta activity to a broad spectrum of control operations. We argue that frontal-midline theta provides a neurophysiologically plausible mechanism for optimally adjusting behavior to uncertainty, a hallmark of situations that elicit anxiety and demand cognitive control. These observations compel a new perspective on the mechanisms guiding motivated learning and behavior and provide a framework for understanding the role of the MCC in temperament and psychopathology.

In many neurological and psychiatric disorders, including Alzheimer’s disease and schizophrenia, symptoms are present that appear to reflect an essential absence of normal movement, cognition and emotional states. These negative symptoms might reflect fundamental impairments in basic brain mechanisms that underlie goal-directed behaviour. Knowledge of the pathology and pathophysiology of these diseases, combined with evidence from basic science, offers opportunities for understanding the neurobiological basis of goal-directed behaviour, particularly the interaction between limbic structures and striato-thalamo-cortical circuits. The study of patients with negative symptoms also provides opportunities for testing cognitive models of goal-directed behaviour, and eventually to map such models onto the neurobiology of both normal and abnormal behaviour.

It is widely thought that phasic and sustained responses to threat reflect dissociable circuits centered on the central nucleus of the amygdala (Ce) and the bed nucleus of the stria terminalis (BST), the two major subdivisions of the central extended amygdala. Early versions of this hypothesis remain highly influential and have been incorporated into the National Institute of Mental Health Research Research Domain Criteria framework. However, new observations encourage a different perspective. Anatomical studies show that the Ce and BST form a tightly interconnected unit, where different kinds of threat-relevant information can be integrated and used to assemble states of fear and anxiety. Imaging studies in humans and monkeys show that the Ce and BST exhibit similar functional profiles. Both regions are sensitive to a range of aversive challenges, including uncertain or temporally remote threat; both covary with concurrent signs and symptoms of fear and anxiety; both show phasic responses to short-lived threat; and both show heightened activity during sustained exposure to diffusely threatening contexts. Mechanistic studies demonstrate that both regions can control the expression of fear and anxiety during sustained exposure to diffuse threat. These observations compel a reconsideration of the central extended amygdala's contributions to fear and anxiety and its role in neuropsychiatric disease.

A sample of clients diagnosed with generalized anxiety disorder (GAD) provided descriptions of the two major problems they worried about and of potential negative consequences associated with these problems, once before and once after they received cognitive-behavioral therapy. When descriptions were rated for concreteness and compared to those of normal controls, results showed that untreated GAD clients provided less concrete descriptions of their major worries relative to controls. After successful therapy, problem descriptions of GAD clients showed the same level of concreteness as those of controls. These findings add further support to the reduced-concreteness theory of worry. Moreover, they indicate that concretization of worries may play a prominent role in the reduction of pathological worry.

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative-affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of selfcoherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative-affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity.

Anthropologische Ansätze in der Psychiatrie erforschen zum einen die Bedingungen psychischer Krankheit in der Organisations- und Lebensform des Menschen, zum anderen die subjektive Erfahrungsdimension seelischen Krankseins. Als grundlegende Methodik dazu dient die Phänomenologie: Sie untersucht die zentralen Strukturen des Erlebens, insbesondere Intentionalität, Leiblichkeit, Zeitlichkeit und Intersubjektivität, um so einem vertieften Verständnis psychischer Krankheit zu gelangen und therapeutischen Ansätzen eine erweiterte Grundlage zu verschaffen. Die verschiedenen Forschungsansätze werden im Überblick dargestellt und u.a. anhand der speziellen Phänomenologie von Schizophrenie und Depression illustriert.

Early life experiences have long-lasting influence on a child. For an infant, the quality of caregiving is one of the most critical factors supporting growth and development. Adverse social events in infancy have the potency to alter the child’s developmental trajectory and elevate the lifetime risk for a range of psychiatric disorders. Although clinical studies associate early childhood adversities with lifetime risk for mental disorders, the knowledge of underlying neural and molecular alterations leading to these disorders comes mostly from animal studies. In this article, we overview selected animal models of early life social adversity, including maternal abuse and neglect, and maternal trauma and fear. We first characterize the major behavioral and neural changes normally occurring in early life. We then present several animal models of maternally mediated early life adversity that contribute to reorient the developmental changes toward pathological outcomes. These models yielded to recently identified neurobiological mechanisms, including epigenetic alterations, through which these adversities lead to a lasting dysregulation of the stress response system, aberrant fear learning and memory, and increased anxiety or depression-like behaviors.

An important international discussion began because of some pioneer studies carried out by Young (1996a) on the Internet Addiction Disorder. In the fifth and most recent version of the DSM there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role it has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis.

Over the past 20 years we have gained a comprehensive understanding of self-oriented and socially prescribed perfectionism, but our understanding of other-oriented perfectionism (OOP)—and how it differs from the other two forms of perfectionism—is still underdeveloped. Two studies with university students are presented examining OOP’s relationships with social goals, the dark triad, the HEXACO personality dimensions, and altruism. OOP showed unique positive relationships with narcissism, Machiavellianism, and psychopathy and unique negative relationships with nurturance, intimacy, and social development goals. Furthermore it showed unique relationships with social dominance goals (positive) and emotionality, agreeableness, and altruism (negative) dependent on the OOP measure used. The findings suggest that OOP is a “dark” form of perfectionism associated with antisocial and narcissistic personality characteristics.

Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings-in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign-probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.

Both lay concept and scientific theory have embraced the view that nonpathological worry may be helpful for defining and analyzing problems. To evaluate the quality of problem elaborations, concreteness is a key variable. Two studies with nonclinical student samples are presented in which participants elaborated topics associated with different degrees of worry. In Study 1, participants' elaborations were assessed using problem elaboration charts; in Study 2, they were assessed using catastrophizing interviews. When participants' problem elaborations were rated for concreteness, both studies showed an inverse relationship between degree of worry and concreteness: The more participants worried about a given topic the less concrete was the content of their elaboration. The results challenge the view that worry may promote better problem analyses. Instead they conform to the view that worry is a cognitive avoidance response.

Children with an anxious temperament (AT) are at risk for developing psychiatric disorders along the internalizing spectrum, including anxiety and depression. Like these disorders, AT is a multidimensional phenotype and children with extreme anxiety show varying mixtures of physiological, behavioral, and other symptoms. Using a well-validated juvenile monkey model of AT, we addressed the degree to which this phenotypic heterogeneity reflects fundamental differences or similarities in the underlying neurobiology. The rhesus macaque is optimal for studying AT because children and young monkeys express the anxious phenotype in similar ways and have similar neurobiology. Fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET) in 238 freely behaving monkeys identified brain regions where metabolism predicted variation in three dimensions of the AT phenotype: hypothalamic-pituitary-adrenal (HPA) activity, freezing behavior, and expressive vocalizations. We distinguished brain regions that predicted all three dimensions of the phenotype from those that selectively predicted a single dimension. Elevated activity in the central nucleus of the amygdala and the anterior hippocampus was consistently found across individuals with different presentations of AT. In contrast, elevated activity in the lateral anterior hippocampus was selective to individuals with high levels of HPA activity, and decreased activity in the motor cortex (M1) was selective to those with high levels of freezing behavior. Furthermore, activity in these phenotype-selective regions mediated relations between amygdala metabolism and different expressions of anxiety. These findings provide a framework for understanding the mechanisms that lead to heterogeneity in the clinical presentation of internalizing disorders and set the stage for developing improved interventions.

Depression is one of the major global health challenges and a leading contributor of health related disability and costs. Depression is a heterogeneous disorder and current methods for assessing its severity in clinical practice rely on symptom count, however this approach is unreliable and inconsistent. The clinical evaluation of depressive symptoms is particularly challenging in primary care, where the majority of patients with depression are managed, due to the presence of co-morbidities. Current methods for risk assessment of depression do not accurately predict treatment response or clinical outcomes. Several biological pathways have been implicated in the pathophysiology of depression; however, accurate and predictive biomarkers remain elusive. We conducted a systematic review of the published evidence supporting the use of peripheral biomarkers to predict outcomes in depression, using Medline and Embase. Peripheral biomarkers in depression were found to be statistically significant predictors of mental health outcomes such as treatment response, poor outcome and symptom remission; and physical health outcomes such as increased incidence of cardiovascular events and deaths, and all-cause mortality. However, the available evidence has multiple methodological limitations which must be overcome to make any real clinical progress. Despite extensive research on the relationship of depression with peripheral biomarkers, its translational application in practice remains uncertain. In future, peripheral biomarkers identified with novel techniques and combining multiple biomarkers may have a potential role in depression risk assessment but further research is needed in this area.

Between Psyche and Brain
Since its development around 1800, psychiatry has been moving between the poles of the sciences and the humanities, being directed towards subjective experience on the one hand and towards the neural substrate on the other hand. Today, this dualism seems to be overcome by a naturalism which identifies subjective experience with neural processes – according to Griesinger’s frequently quoted statement “Mental diseases are brain diseases”. The progress achieved by the neurobiological paradigm on the level of a fundamental science is in contrast to the tendency to isolate mental illnesses from the patients’ social relationships and to neglect subjectivity and intersubjectivity in their explanation. What should be searched for is therefore an overarching paradigm that is able to found psychiatry as a relational medicine in an encompassing sense: as a science and practice of biological, psychological and social relations and their disorders. Within such a paradigm, the brain may be understood and investigated as the central “relational organ” without reductionist constrictions.

Background: Western countries are facing many challenges hosting refugees from several regions in the world. Many of them are severely traumatized and suffer from a variety of mental health symptoms, which complicates the identification and treatment of refugees at risk. This study examined subgroups based on a broad range of psychopathology, and several predictors, including trauma characteristics and gender.
Methods: Participants were 1147 treatment-seeking, traumatized refugees. Latent profile analysis was conducted to identify different subgroups based on levels of posttraumatic stress disorder (PTSD), depression, anxiety, and somatic symptoms. Multinomial logistic regression was used to identify predictors of subgroup membership.
Results: Three distinct subgroups were identified, reflecting Moderate (10.2%), Severe (43.0%), and Highly Severe (45.9%) symptom severity levels, respectively. Symptom severity of all psychopathology dimensions was distributed equally between the subgroups. Participants in the Severe and Highly Severe Symptoms subgroups reported more types of traumatic events compared to the Moderate subgroup. In particular, traumatic events associated with human right abuses, lack of human needs and separation from others predicted subgroup membership, as did gender.
Limitations: The results are confined to treatment-seeking, traumatized refugee populations.
Conclusions: Distinguishable symptom severity profiles of PTSD, depression, anxiety and somatic complaints could be identified in this large treatment-seeking refugee population, without qualitative differences in symptom distribution. Instead of focusing on specific mental disorders, classification based on overall symptom severity is of interest in severely traumatized patients. This knowledge will help to identify individuals at risk and to enhance existing treatment programs for specific patient groups.

Transgender and gender nonconforming (TGNC) people are a highly-stigmatized population. For this reason, they might internalize society's normative gender attitudes and develop negative mental health outcomes. As an extension of the minority stress model, the psychological mediation framework sheds light on psychological processes through which anti-transgender discrimination might affect mental health. Within this framework, the current study aimed at assessing in 149 TGNC Italian individuals the role of internalized transphobia as a mediator between anti-transgender discrimination and mental health, considering resilience as the individual-level coping mechanism buffering this relationship. The results suggest that both indicators of internalized transphobia (i.e., shame and alienation) mediate the relationship between anti-transgender discrimination and depression, while only alienation mediates the relationship between anti-transgender discrimination and anxiety. Furthermore, the results suggest that the indirect relation between anti-transgender discrimination and anxiety through alienation is conditional on low and moderate levels of resilience. Findings have important implications for clinical practice and psycho-social interventions to reduce stigma and stress caused by interpersonal and individual stigma.

Background: The study aimed to elucidate previously observed associations between morningness-eveningness and depressive symptomatology in university students. Relations between components of depressive symptomatology and morningness-eveningness were analysed.
Methods: Nine hundred and seventy-four university students completed Polish versions of the Centre for Epidemiological Studies – Depression scale (CES-D; Polish translation appended to this paper) and the Composite Scale of Morningness. Principal component analysis (PCA) was used to test the structure of depressive symptoms. Pearson and partial correlations (with age and sex controlled), along with regression analyses with morning affect (MA) and circadian preference as predictors, were used.
Results: PCA revealed three components of depressive symptoms: depressed/somatic affect, positive affect, interpersonal relations. Greater MA was related to less depressive symptoms in three components. Morning circadian preference was related to less depressive symptoms in depressed/somatic and positive affects and unrelated to interpersonal relations. Both morningness-eveningness components exhibited stronger links with depressed/somatic and positive affects than with interpersonal relations. Three CES-D components exhibited stronger links with MA than with circadian preference. In regression analyses only MA was statistically significant for positive affect and better interpersonal relations, whereas more depressed/somatic affect was predicted by lower MA and morning circadian preference (relationship reversed compared to correlations).
Limitations: Self-report assessment.
Conclusions: There are three groups of depressive symptoms in Polish university students. Associations of MA with depressed/somatic and positive affects are primarily responsible for the observed links between morningness-eveningness and depressive symptoms in university students. People with evening circadian preference whose MA is not lowered have less depressed/somatic affect.

Background
In the present study, we have explored the link among styles of attachment and psychopathology in drug users. We know that insecure attachment predisposes the individuals the development of drug-addiction and psychopathological symptoms. However, we do not know which attachment is more frequent in drug users and which is related to particular psychopathological symptoms. The aim of the present work is to explore the relationship between childhood attachment state of mind, attachment in close relationships, parental bonding and psychopathology in sample of Italian substance users.
Methods
We explored, in a sample of 70 drug users and drug-addicted patients, the childhood attachment state of mind measured by the Adult Attachment Interview (AAI), the attachment in close relationships by the Relationship Questionnaire (RQ) and parental bonding measured by the Parental Bonding Instrument (PBI). The Symptom Check-List-90-R (SCL-90-R) measured psychopathological symptoms.
Results
We found that parental bonding, rather than state of mind concerning childhood attachment or attachment in close relationships, is related to the psychopathological manifestation of anxiety, hostility, depression and paranoid ideation in the sample. The latter occurs frequently in our sample, independent of state of mind concerning child attachment, attachment in close relationships and parental bonding, suggesting its role either as a factor that favors a bad image of the participants’ own relationships or as a direct effect of consuming drugs.
Conclusion
These results have clinical implications on suggesting ways of interventions that prevent drug addiction, which should include the evaluation of attachment in the prodromic phases of substance use onset or rehabilitation programs to prevent and manage psychotic-like symptoms.

Research has suggested that high levels of attachment insecurities that are formed through interactions with significant others are associated with a general vulnerability to mental disorders. In the present paper, we extend Ein-Dor and Doron's (2015) transdiagnostic model linking attachment orientations with internalizing and externalizing symptoms, to include thought disorder spectrum symptoms. Specifically, we speculate on the processes that mediate the linkage between attachment insecurities and psychosis and obsessive compulsive disorder (OCD) symptoms, and indicate the different contexts that might set a trajectory of one individual to one set of symptoms while another individual to a different set of symptoms.

The Worry Domains Questionnaire (WDQ) (Tallis, Eysenck, & Mathews, 1992) is an instrument widely used to assess the amount of worry across five domains of everyday concern: relationships, lack of confidence, aimless future, work, and financial issues. With 25 items, however, the WDQ is somewhat lengthy. The aim of the present study was therefore to construct a 10-item short form (WDQ-SF). A sample of 1,080 university students completed the 25 items of the WDQ. One half of the sample was used to construct the WDQ-SF by selecting two appropriate items from each of the five WDQ domain subscales. The other half of the sample was used to cross-validate the factorial structure of the WDQ-SF by means of confirmatory factor analysis. Like the WDQ, the WDQ-SF displayed high internal consistency (Cronbach's alpha = .88) and a clear five-factor structure. Moreover, the WDQ-SF showed a near-perfect correlation with the WDQ long form (r = .97). Thus, the WDQ-SF represents a reliable and economical alternative to the full 25-item scale.

Shaun Gallagher has actively looked into the possibility that psychopathologies involving “thought insertion” might supply a counterexample to the Cartesian principle according to which one can always recognize one’s own thoughts as one’s own. Animated by a general distrust of a priori demonstrations, Gallagher is convinced that pitting clinical cases against philosophical arguments is a worthwhile endeavor. There is no doubt that, if true, a falsification of the immunity to error through misidentification would entail drastic revisions in how we conceive the boundary between self and other. However, I argue that (1) the idea of unearthing an exception to the Cartesian thesis is, on further reflection, not a realistic prospect and that (2) this casts doubt on the attempt to conjoin first-person phenomenology and third-person cognitive science in the service of philosophical debates.

Lying is one of the characteristic features of psychopathy, and has been recognized in clinical and diagnostic descriptions of the disorder, yet individuals with psychopathic traits have been found to have reduced neural activity in many of the brain regions that are important for lying. In this study, we examine brain activity in sixteen individuals with varying degrees of psychopathic traits during a task in which they are instructed to falsify information or tell the truth about autobiographical and non-autobiographical facts, some of which was related to criminal behavior. We found that psychopathic traits were primarily associated with increased activity in the anterior cingulate, various regions of the prefrontal cortex, insula, angular gyrus, and the inferior parietal lobe when participants falsified information of any type. Associations tended to be stronger when participants falsified information about criminal behaviors. Although this study was conducted in a small sample of individuals and the task used has limited ecological validity, these findings support a growing body of literature suggesting that in some contexts, individuals with higher levels of psychopathic traits may demonstrate heightened levels of brain activity.

Both in research on Auditory Verbal Hallucinations (AVHs) and in their clinical assessment, it is common to distinguish between voices that are experienced as ‘inner’ (or ‘internal’, ‘inside the head’, ‘inside the mind’, ...) and voices that are experienced as ‘outer’ (‘external’, ‘outside the head’, ‘outside the mind’, ...). This inner/outer-contrast is treated not only as an important phenomenological variable of AVHs, it is also often seen as having diagnostic value. In this article, we argue that the distinction between ‘inner’ and ‘outer’ voices is ambiguous between different readings, and that lack of disambiguation in this regard has led to flaws in assessment tools, diagnostic debates and empirical studies. Such flaws, we argue furthermore, are often linked to misreadings of inner/outer-terminology in relevant 19th and early 20th century work on AVHs, in particular, in connection with Kandinsky’s and Jaspers’s distinction between hallucinations and pseudo-hallucinations.

Eric Wittkower founded McGill University’s transcultural psychiatry unit in 1955. One year later, he started the first international newsletter in this academic field, which became (and remains) the main journal today: Transcultural Psychiatry. However, at the beginning of his career Wittkower gave no signs that he would be interested in social sciences and psychiatry; he originally trained as a specialist in internal medicine in Berlin. This paper describes the historical context of the post-war period, when Wittkower founded a research unit at McGill University with an American anthropologist, Jacob Fried. Using archival material from McGill, I focus on the history of scientific networks and the circulation of knowledge, particularly on the exchanges between the French- and English-speaking academic cultures in North America and Europe. Because the history of transcultural psychiatry is a transnational history par excellence, but also a literature of exile, this leads necessarily to the important question of the reception of this academic field abroad.

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the
origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the
psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment
(forward psychiatry) were introduced, but the former should not be thought of as the fi rst recognition of what is now
called post-traumatic stress disorder and the latter did not off er the solution to the management of psychiatric casualties,
as was subsequently claimed. For this Series paper, we researched contemporary publications, classifi ed military reports,
and casualty returns to reassess the conventional narrative about the eff ect of shellshock on psychiatric practice. We
conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes
presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated
with popular health concerns. Likewise, claims for the effi cacy of forward psychiatry were infl ated. The vigorous debates
that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these
disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq
and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration
and in terms of its contemporary relevance—not as an opportunity for self-congratulation.

The present study investigates the specificity of the six somatic symptoms that are associated with generalized anxiety disorder (GAD) according to DSM-IV. A nonclinical sample of 183 students provided severity ratings for (1) restlessness, (2) easily fatigued, (3) difficulty concentrating, (4) irritability, (5) muscle tension, and (6) sleep disturbance. In addition, they responded to questionnaires assessing pathological worry and depression symptoms. Partial correlations and multiple regression analyses indicated that only muscle tension showed a unique relation to pathological worry. In contrast, difficulty concentrating was exclusively related to depression symptoms. The present findings corroborate psychophysiological findings that elevated muscle tension is a specific characteristic of pathological worriers. Moreover, they suggest that the problem of unclear boundaries between GAD and major depression may be reduced if future revisions of the somatic symptom list for GAD emphasize muscle tension while de-emphasizing difficulty concentrating.

Self-pity is a frequent response to stressful events. So far, however, empirical research has paid only scant attention to this subject. The present article aims at exploring personality characteristics associated with individual differences in feeling sorry for oneself. Two studies with N = 141 and N = 161 university students were conducted, employing multidimensional measures of personality, control beliefs, anger, loneliness, and adult attachment. With respect to personality, results showed strong associations of self-pity with neuroticism, particularly with the depression facet. With respect to control beliefs, individuals high in self-pity showed generalized externality beliefs, seeing themselves as con¬trolled by both chance and powerful others. With respect to anger expression, self-pity was primarily related to anger-in. Strong connections with anger rumination were also found. Further¬more, individuals high in self-pity reported emotional loneliness and ambivalent-worrisome attachments. Finally, in both studies, a strong correlation with gender was found, with women reporting more self-pity reactions to stress than men. Findings are discussed with respect to how they support, extend, and qualify the previous literature on self-pity, and directions for future empirical research are pointed out.

Delusions are currently characterised as false beliefs produced by incorrect inference about external reality (DSM IV). This inferential conception has proved hard to link to explana- tions pitched at the level of neurobiology and neuroanatomy. This paper provides that link via a neurocomputational theory, based on evolutionary considerations, of the role of the prefrontal cortex in regulating offline cognition. When pathologically neuromodulated the prefrontal cortex produces hypersalient experiences which monopolise offline cognition. The result is characteristic psychotic experiences and patterns of thought. This bottom-up account uses neural network theory to integrate recent theories of the role of dopamine in delusion with the insights of inferential accounts. It also provides a general model for evolutionary psychiatry which avoids theoretical problems imported from evolutionary psychology.

Impairments in the mirror neuron system (MNS) have been implicated as a possible underlying neurological basis for deficits in higher-level social cognition in schizophrenia. Previous work testing this hypothesis has used the electroencephalographic mu rhythm as an index of MNS activity, with studies showing mixed results. Here we investigated the role that reward plays in modulating the mu rhythm, and its association with empathy and emotional mental state reasoning. A group of schizophrenia patients and a healthy control group completed an action observation paradigm in which they watched actions that were financially rewarding, punishing, or neutral. Patients showed intact reward-related modulation of the mu rhythm, and greater mu suppression was associated with greater negative symptoms. There was also a trend for reduced mu suppression in patients. Furthermore, both empathy and emotional mental state reasoning were associated with the degree of mu suppression, but only in healthy controls. These findings confirm the association between the mu suppression and high-level social cognition. It is possible that schizophrenia patients utilize different cognitive routes to infer mental states. The demonstration that reward influences the degree of mu suppression in schizophrenia patients may help to account for previous conflicting findings in the literature.

Perfectionistic self-presentation in adolescents is associated with psychological maladjustment and distress. Yet, no study so far has investigated what personality characteristics contribute to perfectionistic self-presentation in adolescence. Using a cross-sectional correlational design with 119 adolescents aged 11-16 years, this study investigated how perfectionism (self-oriented and socially prescribed perfectionism) and affect intensity (positive affectivity, negative intensity, and negative reactivity) predicted individual differences in three modes of perfectionistic self-presentation: perfectionistic self-promotion, nondisplay of imperfection, and nondisclosure of imperfection. Results showed a unique prediction pattern for all three modes of perfectionistic self-presentation. Moreover, affect intensity contributed to perfectionistic self-presentation beyond perfectionism in two of the three modes: Perfectionistic self-promotion was predicted by high self-oriented perfectionism, high socially prescribed perfectionism, high positive affectivity, and low negative reactivity. In contrast, nondisplay of imperfection was predicted by high self-oriented perfectionism, high negative reactivity, and low positive affectivity. Nondisclosure of perfectionism was predicted by high socially prescribed perfectionism only. The findings suggest that affect intensity is a personality characteristic contributing to perfectionistic self-presentation in adolescence beyond perfectionism.

The construct of clinical perfectionism, conceptualized as a one-dimensional construct (Shafran, Cooper, & Fairburn, 2003), has drawn considerable debate because of the associated critique of multidimensional perfectionism’s relevance for clinical theory and research. Hence Dickie, Surgenor, Wilson, and McDowall’s (2012) finding that the Clinical Perfectionism Questionnaire (CPQ), designed to measure clinical perfectionism, was two-factorial and thus multidimensional makes an important contribution to the debate. The present study aimed to replicate Dickie et al.’s finding examining the CPQ’s factorial structure in 316 university students. In addition, the study examined the CPQ’s convergent correlations with dispositional perfectionism, perfectionism cognitions, and perfectionistic self-presentation. CPQ total scores showed large-sized positive correlations with dispositional perfectionism and perfectionism cognitions demonstrating convergent validity. However, the study confirmed that the CPQ was two-factorial with Factor 1 mainly capturing perfectionistic strivings and Factor 2 mainly capturing perfectionistic concerns, thus questioning the CPQ’s construct validity. Together with Dickie et al.’s findings, the present study’s findings suggest that—if the CPQ is a valid measure of clinical perfectionism as conceptualized by Shafran et al. (2003)—the construct of clinical perfectionism and its dimensionality need to be reconsidered.

This article discusses how some Russian satirical journals capitalized on the medical discourse of degeneration shortly after the 1905 Revolution in order to stigmatize certain decadent literary figures as degenerate purveyors of social unrest. This is not an exhaustive examination of the role of satirical journals in this process, but an indicator that the scientific discourse of degeneration was not limited to medical journals, academic lectures and literary salons. Along with this medical discourse, the designation “decadent” became an abusive moniker that was used to stigmatize the writer as a deviant and degenerate psychopath. This article suggests that as a result, medical theory played a more important role in shaping the popular discourse of the Russian fin de siècle than has been previously discussed. In fact, this stigmatizing discourse was quite prevalent, by which criticism of literary decadence was intertwined with the medical pathology of degeneration. Russian satirical journals played a role in this process by popularizing this medical discourse for readers, combining the latest theories on degeneration with sensational accounts of alcoholics, drug addicts and syphilitics, while at the same time depicting modernists as morally corrupt transmitters of social and political discontent.

Computerized cognitive remediation therapy (CCRT) has been shown to improve cognitive functions in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in psychiatric ward. A randomized controlled trial of CCRT vs an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The interventions lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive functions and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing the negative symptoms in schizophrenia individuals.

The purpose was to examine the long-term stability of a diagnosis of psychotic disorder in adolescence and to focus on diagnostic change over time. A total of 88 patients with a first episode of early onset psychosis (before 19 years) were followed up an average of 10.5 years (range 5.1–18.2) after admission. This report includes the 68 patients who could be traced and interviewed with the Positive and Negative Symptom Scale and lifetime Structured Clinical Interview for DSM-IV diagnosis. An initial diagnostic split between schizophrenia spectrum and affective disorder had a good (> 80 %) Positive Predictive Validity and Sensitivity. The main diagnostic shift was an influx to schizophrenia spectrum disorder (n = 6). These patients resembled the stable affective group (n = 27) in premorbid and prodromal aspects but changed over time to resemble the poor outcome of the stable schizophrenia spectrum group (n = 28) albeit with fewer negative symptoms and a better social function. Family history of nonaffective psychosis in first or second degree relatives was often found in the “change to schizophrenia group”. A diagnosis in adolescence of schizophrenia spectrum or affective psychotic disorder is usually stable over time. A subgroup of non-schizophrenia patients go on to develop a schizophrenia spectrum disorder.

Understanding the influence of the mind on behaviour and experience requires a comprehensive account of underlying mechanisms (i.e., the processes that underlie behaviour). This opinion article explores the neurocognitive mechanisms underlying imagery-related psychopathology. Imagery is a psychological process that exploits mental representations to simulate perception and action in the absence of sensory input. Unfortunately, progress in understanding the role of imagery in psychopathology is hampered by inadequate attention to mechanisms. Accordingly, this article uses motor simulation theory to elucidate the mechanisms driving intrusive negative images in conditions such as obsessive-compulsive disorder, post-traumatic stress disorder and suicidality.

Interpersonal problems are a core symptom of borderline personality disorder (BPD). In particular, patients with BPD exhibit a heightened sensitivity to cues of acceptance or rejection in their relationships. The current study investigated the psychological processes underpinning this heightened responsiveness. In a between-subjects design, we implemented a reactivity induction designed to trigger either acceptance or rejection of a partner in two separate groups, and measured the effects which this manipulation had upon 49 patients with BPD, as well as 52 control participants. The experimental paradigm required participants to repeatedly choose whether to coordinate with their partner on a decision-making task. When both players coordinate on the same option, both are rewarded. The experiment probed participants’ commitment to their partners: participants were sometimes presented with tempting opportunities to unilaterally defect from the coordination. The results show that participants in the BPD group were less committed than participants in the control group when exposed to the rejection manipulation.

Aim

As the population ages, the problem of dementia increases and affects a growing number of people. People with mental illness are known to be stigmatised and this has been the subject of numerous studies. There have been contradictory studies assessing the stigma attached to dementia, and the majority focus on stigma at a social level and the public perception of people with dementia. There have been a number of projects that included a study group of people with dementia. However, to date, this topic has not been discussed in Poland. Hence, the aim of this paper is to carry out a literature review addressing this issue.

Perspective

The problem of stigma attached to dementia is particularly significant as it affects not only the subject, but also their family, friends and health professionals. As people with dementia develop cognitive impairment and lose their independence, stigmatisation leads to their social isolation, despite their need for care. Stigma has emotional, behavioural and social implications, including diminished self-esteem, a feeling of anxiety and the development of a sense of shame and a fear of the judgement of others. Family members also deal with the stigma, which manifests itself as embarrassment and anxiety and causes their circle of friends and acquaintances to decrease. Current studies show that professionals can also play a negative role in the process of labelling and stigmatisation of patients.

Conclusion

Stigma is a serious and common problem in dementia. It seems necessary to target this issue in research and social discourse.

The study of Psychopathology has often been presented in a descriptive form. Though this may be relevant for teaching because it helps students to recognize and identify the symptomatology of each psychopathology, it overlooks the subjective dimension of falling ill and its relational aspects. By approaching the issue from the standpoint of existential anthropology, we present a practical psychopathology teaching experience that regards these dimensions as relevant to the understanding of mental suffering. Two new modes of practical teaching employed in the "Special Psychopathology I" course offered to psychology students of the Federal University of Rio de Janeiro are presented, using the descriptive case study method. The idea is to expand practical teaching, traditionally based on the model of a long clinical interview carried out in the presence of a large group of students that observe everything passively. Our aim is to bring teaching and the practice of psychopathology closer to the ideals of the Brazilian Psychiatric Reform, which views mental illness as a complex phenomenon that involves the relationship of the subject with the world.

This milestone text provides a comprehensive and state-of-the art overview of perfectionism theory, research, and treatment from the past 25 years, with contributions from the leading researchers in the field. The book examines new theories and perspectives including the social disconnection model of perfectionism and the 2 × 2 model of perfectionism. It also reviews empirical findings, with a special focus on stress, vulnerability, and resilience, and examines perfectionism in specific populations. Finally, it considers how perfectionism relates to physical health and psychophysiological processes and introduces new approaches to effective prevention and treatment. By increasing our understanding of perfectionism as a complex personality disposition and providing a framework for future explorations, this landmark publication aims to promote further research in this field. It will be invaluable reading for academics, students, and professionals in personality psychology, clinical and counselling psychology, applied psychology and related disciplines.

The article covers Erwin W. Straus’ (1891–1975) views on the problem of
time and temporal experience in the context of psychopathology. Beside Straus’ published scholarship, including his papers dealing exclusively with the subject of time, the sources utilized in this essay comprise several of Straus’ unpublished manuscripts on temporality (all from the Erwin. W. Straus Archive, Simon Silverman Phenomenology Center, Duquesne University, USA), with the primary focus on the1952 manuscript Temporal Horizons, which is discussed in greater detail and subsequently published for the first time in this journal. In the first part of the article, the author introduces what he considers to be the central tension of the whole of Straus’ work on the issue of time, namely, the tension stemming from a dualistic account of time with its personal (experienced) and impersonal (clock time) dimensions. Interpretative
developments of this tension are followed covering Straus’ early German works and his late American scholarship. The author presents Straus’ way of overcoming the dualistic account of time and his arguments in favour of what is termed here the unified view of time. Of critical importance for the unified view is Straus’ concept of today, which is extensively commented upon. In the second part of the article, the
author focuses on the psychopathological consequences of the unified view as seen by Straus. A clear-cut boundary between a normal and a psychotic experience of time is supposed to lie in breaking the bond between the personal and the impersonal orders of time, leading to a fundamental estrangement. This view, it is claimed, is already present
in a nutshell in Straus’ earliest work, and is elaborated upon later. In conclusion, both the merits and the weaknesses of Straus’ account of temporality are presented. A major advantage is that Straus abstains from a dualistic conception of time and reappraises the often-devalued clock time. A fundamental drawback is that Straus does not venture to
explore the pathological varieties of temporal experience and fails to specify the acknowledged differences between, on the one hand, psychotic elements in depressive disorders, and, on the other hand, such elements in schizophrenic disturbances.

Background:  This study examined relations between Israeli adolescents’ political violence exposure and psychiatric consequences over seven years around the second Intifada and possible differential effects according to age and gender.Methods:  Cross-sectional data was collected from 3667 adolescents aged 10–18, constituting two age groups of early and late adolescents sampled in three different exposure periods: pre-Intifada, Intifada peak, and Intifada recession.Results:  The first hypothesis predicting a main effect of severity of political violence exposure on psychiatric indices was confirmed for all Brief Symptom Index scales. The second hypothesis predicting a main effect of exposure period was confirmed with higher psychopathological indices at the Intifada peak than at the pre-Intifada and receding Intifada periods. The exploratory question of possible moderating effects in the relation between Political Life Events exposure and exposure period to psychiatric indices showed that higher levels of exposure to political violence were associated with higher rates of symptomatology for both younger and older adolescents. For both genders, a general direct relation emerged between level of severity of political violence exposure and severity of psychiatric outcome, but differently according to Intifada exposure period.Conclusions:  Findings document the psychiatric toll paid by adolescents who grow up in protracted conflict and political violence, emphasizing the delicate interaction between individual and conflict factors.

L'article propose de soulever certaines questions cliniques et épistémologiques posées par la notion de vulnérabilité psychotique, dans le champ de la psychopathologie de l'enfant et de l'adolescent. La vulnérabilité s'est en effet constituée comme un paradigme majeur de la santé mentale contemporaine, suscitant un nombre considérable de recherches sur les facteurs de risque et d'apparition des troubles psychotiques. Les études consacrées au risque de psychose et à sa détection précoce ont marqué, depuis une vingtaine d'années, un tournant dans les modèles de vulnérabilité : les facteurs de vulnérabilité y sont englobés dans la catégorie dite à très haut risque (ultra-high risk), voire dans un syndrome de risque de psychose. Mais, concevoir la vulnérabilité comme risque pose plusieurs problèmes : celui d'une spécificité clinique suffisante pour fonder la prédiction, et celui de sa fidélité aux trajectoires développementales singulières. L'article examine ces interrogations à partir de deux exemples aujourd'hui paradigmatiques de la vulnérabilité psychotique : celui des expériences dites quasi-psychotiques chez l'adolescent, et celui du syndrome développemental de microdélétion 22q11.2.




ENG - The goal of this paper is to shed light on specific clinical and epistemological questions raised by the notion of psychotic vulnerability in the field of child and adolescent psychiatry. This notion has nowadays become a major research paradigm and orients numerous studies on risk factors for transition to psychosis. In the last 20 years studies focusing on such risk factors and their early identification have given a new impetus to models of vulnerability: they unify vulnerability factors under the category of ultra-high risk, or even risk syndrome for psychosis. Method.-A review of the conceptual and historical background framing the notion of vulnerability sheds light on epistemological and clinical ambiguities characterizing its scope and relevance for child and adolescent psychopathology. The paper aims to clarify these questions raised by the vulnerability models by focusing on two paradigm cases of vulnerability to psychosis: psychotic-like experiences in adolescents, and the 22q11.2 microdeletion developmental syndrome. Results.-The discrepancy between the statistical background of vulnerability factors and a clinical understanding of the vulnerability involves two main difficulties for the clinical scope of these models: the first one relates to a specific vulnerability to psychosis, opposed to a general vulnerability to develop a mental disorder. The second one is the difficulty to grasp, from the perspective of risk models, the clinical and dynamic temporality of the transition toward psychotic symptoms. Discussion.-These ambiguities raised by the ultra-high risk models call for a psycho-dynamic approach, regarding diagnosis in light of a subjective experience and trajectory, and of the psychic functions and dynamics of a symptom. Such a psycho-dynamic point of view can shed light on a clinical understanding of the vulnerability models.