In schizophrenia and major depressive disorder, anhedonia (a loss of capacity to feel pleasure) had differently been considered as a premorbid personological trait or as a main symptom of their ...clinical picture. The aims of this study were to examine the pathological features of anhedonia in schizophrenic and depressed patients, and to investigate its clinical relations with general psychopathology (negative, positive, and depressive dimensions).
A total of 145 patients (80 schizophrenics and 65 depressed subjects) were assessed using the Physical Anhedonia Scale and the Social Anhedonia Scale (PAS and SAS, respectively), the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS, respectively), the Calgary Depression Scale for Schizophrenics (CDSS), and the Hamilton Depression Rating Scale (HDRS). The statistical analysis was performed in two steps. First, the schizophrenic and depressed samples were dichotomised into 'anhedonic' and 'normal hedonic' subgroups (according to the 'double (PAS/SAS) cut-off') and were compared on the general psychopathology scores using the Mann-Whitney Z test. Subsequently, for the total schizophrenic and depressed samples, Spearman correlations were calculated to examine the relation between anhedonia ratings and the other psychopathological parameters.
In the schizophrenic sample, anhedonia reached high significant levels only in 45% of patients (n = 36). This 'anhedonic' subgroup was distinguished by high scores in the disorganisation and negative dimensions. Positive correlations of anhedonia with disorganised and negative symptoms were also been detected. In the depressed sample, anhedonia reached high significant levels in only 36.9% of subjects (n = 24). This 'anhedonic' subgroup as distinguished by high scores in the depression severity and negative dimensions. Positive correlations of anhedonia with depressive and negative symptoms were also been detected.
In the schizophrenic sample, anhedonia seems to be a specific subjective psychopathological experience of the negative and disorganised forms of schizophrenia. In the depressed sample, anhedonia seems to be a specific subjective psychopathological experience of those major depressive disorder forms with a marked clinical depression severity.
Abstract
Background
The purpose of the present review was to summarize the main literature contribution on the relationship between borderline personality disorder (BPD) and early psychosis. While ...retracing the historical path of the term “borderline”, specific attention was paid to psychotic and psychotic-like symptoms in BPD. Its relationship with At Risk Mental State was evaluated, as well.
Methods
This search was conducted on PUBMED/MEDLINE and PsycInfo, looking for “Borderline personality disorder, First Episode Psychosis, Early Psychosis, Ultra-High Risk AND/OR Clinical High Risk” for psychosis.
Results
Eight pertinent papers were identified on this topic. Their main findings were then discussed. The term “borderline” has undergone different changes in meaning and use, despite always referring to states considered on the fence between neurosis and psychosis. However, considering the history of psychopathology and its relationship with diagnostic manuals, little attention has been given to its psychotic features. Being those symptoms highly burdensome, this neglect has often led to misdiagnosis and under-treatment.
Conclusions
Psychotic symptoms in BPD can be severe and distressing. Nonetheless they can be easily neglected, and when found they challenge clinicians in defining a differential diagnosis to distinguish between BPD and Psychosis Spectrum Disorders. Given specific needs and interventions for these different conditions, a dimensional, rather than categorical, approach should be considered, as well as specific care pathways and monitoring should be advised.
Previous findings suggested deficits in pleasure experience in schizophrenia, but little is known in psychosis risk prodrome, especially in adolescence. Aim of this study was (1) to assess anhedonia ...in distinct help-seeking subgroups of adolescents identified through the ultra-high risk (UHR) criteria, (2) to explore any association of anhedonia with other psychopathological aspects in the UHR group, and (3) to monitor longitudinally the stability of anhedonia in UHR individuals across 1-year follow-up period. 123 participants (13–18 years) completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II, the Schizotypal Personality Questionnaire-Brief version, the Brief-O-LIFE questionnaire (BOL), and the Brief version of the World Health Organization Quality of Life scale (WHOQOL-BREF). Two different indexes of anhedonia were used: CAARMS “Anhedonia” item 4.3 and BOL “Introvertive Anhedonia” subscale scores. No difference in anhedonia levels between UHR and First Episode Psychosis (FEP) groups was found. UHR adolescents showed higher CAARMS and BOL anhedonia scores than non-UHR/FEP. After 1-year follow-up period, UHR adolescents had a significant decrease in severity only in CAARMS anhedonia subscores. In UHR subgroup, CAARMS anhedonia measures showed significant correlations with impaired role functioning and negative symptoms, while BOL anhedonia was significantly correlated with specific schizotypal personality traits concerning interpersonal deficits. Anhedonia is prominent in the psychosis prodrome, also in adolescence. Its severity is not statistically different from that of FEP adolescents and is related to more severe functioning impairment and a worse quality of life.
Offspring of individuals with serious mental illness (SMI) constitute a special population with a higher risk of developing psychiatric disorders, which is also highly prevalent among referrals to ...child and adolescent mental health services (CAMHS). They often exhibit more or less subclinical conditions of vulnerability, fueled by mutually potentiating combinations of risk factors, such as presumed genetic risk, poor or inadequate affective and cognitive parenting, and low socio-economic status. Despite this evidence, neither specific preventive programs for offspring of parents with SMI are usually implemented in CAMHS, nor dedicated supportive programs for parenting are generally available in adult mental health services (AMHS). Needless to say, while both service systems tend to focus on individual recovery and clinical management (rather than on the whole family system), these blind spots add up to frequent gaps in communication and continuity of care between CAMHS and AMHS. This is particularly problematic in an age-range in which an offspring's vulnerabilities encounter the highest epidemiological peak of incident risk of SMI. This paper offers a clinical-conceptual perspective aimed to disentangle the complex intertwine of intergenerational risk factors that contribute to the risk of developing SMI in offspring, taking schizophrenia spectrum disorders as a paradigmatic example.
The COVID-19 pandemic has crosses every health care area (from primary care to specialist ones), leading to a review of all public health policies. The use of smart working allows important ...technological innovations, but it must be accompanied by a review of hospital and residential programs and locations. Since many institution are talking about economic investments for mental health (a crucial area for a full recovery of the society), specific funds are needed in mental health professionals (eg, psychologists), skills, and innovation of locations and technology, such as the conversion of psychiatric wards to community services that carefully must consider the patient experience and clinician’s point of view. Some considerations on the COVID-19 experience in Italy are reported, and suggestions on future directions for public mental health service organization are hypothesized.
The term "brittle" is used to describe an uncommon subgroup of patients with type 1 diabetes whose lives are disrupted by severe glycaemic instability with repeated and prolonged hospitalization. ...Psychosocial problems and emotional disturbances are the major perceived underlying causes of brittle diabetes. Aim of this study is (a) to assess alexithymia in patients with brittle and non-brittle diabetes, and (2) to examine its relationship with specific parameters of general psychopathology.
Participants comprised 44 patients with brittle diabetes and a case-control group of 88 individuals with stable (non-brittle) diabetes, matched for age, gender, years of education, and diabetes duration. Alexithymia and general psychopathology were assessed using the "20-item Toronto Alexithymia Scale" (TAS-20) and the "Symptom Checklist-90-Revised" (SCL-90-R).
Patients with brittle diabetes were more alexithymic than the control group. Alexithymia scores showed significant correlations with SCL-90-R anxiety and somatization subscales, but were relatively independent from gender, education, diabetes duration and complications, depression and glycaemic control.
Given the impact of alexithymia on type 1 diabetes, the early detection and intervention of alexithymic subjects are very important for a better outcome of diabetes.
Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Aim of this ...study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period. Participants 51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients, aged 13–18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE “Social Cognition” subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.
Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk ...factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP) and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group.
Adolescents (
= 147) completed an
sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status.
More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect).
Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).
Individual placement and support (IPS) is an evidence-based intervention helping people with mental illness to obtain competitive jobs. In the last decade, European mental health leaders were ...interested on its implementation. Aim of the study was to assess the IPS feasibility in Italian patients with moderate-to-severe mental illness. To date, no evaluation of IPS has been conducted exclusively in Italy. Participants (n = 95) were clients of community mental health centers of the Reggio Emilia Department of Mental Health. In addition to drop-out rates, we calculated job acquisition, job duration, and total hours per week worked. A crude competitive employment rate of 41.1% and a crude drop-out rate of 30.5% were found over 42-month follow-up period. Using a Kaplan–Meyer survival analysis, the cumulative employment rate increased up to 44% at 12 months and 61% both at 24 and 42 months. This study documents the feasibility of an implementation strategy for introducing the IPS model in the public mental health care system in Italy.
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