School refusal behavior. role of personality styles, social functioning, and psychiatric symptoms in a sample of adolescent help-seekers

Objective: School refusal (SR) in adolescence represents an important risk factor associated with adverse consequences. Although many clinical features of adolescents presenting with SR have been studied, the relationship between SR and personality styles-specifically in the help-seeking population-remains unclear. The present study aimed at investigating differences in personality style, adaptive functioning, and symptomology between Italian help-seeking adolescents who refused (SRa) and did not refuse (non-SRa) to attend school, to provide preliminary evidence of personality patterns in adolescent help-seekers presenting with SR.Method: The study sample was comprised of 103 help-seeking adolescents (54 female, 49 male) aged 14-18 years. Participants were recruited during their first clinical visit and evaluated using the Shedler and Westen Assessment Procedure - Adolescent version (SWAP-A), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Maniac Rating Scale (MRS), the Global Assessment of Functioning (GAF), the Global Functioning Social Scale (GFSS), and the Global Functioning Role Scale (GFRS). Differences in the studied variables between SRa and non-SRa were measured and a multivariable logistic regression analysis was performed to identify possible predictive factors of SR.Results: SRa presented with more anxious and depressive symptomatology and worse social functioning compared to non-SRa. With respect to personality, SRa displayed more schizoid and schizotypal characteristics and fewer adaptive and healthy personality features. Irrespective of any differences between groups, SRa were largely characterized by inhibited-self-constricted and emotionally dysregulated personality styles.Conclusions: The results suggest that personality styles arc clinical features that may contribute to broadening our knowledge of SR behavior and aid in the detection of SRa, also in the help-seeking population. The findings have clinical, social, and political implications for prevention, diagnosis, and treatment, in both clinical and non-clinical settings. However, more data are needed on personality features to clarify their contribution to the more complex phenomenon of school absenteeism

Sintomatologia, sistemi emotivi di base e tratti di personalità predittivi dell’alleanza di lavoro e del drop-out terapeutico con pazienti adolescenti

Introduzione. L’alleanza di lavoro e la prevenzione del drop-out psicoterapeutico rappresentano due fenomeni molto importanti per la gestione del processo terapeutico. La letteratura sottolinea la scarsità di studi che esplorino il contributo del paziente adolescente rispetto a questi fenomeni. Obiettivi. L’obiettivo di questo studio consisteva nell’esplorare la relazione tra la sintomatologia e la personalità rispetto all’alleanza di lavoro a breve termine e a medio termine e il drop-out. I modelli di personalità ai quali si è fatto riferimento sono quelli delle neuroscienze affettive e del Modello alternativo dei disturbi di personalità del DSM-5. Metodi. Si sono condotti tre studi, con pazienti adolescenti di età compresa tra i 14 e i 19 anni, che si rivolgevano alle cure psichiatriche. I soggetti sono stati valutati con i seguenti strumenti: WAI-T, HAM-A, HAM-D, YMRS, ANPS 2.4, ANPS-AR, PID-5, TAS-20. Risultati. La sintomatologia clinica non risultava predittiva dell’alleanza di lavoro. I sistemi emotivi di base della CURA, del GIOCO e della RABBIA erano predittivi dell’alleanza di lavoro a breve e medio termine. Nessun sistema di base era predittivo del drop-out. I domini DSM-5 “Distacco” e “Antagonismo” mostravano una abilità significativa e negativa di predire l’alleanza di lavoro a breve termine, ma non a medio termine. Alcuni tratti DSM-5 (insensibilità, ostilità, irresponsabilità, impulsività) predicevano in senso negativo il drop-out. Infine, l’alessitimia è risultata predittiva in senso negativo dell’alleanza di lavoro, ma non del drop-out. Conclusioni. La considerazione degli elementi sintomatologici e personologici può fornire importanti informazioni per la gestione dell’alleanza di lavoro e del drop-out terapeutico

Modificazioni metaboliche in eritrociti di coniglio indotte in vitro dal sistema ferro(2.)-ascorbato

Dottorato di ricerca in metodologie biochimiche e farmacologiche. 6. ciclo. A.a. 1990-91. Coordinatore M. Dacha'Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7, Rome; Biblioteca Nazionale Centrale - P.za Cavalleggeri, 1, Florence / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Teoria e tecnica del colloquio in psicologia clinica e psichiatria

Il manuale “Teoria e tecnica del colloquio in psicologia clinica e psichiatria” è destinato agli operatori dei settori sanitari che hanno l’esigenza di orientarsi nella gestione di un colloquio, mantenendo un equilibrio tra strutturazione e flessibilità, tra rigore scientifico e arte dialogica. Per questo obiettivo, vengono illustrate numerose tecniche che permettano di raccogliere con ordine e senso clinico i principali contenuti diagnostici e che, al contempo, consentano di gestire il processo relazionale con il cliente, momento per momento. Sono descritti il rationale e la tempistica di ciascun intervento, in riferimento al disagio sintomatologico presentato dal cliente, al suo stile di personalità, alla motivazione e alla resistenza, allo stadio del cambiamento, alla bontà dell’alleanza di lavoro e agli schemi di transfert e controtransfert. Il manuale pone una particolare attenzione alla fase dell’assessment diagnostico, fornendo delle coordinate sintetiche per la prima formulazione della domanda di consultazione e del caso clinico. La prospettiva teorica di riferimento è quella delle neuroscienze affettive (e della teoria evoluzionista), nella convinzione che tale bacino teorico possa rappresentare una feconda area di convergenza tra i principali orientamenti psicologici -cognitivi, psicodinamici, sistemici- e possa fornire senso e coerenza all’operato clinico

Relationships between Affective Neuroscience primary brain emotional systems, working alliance and countertranference in a sample of adolescent helpseekers

Introduction Affective Neurosciences identify seven ancestral emotion systems, categorizing them in positive (SEEKING, LUST, CARE, PLAY) and negative (FEAR, RAGE, SADNESS/PANIC). The activation of one – or more – of the seven emotional systems is related to distinct affect feeling states, promoting some specific behavioral patterns according to individual’s experience. Each one of the seven systems is important to understand and define features of human personality. These domains are presented as fundamental for the development of the human personality, and can therefore be used as a potentially new model for the evaluation of the personality and for the therapeutic process. Futhermore, the consideration of these basic emotional sistems can produce longer therapeutical changes (Montag, Panksepp, 2017). In this regard, working alliance and countertranference are considered very important “common factors” of the therapeutic process (Norcross, 2011) and they are associated to a good outcome and to reduction of the drop-out (Horvath, Re, Fluckiger, Symonds, 2011). Therefore, we evaluated the relationship between Affective Neuroscience primary brain emotional systems, working alliance and countertranference in a sample of adolescent helpseekers. Method A sample of 87 patients, 48% males, (14-18 years) were included and referred to the clinic for Anxiety and Mood Disorders in Adolescence (Department of Psychiatry of Sant'Andrea Hospital in Rome). Subjects met diagnostic criteria for the following DSM-5 diagnoses: Anxiety Disorders (30%), Depressive Disorders (40%), Bipolar Disorders (15%), Obsessive-Compulsive Disorders (10%). The sample was evaluated with the Affective Neuroscience Personality Scales 2.4 (ANPS 2.4), Working Alliance Inventory-Therapist Form (WAI-T) and Therapist Response Questionnaire (TRP). Results and conclusions Higher levels of CARE correlate with a better working alliance and with a countertransference response Special/Overinvolved. Instead, high levels of RAGE and Dominance correlate with lower levels of working alliance. Low activation of SEEKING correlates with high levels of the factors Helpless/Inadequate, Parental/Protective and Disengaged. The emotive and motivational system FEAR correlates with the countertranference factors Positive/Satisfying, Parental/Protective, Overwhelmed/Disorganized, Special/Overinvolved. There is a relationship between the RAGE system and the countertransference factor Hostile/Mistreated. SADNESS/PANIC system correlates with Parental/Protective and Special/Overinvolved factors. Dominance is related to the factor Overwhelmed/Disorganized. In conclusion, the drive to care and compassion appears to be associated with a better ability to cooperate with the therapist in order to achieve common goals, contrary to the propensity to defensive, choleric and intrapsychic or interpersonal control (Gilbert, 2014), which also trigger reactions of antagonism in the therapist or a sense of confusion. The feelings of impotence, protection and detachment from the therapist can signal the hypoactivation of attitudes of exploration, problem-solving and curiosity in the patient (Panksepp, 2010). The activation of threat feelings seems to trigger a variegated countertransferential reaction. The sense of loneliness and the need for attachment activate therapeutic attitudes of care and hypercooling. References Montag C, Panksepp J. Primary emotional systems and personality: an evolutionary perspective. Frontiers in Psychology. 2017; 8. Horvath AO, Re ACD, Fluckiger C, Symonds D. Alliance in individual psychotherapy. In Norcross JC (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press 2011, pp. 25–69. Norcross JC. Evidence-based therapy relationships. In Norcross JC (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press 2011 Gilbert P. The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 2014; 53: 6–41. Panksepp J. Affective neuroscience of the emotional BrainMind: Evolutionary perspectives and implications for understanding depression. Dialogues in Clinical Neuroscience. 2010; 12: 383–39