Fenomeni dissociativi in un campione di pazienti Borderline La patologia dissociativa come processo patogenetico nucleare del Disturbo Borderline di Personalità

Obiettivi. Scopi di tale studio sono: indagare il rapporto tra fenomeni dissociativi e Disturbo Borderline di Personalità, indagare rispetto a quale fattore sintomatologico dissociativo sia più forte il legame con il DBP e, infine, indagare se la presenza di fenomeni dissociativi sia legata al numero di tratti (sintomi) di DBP o alla diagnosi dello stesso. Metodi. Al campione (n = 1033), estratto dalla popolazione di pazienti di un ambulatorio di salute mentale privato della provincia di Napoli, sono stati somministrati gli strumenti DES e SCID II. Le valutazioni inferenziali sono state effettuate applicando il test T di Student, la regressione logistica e l’anova ad una via. Le variabili continue sono state standardizzate prima di effettuare il test di regressione. I dati raccolti sono stati trattati statisticamente attraverso l’ausilio del pacchetto SPSS per le analisi statistiche. Risultati. Il punteggio medio alla DES totale è significativamente più alto (t = -3,11) nei soggetti con DBP (μ = 17,38) rispetto a quello dei soggetti senza DBP (μ = 10,72). Dalla regressione logistica emerge che il legame tra fenomeni dissociativi e DBP è forte in relazione al Fattore III della DES (depersonalizzazione/derealizzazione) e che all’aumentare di un punto standard del Fattore III della DES aumenta del 50% la probabilità di riscontrare un DBP. L’analisi della varianza evidenzia che all’aumentare del numero di tratti di DBP si manifestano punteggi medi più alti alla DES totale. Discussione e conclusioni. Si evidenzia che i fenomeni dissociativi sono più frequenti nei pazienti con DBP rispetto ai pazienti senza DBP. Si evidenzia, inoltre, che il legame tra fenomeni dissociativi e DBP è più forte per quanto riguarda il fattore sintomatologico di depersonalizzazione/derealizzazione. Si rileva, infine, che i punteggi medi alla DES TOT aumentano all’aumentare del numero di tratti di DBP ma che, in particolare, tali punteggi sono più alti alla presenza di 4 tratti. Questa evidenza ci consente di concludere che il legame tra fenomeni dissociativi e DBP si collega al numero di tratti di DBP e non necessariamente alla diagnosi dello stesso.Aims. This study aims to investigate the relationship between dissociative phenomena and the Borderline Personality Disorder, in order to identify which one of dissociative symptoms factor has a stronger tie with Borderline Personality Disorder. Moreover, this study aims to find out if the presence of dissociative symptoms is linked to the number of Borderline Personality Disorder traits (symptoms), or the Borderline Personality Disorder diagnosis itself. Methods. A representative sample (n = 1033) was selected from patients visiting a private mental health clinical center in Naples. Inclusion criteria provided both Borderline Personality Disorder and non-Borderline Personality Disorder patients. The Dissociative Experiences Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis II Disorders were used in order to collect data. Statistical Analysis involved the Student’s T-test, logistic regression and one-way Analysis of Variance. Continuous variables were standardized before the regression test. In addition, collected data were analyzed by the software Statistical Package of Social Science. Results. The mean of DES-Total scores in Borderline Personality Disorder patients (μ = 17,38) was significantly higher (t = -3,11) than in non-Borderline Personality Disorder patients (μ = 10,72). Logistic regression showed a strong link between dissociative phenomena and Borderline Personality Disorder respect to DES Factor III (depersonalization/derealization). Furthermore, it shows how increasing one standard point in DES Factor III increases by 50% the chance to detect a Borderline Personality Disorder. Lastly, the Analysis of Variance highlighted that more the number of Borderline Personality Disorder traits increase, the higher average are shown on DES-Total scores. Discussion and conclusions. The study has shown that Dissociative phenomena are more frequent in Borderline Personality Disorder patients rather than non-Borderline Personality Disorder patients. Moreover, it shows that the link between dissociative phenomena and Borderline Personality Disorder is stronger in relation to symptom factor depersonalization/derealisation. Finally, results show that DES-Total mean scores increase as Borderline Personality Disorder traits number increases, with higher scores when four specific traits are detected. This evidence confirms that the relationship between dissociative phenomena and Borderline Personality Disorder depends on the number of Borderline Personality Disorder traits detected, but not necessarily on the Borderline Personality Disorder diagnosis

The Nodes of Treatment: A Pilot Study of the Patient-Therapist Relationship Through the Theory of Complex Systems

Psychotherapy, unanimously described as a particular organized and systematic relationship between a patient and a therapist, is a real complex system. The interaction between the numerous variables belonging to the patient, the therapist and the context in which the therapeutic couple is inserted, presents auto-poietic characteristics and generates emergent qualities that, at the current state of psychotherapy research, have not been effectively addressed. The methods of machine learning are suitable for analyzing complex systems and in our opinion, at the moment, they are the most appropriate for studying the therapeutic relationship, understood as a quality emerging from patient-therapist interaction. In fact, through the use of artificial intelligence methods it is possible to construct a model of interaction between therapist and patient by integrating in it the non-linearity of information exchanges between the components of the system. The humanistic therapies vision of the patient-therapist relationship as a complex and organized interaction between the parts of a system is comparable to the networks of cellular chemical reactions described by Varela and Maturana. In these networks, which are a complex systems, what is important for maintaining the cell’s integrity and its functioning it is not the nature of every single chemical reaction but the form and dynamics of their interaction. This research is a pilot study that intends to evaluate the possibility of describing the complexity of therapeutic relationships using the methods of machine learning and complex networks, ordinarily used to study systems composed of numerous interacting variables. From this pilot study emerges that the use of graphs is certainly a valid tool for the analysis of both the psychotherapeutic sessions and the evolution of the care relationship over time. Numerous suggestions on the dynamics within the patient-therapist system emerge from the construction of a complex network useful for describing the trend of psychotherapy, which in this way can be described without losing the value of the wealth of each individual experience

Decision-making Styles and Personality Traits: A pilot study on the predictive capacity of the TCI regarding the quality of the decision

The way individuals make choices and decisions influences their behavior and life style. The choice is not simply based on rational and formal logic, but it's influenced by many emotional and social factors. Starting from this assumption, some studies investigated the way in which emotions influence decision-making processes, while others explored the possibility that decision-making processes are compromised by the onset of psychiatric pathologies and by the presence of prefrontal cortexlesions, which can induce a radical change in basic preferences of the subject. In our opinion, the decision-making style is strictly connected to the normal personality structure while the relationship with psychopathology can be framed within the non-causal and non-linear effects typical of risk or protection factors. The present pilot study, first, intends to explore the relation between decision-making styles, non-pathological personality traits and psychic disorders; second, it intends to propose a psychometric tool administrable via mobile app, aimed at studying the influence of decision-making styles, related to personality, on the quality and effectiveness of decisions. The present pilot study, was developed in a sample of outpatients in a private psychotherapy service made up of subjects diagnosed with personality disorder. The TCI test was been administered to identify the decision-making styles related to the character traits and temperament. Through statistical analyses, five factors were extracted (5 decision-making styles) and only two personality disorders appear to be related to decision-making styles. This results describe a significant but marginal impact of decisional styles on the pathology of personality, with respect to which they play a role of risk or protection factor

A deep learning algorithm to prevent burnout risk in Family Caregivers of patients undergoing dialysis treatment.

Continuous management of dialysis patients exposes family caregivers to significant psychophysical risks. Having demonstrated the effectiveness of artificial intelligence in the care and assistance processes, it was hypothesized the implementation of a mobile app which would detect the distress of these Family Caregivers in order to activate support actions and adequate sustenance. In order to identify the Burnout risk factors of the Family Caregivers of dialysis patients, 31 items were selected, from the questionnaires recognized in the literature, and submitted to a sample of 713 subjects. The four components extracted through factor analysis identify critical aspects of the family caregiver's experience. The neural network implemented on these four dimensions shows that overall they have an excellent ability to predict the stress state of the subjects (82%). From this study emerged the basic structure of a psychometric instrument suitable for the assessment of the stress of the family caregivers of patients undergoing dialysis treatment. This reagent can be administered through a mobile app and, using a deep learning algorithm, can report in real time the discomfort of the family caregivers

The effects of the endocrine disruptors and of the halogens on the female reproductive system and on epigenetics: A brief review

Introduction: An endocrine-disrupting chemical (EDC) is defined as "an exogenous chemical or a mixture of chemicals that interfere with any aspect of the hormonal action". Endocrine systems are a physiological interface with the environment and genetic-environmental interactions are disrupted by EDCs. Today, there are almost 1000 chemicals reported to have endocrine effects: the prevalence of EDC in our environment and in our bodies represents a major global health challenge. This review gathers the studies that have investigated the correlations between exposure to EDC and pathologies of the female reproductive system and fetal development. Methods: A PubMed research was conducted using the keywords, their variants, and their combinations (BPA, DES, MXC, pesticides, phthalates, plasticizers, PCBs, dioxins, ovaries, oocytes, ovaries, fallopian tubes, follicles, vagina, uterus, fibroids, fertility, infertility, puberty, polycystic ovary syndrome, premature ovarian failure, birth, preterm birth, birth outcome, steroid, hormone, female, girl and menopause). Results: The endocrine system plays a central role in all vertebrates and regulates critical biological functions such as metabolism, development, reproduction, and behavior. Epidemiological studies link EDCs with reproductive effects, neuro-behavioral and neurodevelopment alterations, metabolic syndrome, bone disorders, immune disorders, and cancers in humans. Human investigations confirm the results of the studies carried out on animal showing associations with many additional effects on health, including asthma, learning and behavior problems, premature puberty, infertility, breast and prostate cancer, Parkinson's disease, obesity and other diseases. Conclusions: It is important to undertake research with follow-up methodologies and/or longitudinal studies to detect the extent of exposure of pregnant women to EDCs and halogenated substances and the effects of such exposure on brain development. A future research hypothesis may consider the effect that these substances have on neuro-development and, more specifically, how EDCs are involved in pathogenic disorders such as autism spectrum disorders (ASD). In addition, a scientific study could be performed on the correlations between this type of substance and the inconveniences found in the field of executive frontal functions

Complexity in the narration of the self A new theoretical and methodological perspective of diagnosis in psychopathology based on the computational method

Psychopathological diagnostics is affected by structural methodological limitations that make it less effective in clinical and research applications. These limits are related to: the intrinsic characteristics of psychopathological experiences which cannot be described in the third person; to the complexity of the individual-environment system that cannot be studied using methods based on linear causality; to the forms of psychodiagnostic reagents that hypothesize the possibility of obtaining quantitative measurements of psychic phenomena. In order to overcome these limitations, a complex psychodiagnostic evaluation model is presented in which self-report questionnaires, technologies for the evaluation of physiological indices and methods of analysis of data derived from artificial intelligence are integrated. In this project, the objectives of diagnostic evaluations are: emotional experiences articulated according to a phenomenological vision; the relational dynamics analyzed through the complex network method; the biological variations of the organism detected with the HRV. These assessments could converge towards an integrated and ecological knowledge of the individual, naturalistically based, adapted to clinical decisions and research programs

What Does Personality Mean in the Context of Mental Health? A Topic Modeling Approach Based on Abstracts Published in Pubmed Over the Last 5 Years

Personality disorders (PDs) are one of the major problems for the organization of public health systems. Deepening the link between personality traits and psychopathological drifts, it seems increasingly essential for the often dramatic repercussions that PDs have on social contexts. Some of these disorders, such as borderline PD, antisocial PD, in their most tragic expression, are the basis of problems related to crime, sexual violence, abuse, and mistreatment of minors. Many authors propose a dimensional classification of personality pathology, which has received empirical support from numerous studies over the last 20 years based on more robust theoretical principles than those applied to current nosography. The present study investigates the nature of the research carried out in the last years on the personality in the clinical field exploring the contents of current research on personality relapses, evaluating, on the one hand, the emerging areas of greatest interest and others, those that they stopped generating sufficient motivations in scholars. This study evaluates text patterns regarding how the terms "personality" and "mental health" are used in titles and abstracts published in PubMed in the last 5 years. We use a topic analysis: Latent Dirichlet Allocation that expresses every report as a probabilistic distribution of latent topics that are represented as a probabilistic distribution of words. A total of 7,572 abstracts (from 2012 to 2017) were retrieved from PubMed for the query on "mental health" and "personality." The study found 30 topics organized in eight hierarchical clusters that describe the type of current research carried out on personality and its clinical relapse. The hierarchical clusters latent themes were the following: social dimensions, clinical aspects, biological issues, clinical history of PD, internalization and externalization symptoms, impulsive behaviors, comorbidities, criminal behaviors. The results indicate that the concept of personality is associated with a wide range of conditions. The study of personality and mental health still proceeds, mainly, according to a practical-clinical approach; too little moves, however, according to an innovative research approach, but the work shows the common commitment of scholars to a new way of dealing with the study of personality

Mind, brain and altered states of consciousness

The consciousness is the expression of an enormous and complex variety of neurobiological events, phenomenological and psychological that, from the early stages of development, prepare the emergence soil of the Self. It is a complex of tangible and intangible characters distinct from one another - neural infrastructure, awareness, temporality, qualitative subjectivity, intentionality - to such an extent as to seem welded faces of the same prism. Consciousness is not a simple function of the mind, but its organization. In this paper we intend to show how its order is not strictly hierarchical, but sustained by multiple horizontal levels, each of which in a structural and functional continuum with several emerging phenomena. The same distinction between quantitative aspects (surveillance) and qualitative (content of consciousness) of consciousness is founded on the premise that the supervision is regulated by widespread in projection systems of the brain stem, hypothalamus and thalamus; while the content of consciousness depends on the cortical activity, and particularly from the associative areas of the cortex connected between them. The so-called disturbances of consciousness (vegetative state, the minimally conscious state, a coma, the Locked in syndrome) suggests the existence of an alteration of a common underlying system. Although the current heterogeneity of the data makes it impossible to attribute with certainty whether positive or negative about the alleged absence of consciousness in the individual patient, the search is deriving significant benefits from the accumulation of neuroimaging evidence in paintings like coma, general anesthesia , sleep, epilepsy and somnambulism. In this sense, it seems increasingly urgent a deeper understanding of the neural correlates during sleep or general anesthesia, as well as the relationships between neural processes and altered states of consciousness generated by pharmacological manipulations