Il potere predittivo positivo del modello dimensionale DSM 5 per la diagnosi di personalità in un campione di pazienti comorbidi per disturbi dell'umore

Introduzione: La diagnosi dei disturbi di personalità (DP), soprattutto se categoriale ed effettuata attraverso strumenti differenti è spesso poco attendibile. Il DSM 5 ha proposto pertanto un nuovo modello gerarchico e multidimensionale. La relazione tra DP e disturbi dell'umore è complessa e molte questioni metodologiche restano aperte: scarsità e contraddittorietà dei dati, mancanza di teorie eziologiche definite, farmacoresistenza dei pazienti comorbidi che presentano decorso e outcome peggiori, anche nelle forme sotto-soglia. Metodi: 30 pazienti con disturbi dell'umore sono stati sottoposti a screening con il questionario self-report della SCID-5-PD e successivamente diagnosticati con la SCID-5-PD, il Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ) e l'Inventario di Personalità per il DSM 5 (PID-5). Risultati: Le diagnosi dimensionali e la variabile “caratteristiche clinicamente significative” consentono di predire tratti psicopatologici in assenza del superamento del cut-off categoriale: manipolatività, ostilità e antagonismo nella personalità evitante, comportamento dissociale nella personalità paranoide, comportamento compulsivo ma anche persistenza e perfezionismo in quella schizotipica, ansietà nella personalità narcisistica, disinibizione e inganno in quella dipendente. Conclusioni: Il nuovo modello appare valido e più utile clinicamente a cogliere caratteristiche patologiche e risorse di personalità finora inedite o poco indagate

Resilience and Attachment in Patients with Major Depressive Disorder and Bipolar Disorder

Background: Resilience represents one of the fundamental elements of attachment and has often been investigated in mood disorders. This study aims to investigate possible correlations between attachment and resilience in patients with major depressive disorder (MDD) and bipolar disorder (BD). Methods: 106 patients (51 MDD, 55 BD) and 60 healthy controls (HCs) were administered the 21-item Hamilton Depression Rating Scale (HAM-D-21), the Hamilton Anxiety Rating Scale (HAM-A), the Young Mania Rating Scale (YMRS), the Snaith–Hamilton Pleasure Scale (SHAPS), the Barratt Impulsiveness Scale-11 (BIS-11), the Toronto Alexithymia Scale (TAS), the Connor–Davidson Resilience Scale (CD-RISC), and Experiences in Close Relationship (ECR). Results: MDD and BD patients did not significantly differ from each other according to the HAM-D-21, HAM-A, YMRS, SHAPS, and TAS, while they scored higher than HCs on all these scales. Patients in the clinical group scored significantly lower on CD-RISC resilience than HCs (p < 0.01). A lower proportion of secure attachment was found among patients with MDD (27.4%) and BD (18.2%) compared to HCs (90%). In both clinical groups, fearful attachment prevailed (39.2% patients with MDD; 60% BD). Conclusions: Our results highlight the central role played by early life experiences and attachment in participants with mood disorders. Our study confirms the data from previous research showing a significant positive correlation between the quality of attachment and the development of resilience capacity, and supports the hypothesis that attachment constitutes a fundamental aspect of resilience capacity

Childhood trauma and resilience in psoriatic patients: A preliminary report

Aims Psoriasis is a chronic inflammatory skin disease with a complex etiology, involving the immune system, genetic factors, and external/internal triggers, with psychosomatic aspects. The aim of the study was to investigate childhood trauma and resilience in a psoriatic sample compared with healthy controls. Correlations between childhood trauma, resilience, quality of life, clinical data and psoriatic features were also evaluated. Methods Seventy-seven psoriatic patients and seventy-six homogeneous healthy controls were enrolled. We used the Psoriasis Area and Severity Index (PASI) to assess the severity of psoriasis and the Skindex-29 to measure health-related quality of life. The psychometric battery included the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-Risc) to assess trauma exposure and resilience, respectively. Results Psoriatic patients showed a significant prevalence of childhood trauma and a lower resilience level compared to healthy controls. Associations between traumatic experiences, low resilience and reduced quality of life in psoriatic subjects were also observed. Conclusions A multidisciplinary approach is helpful to investigate clinical aspects, trigger factors and psychophysiological stress response in psoriatic subjects. Improving resilience with an early psychological intervention focused on self-motivation and strengthening of self-efficacy could facilitate the management of psoriasis