Metacognition as a predictor of improvements in personality disorders

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variable

Extracellular matrix components affect cell migration and invasive potential of cultured human pancreatic ductal adenocarcinoma cells

The tumor microenvironment influences cancer cell behavior in relation to tumor progression, as well as cell proliferation and invasion. Pancreatic ductal adenocarcinoma (PDAC) is characterized by an intense desmoplastic reaction and extracellular matrix (ECM) components in the tumor microenvironment are involved in a cross-talk between tumor cells, stromal fibroblasts and ECM components, influencing tumor cell behavior. We aimed at analyzing in vitro the effect of the crosstalk between PDAC cells and the ECM of the microenvironment by culturing PDAC cells on different ECM proteins used as a substrate, in order to better understand the relationship between cancer cell phenotype and the proteins occurring in the desmoplastic tissue. For this purpose, we analyzed some epithelial-to-mesenchymal transition (EMT) markers and the migration and invasive potential in human HPAF-II, HPAC and PL45 PDAC cells cultured on collagen type I (COL), laminin (LAM) and fibronectin (FN). Interestingly, the expression of E-cadherin was not significantly affected, but some differences were revealed by the wound healing assay. In fact, migration of HPAF-II and PL45 cells was decreased on FN and LAM, and increased on COL, compared to control cells grown on plastic (NC). By contrast, HPAC was very rapid and unaffected by the substrate. SDS-zymography showed that COL induced a strong upregulation of MMP-2 activity in HPAF-II and HPAC cells, and of MMP-9 in HPAF-II and PL45 cells, compared to NC. These preliminary results suggest that ECM components could differently affect PDAC migration and invasion, possibly depending on the differentiation grade. The characterization of the mutual effects elicited by the tumor-stroma interplay on the cancer cell will contribute to better understand the influence of the stroma on PDAC cancer cell phenotype, in order to develop new therapeutic strategies

Characterization of an in vitro model to study the role of human Polyomavirus BK in prostate cancer

Prostate cancer (PCa) is one of the most common male neoplasm in the western world, being the most commonly diagnosed non-skin cancer and the second leading cause of cancer death. Various potential risk factors exist for the initial triggering events, including exposure to infectious agents, such as the human Polyomavirus BK (BKV). BKV is a good candidate as risk factor of PCa because it naturally infects the human reno-urinary tract, it establishes latency, and encodes oncoproteins that interfere with tumor suppressors pathways, thus altering the normal progression of cell cycle. Previous studies suggested a potential association between BKV and PCa, revealing that the prevalence of BKV was significantly higher in cancer than in control tissues, with a significant association between viral expression and cancer. However, this hypothesis is controversial because BKV is not restricted to tumor tissues but also infects healthy individuals in a high percentage. Moreover, an in vitro model of BKV infection in prostate cells is not available to understand the role for BKV in pathogenesis of PCa. Our aims were to determine whether BKV a) could infect normal epithelial prostate cells, b) affects cell phenotype and c) affects the phenotype of human prostate tumor cell line PC3. For this purpose normal epithelial prostate cell line RWPE-1 and prostate cancer cells PC3 were infected with BKV for 21 days. Cell proliferation, epithelial-to-mesenchymal markers (EMT) and invasion potential were analyzed by, respectively, MTT, immunofluorescence and SDS-zymography. Our results show that cell proliferation was increased or decreased by BKV, respectively, in RWPE-1 and PC3 cells. BKV induced E-cadherin downregulation and vimentin expression in both control and BKV-infected cells RWPE-1, suggesting that uninfected cells underwent EMT. Matrix metalloproteinase-2 and 9 activity was increased in RWPE-1 cells after BKV infection. By contrast, BKV did not significantly modified the phenotype of PC3 cells. These preliminary results suggest that normal epithelial prostate cells RWPE-1 and PC3 are susceptible and permissive to BKV infection. However, RWPE-1 cells exhibit some phenotype modifications related to EMT, possibly induced by the papilloma virus used to obtain their immortalization, thus suggesting that further experiments will be necessary to define if they represent a good experimental model to study prostate cancer

Le disfunzioni metacognitive nei disturbi di personalit Una review delle ricerche del III Centro di Psicoterapia Cognitiva

Dagli anni '90, il III Centro di Psicoterapia Cognitiva di Roma si è impegnato nell'attività clinica e di ricerca sul trattamento di pazienti gravi e difficili da trattare. In questo lavoro verranno analizzati alcuni tra i più importanti lavori pubblicati dal Gruppo in questo ambito. Si tratta di ricerche sul processo terapeutico condotte a partire dall’osservazione clinica secondo cui la presenza di specifici malfunzionamenti metacognitivi ostacolerebbe la costruzione della rappresentazione degli stati mentali propri e altrui; la regolazione della relazione terapeutica potrebbe migliorare tali malfunzionamenti rendendo così possibili gli interventi sugli aspetti sintomatici del paziente. Sono state portate, quindi, prove sufficienti a sostenere che la metacognizione sia una grandezza composta da sottofunzioni distinte semi-indipendenti. Altri studi del Gruppo hanno mostrato poi come la realtà clinica del paziente grave sia influenzata in modo diverso dalla presenza di specifici malfunzionamenti metacognitivi

Therapeutic Journey and Economic Burden of Patients with Myasthenia Gravis in Italy: Results of a Real-World Analysis

AIM: This analysis investigated the population with Myasthenia Gravis (MG) in Italy, to describe epidemiology, mortality, patients’ characteristics, comorbidity profile, therapeutic management, and healthcare consumption and related costs.METHODS: From 2012 to 2021, MG patients were identified in administrative flows of healthcare entities through hospitalization discharge diagnosis or exemption code for MG or a pyridostigmine prescription. Medications and comorbidities were searched before inclusion and healthcare costs were analysed at 1-year follow-up. Epidemiology estimates were reported as cases/100,000 people, and mortality rates, stratified by age classes and gender, were assessed during 2019. MG patients were compared with age- and gender-matched subjects without MG.RESULTS: At the end of 2021, MG prevalence was 35.1/100,000 and incidence 4.7/100,000 people. Mortality in 2019 was 3.2% in overall MG sample, and tended to rise in males and elderly patients. About 90% received MG-related treatments, namely pyridostigmine, corticosteroids and immunosuppressants (81.3%, 76.9% and 26.1% of patients respectively). Unsurprisingly, the yearly healthcare resource consumption/patient was higher in MG patients than in non-MG subjects (p<0.001), resulting in increased annual direct costs for MG patients (€5,495 vs €823, p<0.001), related to expenses for hospitalizations (mostly related to nervous system and respiratory system), drugs and outpatient services.CONCLUSIONS: In this study, incidence and prevalence of MG estimated in Italy were similar to other European countries and mortality rates were from 2 to 3-times higher than general population. Despite the current treatment options and adherence to guidelines for MG management, the clinical and economic burden of the disease remains high

Le conseguenze dell'amore. Distacco e solitudine

Il caso di G. permette di fare alcune osservazioni sulla psicopatologia e sulle strategie terapeutiche utilizzabili in un caso del genere. G. viene inquadrata come un individuo con sintomi di compartimentazione dissociativa emersi in seguito ad una relazione affettiva avvenuta in etŕ matura. Le modalitŕ descritte della relazione, cosě come precedenti situazioni relazionali vissute da G. in famiglia, portano all'ipotesi di una co-presenza di un tratto dipendente di personalitŕ. Vengono analizzate le due condizioni di sofferenza psicopatologica e di eventuale co-esistenza nel descrivere le dinamiche di mantenimento e poi di scompenso psicopatologiche del caso. Alcune brevi note sulle strategie terapeutiche da adottare in una prospettiva cognitiva vengono aggiunte a conclusione del commento.</jats:p

Le terapie on-line: opportunit&amp;agrave; o ripiego?

La crisi mondiale della pandemia per coronavirus (Covid-19) ha colpito la nostra vita. Nel 2020 la popolazione ha affrontato repentini cambiamenti cognitivi-emotivi e relazionali, questa condizione ha implementato l'utilizzo di comunicazioni on-line. In USA i Centers for Disease Control and Prevention hanno dichiarato che la pandemia ha aumentato i livelli di stress degli individui. Altri studi hanno confermato che i sintomi ansioso depressivi sono reazioni psicologiche comuni alla pandemia Covid-19.Il mondo della psicoterapia come sta reagendo all'impatto della pandemia? L'utilizzo della tecnologia &amp;egrave; da tempo presente in ambito clinico anche se molti professionisti sono incerti e impreparati. Fino a poco tempo fa la terapia on-line &amp;egrave; stata considerata sacrilega da molti. Per i terapeuti cognitivo-comportamentali (CBT) il passaggio alla terapia on-line &amp;egrave; stato pi&amp;ugrave; semplice perch&amp;eacute; i professionisti si sono mostrati pi&amp;ugrave; flessibili nell'adattare le loro tecniche a Internet. Ma quanto i trattamenti on-line sono efficaci? Quali sono gli aspetti fondamentali?In questo articolo vogliamo descrivere le prove empiriche a supporto dell'efficacia della CBT on-line, includendo aspetti favorevoli e contrari, in contesti e popolazioni differenti, senza trascurare i limiti e le possibili criticit&amp;agrave;, al fine di riflettere sui due trattamenti e confrontarli. I risultati complessivi evidenziano poche differenze tra i due metodi. Sono molti gli studi sulla terapia cognitivo-comportamentale via Internet (iCBT), ma con risultati ancora poco esaustivi, in particolare per quanto riguarda gli esiti di condizioni psichiatriche e somatiche, pertanto, sono necessarie ulteriori ricerche per stabilire l'equivalenza dei due formati di trattamento.</jats:p

La formazione a distanza in psicoterapia cognitivo-comportamentale: rischi ed opportunit&amp;agrave;

La pandemia da Covid-19 ha modificato radicalmente la pratica clinica, introducendo la necessit&amp;agrave; di erogare interventi in modalit&amp;agrave; telematica per molti mesi; al tempo stesso anche le scuole di formazione in psicoterapia hanno dovuto inizialmente sospendere la formazione in presenza per poi riprendere i corsi in modalit&amp;agrave; telematica, adattando la struttura dei corsi a questa nuova modalit&amp;agrave;.La peculiarit&amp;agrave; della formazione in psicoterapia rende complessa una formazione completamente a distanza soprattutto per la dimensione esperienziale della formazione.&amp;Egrave; stata effettuata una SWOT analysis che ha coinvolto i direttori delle scuole di specializzazione in psicoterapia afferenti alla SITCC per identificare i punti di forza e debolezza delle scuole e le opportunit&amp;agrave; e i rischi che l'attuale situazione determina per la formazione e per gli specializzandi nei prossimi mesi.I risultati si sono focalizzati su due macro-categorie (opportunit&amp;agrave; e rischi) che includono alcuni temi e sotto-temi che vengono discussi per fornire alcuni spunti di riflessione e discussione per l'organizzazione di una nuova didattica.La didattica telematica presenta indubbi vantaggi che tutti i partecipanti hanno sottolineato, tuttavia &amp;egrave; importante considerare gli adattamenti necessari ad un uso efficace di questa modalit&amp;agrave;.La maggior parte delle scuole ha espresso la volont&amp;agrave; di mantenere la modalit&amp;agrave; telematica per una parte della didattica anche in futuro riconoscendone il valore di esperienza formativa.</jats:p