Andrea Spoto

Knowledge space theory, formal concept analysis, and computerized psychological assessment

In the present study, the use of knowledge space theory (KST), jointly with formal concept analysis (FCA), is proposed for developing a formal representation of the relations between the items of a questionnaire and a set of psychodiagnostic criteria. This formal representation can be used to develop an efficient adaptive tool for psychological assessment. Rusch and Wille (1996) have shown some interesting connections between KST and FCA; these connections are applied in the construction of knowledge structures, starting from a formal context representing the relations between items and criteria. The proposed general methodology was applied, as an example, to the Maudsley Obsessional-Compulsive Questionnaire. We used a data set provided by a sample of patients with a diagnosis of obsessive-compulsive disorder to validate the obtained structures. The parameters of the basic local independence model (BLIM) were estimated for the obtained knowledge structures. The fit of each model was tested by parametric bootstrap because of the sparseness of the derived data matrix. The results are discussed in light of both psychological and methodological relapses. In particular, we propose a reinterpretation of the BLIM parameters that seems suitable for testing reliability and construct validity; furthermore, it is pointed out how the obtained structures could represent the starting point for the development of a computerized assessment tool.

Memantine: new prospective in bipolar disorder treatment

UNLABELLED We review preclinical and clinical evidences strongly suggesting that memantine, an old drug currently approved for Alzheimers dementia, is an effective treatment for acute mania and for the prevention of manic/hypomanic and depressive recurrences of manic-depressive illness. Lithium remains the first line for the treatment and prophylaxis of bipolar disorders, but currently available treatment alternatives for lithium resistant patients are of limited and/or questionable efficacy. Thus, research and development of more effective mood stabilizer drugs is a leading challenge for modern psychopharmacology. We have demonstrated that 21 d administration of imipramine causes a behavioural syndrome similar to a cycle of bipolar disorder, i.e., a mania followed by a depression, in rats. Indeed, such treatment causes a behavioural supersensitivity to dopamine D2 receptor agonists associated with an increase sexual activity and aggressivity (mania). The dopamine receptor sensitization is followed, after imipramine discontinuation, by an opposite phenomenon (dopamine receptor desensitization) and an increased immobility time (depression) in the forced swimming test of depression. Memantine blocks the development of the supersensitivity and the ensuing desensitization associated with the depressive like behavior. On the basis of these observations we have suggested the use of memantine in the treatment of mania and in the prophylaxis of bipolar disorders. To test this hypothesis we performed several naturalistic studies that showed an acute antimanic effect and a long-lasting and progressive mood-stabilizing action (at least 3 years), without clinically relevant side effects. To confirm the observations of our naturalistic trials we are now performing a randomized controlled clinical trial. Finally we described the studies reporting the efficacy of memantine in manic-like symptoms occurring in psychiatric disorders other than bipolar. LIMITATIONS A randomized controlled clinical trial is needed to confirm our naturalistic observations. CONCLUSION We believe that this review presents enough pharmacological and clinical information to consider the administration of memantine in the treatment of bipolar disorders that no respond to standard mood stabilizers.

Psychological and behavioral disease during developmental age: the importance of the alliance with parents

The aim of the study is to analyze the clinician’s alliance with parents during the diagnostic process in relation to therapeutic compliance and clinical evolution of individuals aged 0–11 years. The sample was formed by 84 individuals aged 0 to 11 years (18 < 6 years, 66 aged 6 to 11 years; 62 males and 22 females) who came to the Neuropsychiatric Unit for Children and Adolescents for a consultation regarding psychorelational and behavioral problems. Neuropsychiatric consultation took place in five diagnostic interviews with child and parents, separately. The last session was devoted to communication of psychiatric diagnosis (according to ICD 10) and therapeutic suggestions, if any. The clinician’s relationship with parents and patients’ participation were evaluated in terms of collaboration and quality of interaction, on the basis of pre-established criteria. Data about patients’ therapeutic compliance and clinical outcome were collected during a follow-up visit eight months after the last session. Results suggest that the better the alliance between parents and clinician, the higher the therapeutic compliance and the likelihood of a positive outcome for patients. Our data suggest that good communication with parents benefits child patients, both in terms of response to the parents’ need to report their children’s worrying behavior and as a response to the discomfort expressed by children when they come in for consultation.

Alexithymia, impulsiveness, and psychopathology in nonsuicidal self-injured adolescents

Introduction Nonsuicidal self-injury (NSSI) is a multifaceted phenomenon and a major health issue among adolescents. A better understanding of self-injury comorbidities is crucial to improve our ability to assess, treat, and prevent NSSI. Purpose This study aimed at analyzing some of the psychobehavioral correlates of NSSI: psychological problems, alexithymia, impulsiveness, and sociorelational aspects. Patients and methods This was a case–control study. The clinical sample (n=33) included adolescents attending our unit for NSSI and other issues; the controls (n=79) were high-school students. Data were collected using six questionnaires: Youth Self-Report, Barratt’s Impulsiveness Scale, Toronto Alexithymia Scale, Children’s Depression Inventory, Symptom Checklist-90-R, and Child Behavior Checklist. Results Cases scored significantly higher in all questionnaires. Habitual self-injurers scored higher on impulsiveness and alexithymia. The gesture’s repetition seems relevant to the global clinical picture: habitual self-injurers appear more likely to seek help from the sociosanitary services. We found a difference between the self-injurers’ and their parents’ awareness of the disorder. Conclusion Habitual self-injurers show signs of having difficulty with assessing the consequences of their actions (nonplanning impulsiveness) and the inability to manage their feelings. Given the significantly higher scores found for cases than for controls on all the psychopathological scales, NSSI can be seen as a cross-category psychiatric disorder, supporting the Diagnostic and Statistical Manual of Mental Disorders decision to include it as a pathological entity in its own right.

Beyond the Score: Clinical Evaluation Through Formal Psychological Assessment

Questionnaires generate numerical scores, but endorsing different sets of items could produce the same score despite reflecting qualitatively different configurations of clinical features. Formal psychological assessment (FPA) attempts to overcome this by identifying the clinical features entailed by observed response patterns. This study illustrates an application of FPA to the cleaning subscale of a questionnaire assessing obsessive–compulsive symptoms and DSM–IV–TR diagnostic criteria for obsessive–compulsive disorder. A deterministic model of the items–criteria relationships was constructed by mapping each item to each diagnostic criterion. The resulting model was tested on a large community sample (N = 4,412). Results indicate that the theoretical model has adequate fit; item error rates and probabilities for each of the criteria are examined. Clinically relevant examples of the items–criteria relationships are discussed. Possible applications of FPA to personality assessment are also discussed, including long multidimensional questionnaires and questionnaires that use subtle item content.

Formal Psychological Assessment in Evaluating Depression: A New Methodology to Build Exhaustive and Irredundant Adaptive Questionnaires

Psychological Assessment can be defined as a complex procedure of information collection, analysis and processing. Formal Psychological Assessment (FPA) tries to improve this procedure by providing a formal framework to build assessment tools. In this paper, FPA is applied to depression. Seven questionnaires widely used for the self-evaluation of depression were selected. Diagnostic criteria for major depressive disorder were derived from the DSM-5, literature and Seligman’s and Beck’s theories. A Boolean matrix was built, including 266 items from the questionnaires in the rows and 20 selected attributes, obtained through diagnostic criteria decomposition, in the columns. In the matrix, a 1 in a cell meant that the corresponding item investigated the specific attribute. It was thus possible to analyze the relationships between items and attributes and among items. While none of the considered questionnaires could alone cover all the criteria for the evaluation of depressive symptoms, we observed that a set of 30 items contained the same information that was obtained redundantly with 266 items. Another result highlighted by the matrix regards the relations among items. FPA allows in-depth analysis of currently used questionnaires based on the presence/absence of clinical elements. FPA allows for going beyond the mere score by differentiating the patients according to symptomatology. Furthermore, it allows for computerized-adaptive assessment.

Adolescent insight within the working alliance: A bridge between diagnostic and psychotherapeutic processes

In the literature it has been stressed how important it is during consultation interviews to evaluate an adolescent’s insight with a view to starting psychotherapeutic work. Motivated adolescents bring to the therapeutic effort a real, interiorized request for help and can start moving towards a change. The aim of this study is to assess the insight of adolescents with mental disorders during the diagnostic process and to analyze how this relates to further therapeutic compliance and clinical evolution. The study included 55 adolescents, 35 males and 20 females aged between 11 and 19 years, who were advised to receive psychotherapeutic treatment after a diagnostic procedure. Patient insight was assessed at the beginning and end of the diagnostic process. Then, six months later, a clinical interview assessed their therapeutic compliance and clinical evolution. The findings suggest that insight is important when working with adolescents because it influences both therapeutic compliance and clinical outcome.

Unveiling the structure: effects of social feedback on communication activity in online multiplayer videogames

Feedback intervention in computer-mediated situations can be interpreted as a way to augment communication. According to this idea, this study investigates the effect of providing a group with a Social Network Analysis-based feedback on communication in an on-line game where players talk to each other via textual chat. Three different situations across two different sessions were compared: an Informed Group with a correct feedback, a not-Informed Group with no feedback and a mis-Informed group with an incorrect feedback. Results show that giving correct information increases the related dimensions of communication, while the absence of feedback and the incorrect feedback were not accompanied by any significant modification.

ATS-PD An Adaptive Testing System for Psychological Disorders

The clinical assessment of mental disorders can be a time-consuming and error-prone procedure, consisting of a sequence of diagnostic hypothesis formulation and testing aimed at restricting the set of plausible diagnoses for the patient. In this article, we propose a novel computerized system for the adaptive testing of psychological disorders. The proposed system combines a mathematical representation of psychological disorders, known as the “formal psychological assessment,” with an algorithm designed for the adaptive assessment of an individual’s knowledge. The assessment algorithm is extended and adapted to the new application domain. Testing the system on a real sample of 4,324 healthy individuals, screened for obsessive-compulsive disorder, we demonstrate the system’s ability to support clinical testing, both by identifying the correct critical areas for each individual and by reducing the number of posed questions with respect to a standard written questionnaire.

A class of k-modes algorithms for extracting knowledge structures from data.

One of the most crucial issues in knowledge space theory is the construction of the so-called knowledge structures. In the present paper, a new data-driven procedure for large data sets is described, which overcomes some of the drawbacks of the already existing methods. The procedure, called k-states, is an incremental extension of the k-modes algorithm, which generates a sequence of locally optimal knowledge structures of increasing size, among which a “best” model is selected. The performance of k-states is compared to other two procedures in both a simulation study and an empirical application. In the former, k-states displays a better accuracy in reconstructing knowledge structures; in the latter, the structure extracted by k-states obtained a better fit.