Daniele La Barbera

Do Child Abuse and Maltreatment Increase Risk of Schizophrenia

Introduction IntroductionaaAlthough childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues. Methods Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results. Results An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated. Conclusion Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.

Break in volition: a virtual reality study in patients with obsessive-compulsive disorder

Research in obsessive-compulsive disorder (OCD) produced inconsistent results in demonstrating an association between patients’ symptom severity and their cognitive impairments. The process involved in volition aspects of behavioral syndromes can be extensively analyzed using specific tests developed in virtual environments, more suitable to manipulate rules and possible breaks of the normal task execution with different, confusing or stopping instructions. The study involved thirty participants (15 OCD patients and 15 controls) during task execution and the relative interferences. At this purpose, the virtual version of Multiple Errands Test was used. Virtual reality setting, with a higher ecological validity respect to a classic neuropsychological battery, allowed us to take into account deficits of volition and the relative dysexecutive functions associated with OCD patients. The proposed paradigm also allows the development of innovative prototypes of coevolving technologies based on new theories and models and deeper understanding of human behavior.

Mafia and psychopathy.

BACKGROUND In popular culture, Mafia members are often portrayed as ruthless, callous and remorseless, but there is no empirical research on their personality traits. AIMS The goal of this research was to examine levels of psychopathic traits among Mafia members who have been convicted of a criminal offence. METHODS The Psychopathy Checklist-Revised (PCL-R) rated 30 Italian adult male prisoners who had been convicted for Mafia-related crimes (86% resident in one 6-month period) and 39 next adjacent convicted men who were not enrolled in any criminal organisation. RESULTS Mafia members obtained lower PCL-R total scores, interpersonal and affective (PCL-R factor 1) scores and lifestyle scores (factor 2) than the other offenders. Logistic regression analysis showed that lower PCL-R factor 1 scores with higher factor 2 scores in the absence of a history of substance misuse disorder distinguished Mafia from non-Mafia offenders. A probability curve confirmed an exponential growth in the probability of classification as a Mafia member in relation to lower PCL-R factor 1 scores. CONCLUSIONS Our findings bring new hope for resocialisation of convicted Mafia members, because they showed significant antisocial traits but they maintained a capacity for emotional connection and greater likelihood of engaging with training and resocialisation programmes than other imprisoned offenders in Italy.

Development of a new measure for assessing insight: Psychometric properties of the insight orientation scale (IOS)

INTRODUCTION Given the centrality of insight in promoting change, the relevance of measures for assessing this construct has become increasingly clear. This paper describes a new self-report measure for assessing some of the characteristics of insight, the insight orientation scale (IOS). AIMS In study 1, we evaluated the factor structure and the reliability of the scale. In study 2, we analyzed the concurrent and discriminant validity of the scale in patients with different clinical diagnoses. METHODS In study 1 participants were 600 individuals (41.1% male, 58.9% female) with a mean age of 33.95 years (SD = 13.04). In study 2 participants were 136 individuals divided into the following groups: 1) schizophrenia spectrum and other psychotic disorders (n = 26); 2) substance-related disorders (n = 55); 3) depressive disorders (n = 27); and 4) personality disorders (n = 28). INSTRUMENTS Instruments are the insight orientation scale (IOS) and the Beck cognitive insight scale. RESULTS The goodness-of-fit indices showed a satisfactory fit of a one factor model. We found also a good internal consistency (α = .77). CONCLUSIONS These findings support the dimensionality of the IOS and suggest that it may be useful as an assessment tool for use in guiding psychotherapy.

Interaction between cannabis consumption and childhood abuse in psychotic disorders: preliminary findings on the role of different patterns of cannabis use

Several studies have suggested that lifetime cannabis consumption and childhood abuse synergistically contribute to the risk for psychotic disorders. This study aimed to extend existing findings regarding an additive interaction between childhood abuse and lifetime cannabis use by investigating the moderating role of type and frequency of cannabis use.

Assessment of executive functions in patients with obsessive compulsive disorder by NeuroVR.

Executive functions are often impaired in obsessive-compulsive disorder (OCD). We used a Virtual Reality version of the Multiple Errand Test (VMET) - developed dusing the free NeuroVR software (http://www.neurovr.org) - to evaluate the executive functions in daily life in 10 OCD patients and 10 controls. It is performed in a shopping setting where there are items to be bought and information to be obtained. The execution time for the whole task was higher in patients with OCD compared to controls, suggesting that patients with OCD need more time in planning than controls. The same difference was found in the partial errors during the task. Furthermore, the mean rank for and for interpretation failures is higher for controls, while the values of divided attention and the of self correction seems to be lower in controls. We think that obsessive patients tend to work with greater diligence and observance of rules than controls. In conclusion, these results provide initial support for the feasibility of VMET as assessment tool of executive functions. Specifically, the significant correlation found between the VMET and the neuropsychological battery support the ecological validity of VMET as an instrument for the evaluation of executive functions in patients with OCD.

Interaction between cannabis consumption and childhood abuse in psychotic disorders

Several studies have suggested that lifetime cannabis consumption and childhood abuse synergistically contribute to the risk for psychotic disorders. This study aimed to extend existing findings regarding an additive interaction between childhood abuse and lifetime cannabis use by investigating the moderating role of type and frequency of cannabis use.

Validation of the Italian version of the Burn Specific Health Scale-Brief

INTRODUCTION A growing awareness of psychological and functional impairment due to burns have led to the development of specific instruments to evaluate Quality of Life in this population, such as the Burn Specific Health Scale - Brief (BSHS-B), whose psychometric properties have been consistently verified. The aim of this study was to translate the BSHS-B into Italian and to investigate its reliability and validity. METHODS Translation procedures were carried out according to accepted standards. Internal reliability was assessed using Cronbachs alpha coefficient. Concurrent validity was evaluated through correlations between the BSHS-B and the Short-Form 36 Health Survey (SF-36), the Self-report Clinical Inventory (SCL-90), and the Body Uneasiness Test (BUT). RESULTS The overall Cronbachs alpha value for the scale was 0.887. Significant correlations were found between the Italian BSHS-B domains, the SF-36 subscales (Spearmans rho: 0.184-0.414), and several SCL-90 subscales (Spearmans rho: -0.173 to -0.477). Furthermore, the affect and relationship domain and the skin domain of the BSHS-B negatively correlated with the compulsive self-monitoring and depersonalization subscales of the BUT. CONCLUSION The Italian translation of BSHS-B has shown satisfactory internal consistency, criterion validity, and convergent validity, supporting its application in routine clinical practice as well as in international studies.

Searching for the truth about schizophrenia requires the application of similarly high standards of proof to biological and social risk factors

In their provocative paper, Bentall and Varese (2012) criticize our review on child abuse and schizophrenia (Sideli, Mulè, La Barbera, & Murray, 2012) and suggest that we have a biological bias which causes us to apply more stringent criteria when evaluating causality in psychosocial than bio-genetic research. This critique surprises us, as of the review’s two senior authors, one (RMM) has recently coauthored a paper on a “sociodevelopmental model of schizophrenia” (Morgan, Charalambides, Hutchinson, & Murray, 2010) while the other (DLB) has a proud record in psychosocial and therapeutic aspects of psychiatry – we are hardly a troupe of hard-line reductionists! Furthermore, not only did our review recognize the significant association between child abuse and positive psychotic symptoms, but our group has also contributed to the literature on this subject (Aas et al., 2011; Fisher et al., 2009; Fisher et al., 2010; Mondelli et al., 2010; Schäfer et al., 2011; Sideli et al., in press); indeed, while complaining about our review, Bentall and Varese (2012) quote our group’s research in support of the reliability of patients’ accounts of abuse (Fisher et al., 2011). Bentall and Varese criticize us for saying that “none of the studies reported indicate that child abuse is either necessary or sufficient to develop a psychotics disorder”. They do not, however, contest this statement which is, of course, true not only for child abuse but for all putative causes of psychosis including other risk factors which our group has investigated, e.g. susceptibility genes, obstetric factors and cannabis abuse. Bentall and Varese complain that “shockingly, the Sideli review concludes that ‘the possibility cannot be excluded that a child destined to develop schizophrenia may show characteristics in childhood that increase the risk of abuse’”. In response, we would gently remind them that developmental anomalies and childhood psychopathology, which often precede schizophrenia (Welham, Isohanni, Jones, &

Cognitive thought diary in supportive psychology for people undergoing radiotherapy: a feasibility study.

BACKGROUND: Radiation therapy (RT) has become one of the most widely-used and efficient treatments for cancer; nevertheless, people who undergo radiotherapy suffer the physical and psychological consequences of this stressful treatment, in addition to the psychosocial distress related to cancer. however, a radiotherapy Unit is often a place where several patients crowd in from various hospitals with restricted timetables and, for logistic reasons, it is not easy to provide regular psychological sessions for each one. It is important to find a setting that allows us the involvement of the largest number of patients referred to the unit. in this study, we aimed to evaluate the feasibility and the effect of a brief intervention of cognitive-oriented diary on the quality of life, anxiety and depressive symptoms of patients undergoing radiotherapy (rt), compared to a control group. MethODs: the sample was constituted of 68 experimental subjects and 78 controls, treated with rt. Both groups were assessed with the toronto alexithymia scale (tas-20), the hamilton anxiety and Depression scale (haDs) and the eOrtc-QLQ at the beginning and at the end of their rt. experimental subjects were instructed to report emotions and thoughts before attending the rt sessions in a thought diary. resULts: the experimental group showed a good adherence to the diary, a reduction in mean scores of anxiety (P<0.001), depression (P<0.001), and alexithymia (P<0.001) together with an ameliorative effect on quality of life (P<0.014), compared to control group. CONCLUSIONS: We observed a reduction in alexithymia scores in the experimental group, together with a significant reduction in anxiety and depression symptoms and an improvement in quality of life, with a moderator role of social disparity in treatment adherence. Our outcomes suggest the opportunity to consider the diary an affordable and effective device for psychologists operating in rt units, able to be extended to the majority of patients, in a simple and replicable setting. (Cite this article as: Marrazzo G, Ferraro L, Meo c, sideli L, Mulè a, La cascia c, et al. cognitive thought diary in supportive psychology for people undergoing radiotherapy: a feasibility study. Minerva Psichiatr 2017;58:1-9. DOi: 10.23736/ s0391-1772.17.01916-1)