Laura Perini

Anxious ultimatums: How anxiety disorders affect socioeconomic behaviour

Although the role of emotion in socioeconomic decision making is increasingly recognised, the impact of specific emotional disorders, such as anxiety disorders, on these decisions has been surprisingly neglected. Twenty anxious patients and twenty matched controls completed a commonly used socioeconomic task (the Ultimatum Game), in which they had to accept or reject monetary offers from other players. Anxious patients accepted significantly more unfair offers than controls. We discuss the implications of these findings in light of recent models of anxiety, in particular the importance of interpersonal factors and assertiveness in an integrated model of decision making. Finally, we were able to show that pharmacological serotonin used to treat anxious symptomatology tended to normalise decision making, further confirming and extending the role of serotonin in co-operation, prosocial behaviour, and social decision making. These results show, for the first time, a different pattern of socioeconomic behaviour in anxiety disordered patients, in addition to the known memory, attentional and emotional biases that are part of this pathological condition.

Impaired configural body processing in anorexia nervosa: Evidence from the body inversion effect

Patients with anorexia nervosa (AN) suffer from severe disturbances of body perception. It is unclear, however, whether such disturbances are linked to specific alterations in the processing of body configurations with respect to the local processing of body part details. Here, we compared a consecutive sample of 12 AN patients with a group of 12 age-, gender- and education-matched controls using an inversion effect paradigm requiring the visual discrimination of upright and inverted pictures of whole bodies, faces and objects. The AN patients presented selective deficits in the discrimination of upright body stimuli, which requires configural processing. Conversely, patients and controls showed comparable abilities in the discrimination of inverted bodies, which involves only detail-based processing, and in the discrimination of both upright and inverted faces and objects. Importantly, the body inversion effect negatively correlated with the persistence scores at the Temperament and Character Inventory, which evaluates increased tendency to convert a signal of punishment into a signal of reinforcement. These results suggest that the deficits of configural processing in AN patients may be associated with their obsessive worries about body appearance and to the excessive attention to details that characterizes their general perceptual style.

White matter abnormalities in the right posterior hemisphere in generalized anxiety disorder: a diffusion imaging study

BACKGROUND Prior imaging studies have shown structural, functional and biochemical impairments in patients with generalized anxiety disorder (GAD), particularly in the right hemisphere. In this study we investigated, for the first time to the best of our knowledge, the white-matter microstructure organization in GAD. METHOD A total of 12 patients with DSM-IV GAD and 15 matched healthy controls underwent a magnetic resonance imaging session of diffusion weighted imaging, exploring white-matter water molecules by the means of apparent diffusion coefficients (ADCs). Regions of interests were placed in the frontal, parietal, temporal and occipital lobes and in the splenium and genu of the corpus callosum, bilaterally. RESULTS ADC measures were significantly greater in patients with GAD in the right splenium and right parietal cortex compared with healthy controls (p⩽0.002). No significant correlations between ADCs and age or clinical variables were found. CONCLUSIONS We provide evidence that GAD is associated with disrupted white-matter coherence of posterior right hemisphere regions, which may partly sustain the impaired cognitive regulation of anxiety. Future diffusion imaging investigations are expected to better elucidate the communication between the parietal cortex and other right hemisphere regions in sustaining the cognitive processing of social and emotional stimuli in patients with GAD.

Body Schema and Self-Representation in Patients with Bulimia Nervosa

OBJECTIVE Neuroimaging evidences in eating disorder (ED) patients document dysfunctional neural activity of the posterior parietal cortex, which is engaged in the representation of body schema. Yet a full neuropsychological investigation of body schema representation in ED patients is lacking. We examined mental imagery and body schema representation in patients with bulimia nervosa (BN) and binge eating disorder (BED). METHOD Consecutive samples of 15 BN patients and 15 BED patients were compared with two groups of 15 age-matched controls in tasks requiring body or object mental transformation. RESULTS BN, but not BED patients, were selectively impaired in the mental transformation of their own body, although this deficit was not correlated with measures of body dissatisfaction. In contrast, no patient group was impaired in the mental transformation of external objects. DISCUSSION Results showed altered self-body representation in BN, but not BED patients, as the neuropsychological consequences of posterior parietal cortex dysfunctions.

Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study.

The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account.

La clinica, i limiti, i confini : L'onorario : un elemento del setting in psicoanalisi : il caso di una adolescente in psicoterapia psicoanalitica pro bono

In questo articolo e esaminata la situazione della psicoterapia psicoanalitica effettuata in regime di gratuita. Quando, per ragioni economiche, ci si trova a cambiare il setting di lavoro, introducendo una modificazione che esclude il pagamento, possono verificarsi delle variazioni del rapporto paziente/ terapeuta che possono anche aiutare lo sviluppo della persona e delle sue relazioni con gli oggetti interni. Il lavoro si apre con una disamina delle esperienze presenti in letteratura di terapie gratuite, delle cause che possono muovere a lavorare gratuitamente e ai pericoli insiti in esso e segue con una esemplificazione clinica di psicoterapia psicoanalitica effettuata a una adolescente, la cui madre, per ragioni intrinseche al suo rapporto con la figlia, decide di interrompere il pagamento delle sedute.