Raffaele Sperandeo

Insight and Resistance in Patients with Obsessive-Compulsive Disorder

The aim of this study was to evaluate the degree of insight and resistance in a sample of obsessive-compulsive patients, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). Ninety-three patients fulfilling DSM-IV criteria for obsessive-compulsive disorder were evaluated. Seventy patients were treated with an SRI in a 24-week open-label trial. Sixteen percent of the patients did not recognize obsessions and compulsions as unreasonable or senseless. Fifty-two percent of the patients did not try to resist, 72% had little or no control over obsessions, and 64% were not able to exercise an effective control over compulsions. Patients with poor insight had a greater severity of obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives and a higher frequency of a history of psychiatric disorders during childhood. Fifty-two percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight were found to be responders. These results suggest the utility of the assessment of insight and resistance in obsessive-compulsive patients, also for the prediction of response to treatment with SRIs.

Dissociative phenomena in a sample of outpatients

AIM The study describes the frequency and the quality of dissociative phenomena and their relationship with axis I disorders and the psychopathological severity in outpatients. METHODS The sample (N=383) was subjected to MINI diagnostic interview and self-assessment scales DES and SCL-90. The data were analysed using SPSS. RESULTS The 11,0% of subjects has a score ≥20 on DES. The 5,2% has no dissociative symptoms. The absorption images is the most frequent dissociative phenomenon, the less common is the dissociation amnesia. A relationship between dissociative phenomena and conditions unemployment, marital separation and single parties and an inverse relationship with age founded. Dissociative phenomena are more frequent in participants who have been diagnosed at least one axis I disorder and their severity is positively correlated with the number of diagnosed diseases and scores to the General Symptomatic Index. DISCUSSION Our results point towards the existence of three types of dissociative experiences. The first type, represented by the factor absorption/imaginative involvement, is expressed along a continuum from normal to pathological; a second type, represented by the factor depersonalization/derealization, occurs in a significantly more intense and specific among subjects with axis I disorders; the latest manifestation dissociative, described by the dissociation amnesia, seems to have a predominantly typological feature that qualifies it as an experience not commonly distributed in the general population. The identifying of dissociative symptoms is necessary for the psychopathologic evaluation and to improve the effectiveness of treatment programs.

A dimensional approach to personality disorders in a sample of juvenile offenders

En una muestra compuesta por 60 sujetos italianos de sexo masculino encarcelados en un instituto correccional para jovenes (ICJ), se hizo la descripcion de los aspectos psicopatologicos de los trastornos de personalidad (AXIS II) y se examino la validez del abordaje dimensional psicopatologico para describir las cuestiones criminologicas. Los datos demuestran que la muestra tiene caracteristicas psicopatologicas que giran alrededor de la debilidad del ego y de gestion deficiente de las relaciones y de la agresion. Estadisticamente, esas caracteristicas psicopatologicas explican el 85% del comportamiento criminal.

A Non-linear Predictive Model of Borderline Personality Disorder Based on Multilayer Perceptron

Borderline Personality Disorder is a serious mental disease, classified in Cluster B of DSM IV-TR personality disorders. People with this syndrome presents an anamnesis of traumatic experiences and shows dissociative symptoms. Since not all subjects who have been victims of trauma develop a Borderline Personality Disorder, the emergence of this serious disease seems to have the fragility of character as a predisposing condition. Infect, numerous studies show that subjects positive for diagnosis of Borderline Personality Disorder had scores extremely high or extremely low to some temperamental dimensions (harm Avoidance and reward dependence) and character dimensions (cooperativeness and self directedness). In a sample of 602 subjects, who have had consecutive access to an Outpatient Mental Health Service, it was evaluated the presence of Borderline Personality Disorder using the semi-structured interview for the DSM IV-TR personality disorders. In this population we assessed the presence of dissociative symptoms with the Dissociative Experiences Scale and the personality traits with the Temperament and Character Inventory developed by Cloninger. To assess the weight and the predictive value of these psychopathological dimensions in relation to the Borderline Personality Disorder diagnosis, a neural network statistical model called “multilayer perceptron,” was implemented. This model was developed with a dichotomous dependent variable, consisting in the presence or absence of the diagnosis of borderline personality disorder and with five covariates. The first one is the taxonomic subscale of dissociative experience scale, the others are temperamental and characterial traits: Novelty-Seeking, Harm-Avoidance, Self-Directedness and Cooperativeness. The statistical model, that results satisfactory, showed a significance capacity (89%) to predict the presence of borderline personality disorder. Furthermore, the dissociative symptoms seem to have a greater influence than the character traits in the borderline personality disorder e disease. In conclusion, the results seem to indicate that to borderline personality disorder development, contribute both psychic factors, such as temperament and character traits, and environmental factors, such as traumatic events capable of producing dissociative symptoms. These factors interact in a nonlinear way in producing maladaptive behaviors typical of this disorder.

Does Neuroeconomics Really Need the Brain

The systematic study of biological basis of behavior and of the process involved in economical choices has outlined a new paradigm of research: neuroeconomics. Now the intersection between neuroscience, psychology and economics, neuroeconomics presents itself as an alternative to the neoclassical vision on economics, according to which the homo oeconomicus acts within the bonds of a formalizing rationality tending to the maximization of the anticipated utility. Brain imagining methods have shown that the decision-making processes activate the frontal lobe and the limbic system above all, a big circonvolution running through the callous body on the medial surface of the hemispheres, extending itself down, responsible for the regulation of emotional phenomena. Reinforcing such a tendency, we find the injury paradigm. It was observed that frontal lobe injuries harm the capacity of making advantageous decisions either in one’s own behalf or in others, as well as decisions according to the social conventions. In this paper, we will try to show that if, by the one hand, the neuro visual methods have given us a great amount of data, on the other hand, using them uncritically, with the recurrent confusion between “correlation” and “causal relation”—contemporary microevents indicate only simple correlations, and no cause-effect relation—risks to stress the relevant explanatory gap regarding the abstract ideal of understanding the nature of the brain.

Does Brain Sweat Pay Off?: The Association between the Need for Cognition and Cognitive Function among the American Elderly

Background: The global incidence of impaired cognition increases with the overall aging of the population. Regarding prophylactic measures, it is unclear whether engaging in cognitively-stimulating activities can decrease the risk of cognitive impairment. Objective: To determine the association between Need for Cognition and cognitive ability within a representative mirroring sample of the elderly population in the United States. Methods: We evaluated the association between Need for Cognition (measured through cognitive effort and enjoyment scores) as a predictor and neurocognitive scores (number series, concept formation, calculations, word attack, picture vocabulary, auditory working memory and similarities) as outcomes using the CogUSA dataset. Results: A total of 1,174 participants of at least 64 years of age were part of this analysis. Participants attending college (49.4%) presented higher cognitive effort and enjoyment scores. The findings demonstrate a two-factor structure, the first related to neurocognitive tests and the second related to need for cognition, with good factor loadings. Conclusion: Need for Cognition and neurocognitive ability is strongly correlated and could perhaps be constructed as a single factor. Future research should focus on assessing the relationship between the Need for Cognition and cognitive function in the context of a multitude of other factors, thus determining the contribution of individual factors under different circumstances.

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

Background: Although positive benefits are associated with shared decision making, no previous studies have evaluated the impact of condition on how shared decision making is implemented. Objective: To compare decision-making preferences across three conditions associated with screening, medical treatment, and invasive interventions: Screening tests for colorectal cancer, initiation of prescription medication for hypertension, and surgical treatment for hip or knee osteoarthritis. Methods: We made use of the publicly available National Survey of Medical Decisions (the DECISIONS study) data and our sample comprised of all subjects who completed the following three specific modules of the decisions study: Colorectal cancerscreening tests, high blood-pressure medication, and knee or hip replacement surgery. Our primary outcomes of interest were (1) Who made the final decision? (2) Extent of patients’ involvement in the decision, and (3) How confident they were about their decision. Results: When comparing baseline characteristics across the three conditions, the group undergoing screening was youngest with a mean age of 58.7 years compared to the medication group (61.27 years), while the group undergoing surgery was oldest (63.14 years). Females constituted over half of all three groups (greater than 50%). In the invasive interventions, decisions were made mainly by the patients, unlike the other groups where shared decision making was predominant. Most patients in all three groups preferred high levels of participation in decision making. Patients undergoing surgery were significantly more likely to have greater confidence in their decisions, followed by patients with medication for hypertension. Conclusion: Shared decision making is less predominant among invasive interventions. Further research should describe the reasons for the limited use of shared decisions among conditions with invasive interventions, along with its consequences for healthcare quality.

The Relationship Between Personality and Neurocognition Among the American Elderly: An Epidemiologic Study

Background: Although different personality traits have often been associated with different levels of mental activity and cognitive functioning, no previous studies have evaluated the association in a sample that mirrors a nationally-representative sample of elderly individuals. Objective: To evaluate the association between personality traits and neurocognitive functioning among individuals 51 years and older using the Cognition and Aging in the USA (CogUSA) database. Methods: We analyzed the association between personality traits and neurocognitive scores derived from Waves I and II of the study. Neurocognitive functions were modeled as an outcome variable using the Big Five Personality Traits as predictors. Results: All personality traits were associated with higher education except Conscientiousness. Older age was associated with higher levels of the Agreeableness and Openness traits. Extraversion, Conscientiousness and Openness were positively associated with increased neurocognitive function and self-rated present memory. Extraversion and Openness also had a positive association with long-term retrieval. Agreeableness was negatively associated with several neurocognitive functions, while Neuroticism was negatively associated with memory and cognitive effort. Conclusion: Extraversion, Conscientiousness and Openness personality traits are associated with good cognitive health. Individuals scoring high in Neuroticism and Agreeableness might benefit from tailored cognitive interventions to prevent age-related cognitive decline.

Uma abordagem dimensional a distúrbios de personalidade em uma amostra de menores infratores

En una muestra compuesta por 60 sujetos italianos de sexo masculino encarcelados en un instituto correccional para jovenes (ICJ), se hizo la descripcion de los aspectos psicopatologicos de los trastornos de personalidad (AXIS II) y se examino la validez del abordaje dimensional psicopatologico para describir las cuestiones criminologicas. Los datos demuestran que la muestra tiene caracteristicas psicopatologicas que giran alrededor de la debilidad del ego y de gestion deficiente de las relaciones y de la agresion. Estadisticamente, esas caracteristicas psicopatologicas explican el 85% del comportamiento criminal.