Mauro Pallagrosi - Academia.edu (original) (raw)
Uploads
Papers by Mauro Pallagrosi
The Clinician in the Psychiatric Diagnostic Process, 2022
The Clinician in the Psychiatric Diagnostic Process, 2022
Psychopathology, 2014
While psychiatric literature has shown renewed interest in fine psychopathological investigation,... more While psychiatric literature has shown renewed interest in fine psychopathological investigation, little study has been devoted to the clinician's subjective experience with the patient, which is highly valued by the phenomenological and psychodynamic traditions. We aimed at developing a valid and reliable instrument to measure such experience. First, 104 self-report items were developed, based on daily clinical practice and references from the literature on clinician's subjective experience. Of these, 46 were retained after pilot testing and exclusion of items with poor psychometric properties. Thirteen psychiatrists and 527 first-contact patients participated in the validation study. Psychiatrists completed the 'Assessment of Clinician's Subjective Experience' (ACSE) instrument and the Brief Psychiatric Rating Scale (BPRS) after the visit and the Profile of Mood State (POMS) before and after it. The ACSE was completed again for 60 patients with stable BPRS scores over a short retest interval. Principal component analysis with orthogonal rotation was performed. The internal consistency and test-retest stability of ACSE factorially derived scales were calculated. Convergent validity was tested by examining the correlations between ACSE scores and change in POMS scores during the visit. Five factors (interpreted as tension, difficulty of attunement, engagement, disconfirmation, impotence) accounting for 57% of total variance were extracted. All ACSE scales showed high internal consistency and stability, and correlated with conceptually related POMS scales. The pattern of subjective experience identified by the ACSE is consistent with classical psychopathological descriptions and previous related studies. Despite limitations such as the relatively small number of psychiatrists studied and the exclusively self-report nature of the instrument, this study supports the validity and reliability of the ACSE and suggests that it may be a valuable tool for training, research and possibly diagnostic purposes.
Clinical Practice & Epidemiology in Mental Health
Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and t... more Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and treatment. A few factors have been recognized that affect it, such as the patient’s personality, the severity of psychopathology, and diagnosis. Other factors, such as patient’s and clinician’s gender, have not been specifically investigated. The aim of this study is to explore the impact of gender differences on the clinician’s subjective experience in a large sample of psychiatric patients. Methods: The study involved 61 psychiatrists and 960 patients attending several inpatient and outpatient psychiatric settings. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire after observing each patient for the first time. Results: In multivariate analysis, higher scores on the Difficulty in Attunement (p < 0.001), Engagement (p<0.05), and Impotence (p<0.01) scales were significantly associated with female clinician gender, whereas highe...
Phenomenology and The Cognitive Sciences, 2021
This chapter discusses the question of temporality from a phenomenological point of view, in whic... more This chapter discusses the question of temporality from a phenomenological point of view, in which the experience of lived time is regarded as a core feature of various manifestations of mental illness. The modern and widespread categorical nosology in psychiatry tends to segment a person into different behavioural criteria, whilst lacking a holistic comprehension of the person. Dimensional psychopathology offers a less anatomic vision of the patient; however, a phenomenological approach, beneficially integrated, could achieve a deeper understanding of the structural aspects of various mental disorders and maximise the efficacy of therapeutic intervention.
![Research paper thumbnail of [Experience of group art therapy with music improvisation in the integrated treatment at a psychiatric Day Hospital: preliminary results]](https://attachments.academia-assets.com/79246206/thumbnails/1.jpg)
](AIM The study aims at evaluating the resocializing effects of music therapy as add-on therapy in ... more AIM The study aims at evaluating the resocializing effects of music therapy as add-on therapy in the course of integrated, pharmacological and psychological, treatment. METHODS During a six months period, 24 patients belonging to a psychiatric Day Hospital were recruited and divided into 2 groups. An accurate music anamnesis was collected for each patient. Group 1 (n=11) received as add-on therapy 14 improvisational music therapy sessions on a weekly basis, while group 2 (n=13) received 7 improvisational music therapy sessions alternated with 7 listening music therapy sessions, on a weekly basis. The response to music therapy was evaluated at the beginning and at the end of the add-on therapeutic process through a music therapy observation form consisting of 9 variables. RESULTS In both groups there was a good response from patients affected by mood disorders as well as obsessive-compulsive disorder, while schizophrenic patients response was either absent or reduced. The improvement...
Psychopathology
Introduction: The last decade has witnessed a resurgence of interest in the clinician’s subjectiv... more Introduction: The last decade has witnessed a resurgence of interest in the clinician’s subjectivity and its role in the diagnostic assessment. Integrating the criteriological, third-person approach to patient evaluation and psychiatric diagnosis with other approaches that take into account the patient’s subjective and intersubjective experience may bear particular importance in the assessment of very young patients. The ACSE (Assessment of Clinician’s Subjective Experience) instrument may provide a practical way to probe the intersubjective field of the clinical examination; however, its reliability and validity in child and adolescent psychiatrists seeing very young patients is still to be determined. Methods: Thirty-three clinicians and 278 first-contact patients aged 12–17 years participated in this study. The clinicians completed the ACSE instrument and the Brief Psychiatric Rating Scale after seeing the patient, and the Profile of Mood State (POMS) just before seeing the patie...
Clinical Practice & Epidemiology in Mental Health
Background: A link between depression and insecure attachment has long been postulated. Although ... more Background: A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce. Objective: We aimed at testing the association between attachment insecurity and unipolar and bipolar depression. Methods: We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style. Results: Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Als...
Psychopathology
Despite the development and widespread diffusion of modern nosographic systems, the diagnosis of ... more Despite the development and widespread diffusion of modern nosographic systems, the diagnosis of schizophrenia continues to raise several epistemological issues. To address these issues, a number of researchers are currently pursuing the possibility of an integration between reliable, objective approaches and the intersubjective perspective in the clinical encounter. In the present article, we discuss Rümke's popular concept of praecox feeling, as introduced in 1941 and re-elaborated over the following 20 years. Our aim was to thoroughly analyze the author's original formulation and to identify the connections between his thinking and certain psychopathological developments, epistemological issues, and research perspectives on schizophrenia. The praecox feeling is presented by Rümke as a sensitive diagnostic tool for schizophrenia that is rooted in the peculiar subjective experience of the clinician when encountering a schizophrenic patient. This experience seems to be characterized by two essential dimensions: a subjective one, which reflects the failure of a clinician's empathic effort due to a fundamental alteration of the intersubjective space, a phenomenon related to schizophrenic autism, and a gestaltic, objective one, which is grounded in the clinician's implicit typifying process as a consequence of collecting recurrent clinical observations over the course of his/her professional experience. According to Rümke, the diagnostic use of the praecox feeling should be limited to the acute phases of the schizophrenic process, as the clinician's experience of an intersubjective struggle is attenuated in interactions with older, chronic patients. The multifaceted nature of Rümke's proposal seems to have contributed to some theoretical critiques and to inconclusive results from empirical investigations, leading to a progressive devaluation of the scientific and diagnostic validity of praecox feeling. The present analysis of the original concept suggests that a renewed research interest in the role of the clinician's subjective experience with regard to the schizophrenic patient could be helpful.
Research in Psychotherapy: Psychopathology, Process and Outcome
The present study aimed at examining the associations between specific elements of the therapeuti... more The present study aimed at examining the associations between specific elements of the therapeutic relationship and Short-Term Psychodynamic Psychotherapy (STPP) outcome. Notably, it focused on countertransference patterns and the quality of the therapeutic alliance evaluated early in treatment, as well as therapists’ subjective experiences in their first clinical interaction with patients, in relation to their symptom changes at the end of STPP. Twenty clinicians completed the Comprehensive Psychopathological Rating Scale to evaluate patients (N = 32)’ symptom severity at the beginning and end of STPP. They also completed the Assessment of Clinicians’ Subjective Experience (ACSE) to assess their subjective experiences of their patients at the first clinical assessment, as well as the Therapist Response Questionnaire (TRQ) and Working Alliance Inventory to evaluate their countertransference reactions and the therapeutic alliance at the sixth therapy sessions. The findings showed tha...
Frontiers in Psychiatry
Autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share clinical and gen... more Autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share clinical and genetic components that have long been recognized. The two disorders co-occur more frequently than would be predicted by their respective prevalence, suggesting that a complex, multifactor association is involved. However, DSM-5 maintains the distinction between ASD, with core social and communication impairments, and SSD, including schizophrenia (SCZ), with hallucinations, delusions, and thought disorder as essential features. ASD and SSD have common biological underpinnings that may emerge early in development and unfold over time. One of the hypotheses supporting the similarities in the social and cognitive disturbances of ASD and SSD relates to abnormalities in the ratio of excitatory to inhibitory cortical activity (E/I imbalance). E/I imbalance in neurodevelopmental disorders could be the consequence of abnormalities in genes coding for glutamatergic and GABAergic receptors or synaptic proteins followed by system derangements. SSD and ASD have been characterized as polygenic disorders in which to the onset and progression of disease is triggered by interactions among multiple genes. Mammalian target of rapamycin signaling is under intense investigation as a convergent altered pathway in the two spectrum disorders. Current understanding of shared and divergent patterns between ASD and SSD from molecular to clinical aspects is still incomplete and may be implemented by the research domain criteria approach.
The Clinician in the Psychiatric Diagnostic Process, 2022
The Clinician in the Psychiatric Diagnostic Process, 2022
Psychopathology, 2014
While psychiatric literature has shown renewed interest in fine psychopathological investigation,... more While psychiatric literature has shown renewed interest in fine psychopathological investigation, little study has been devoted to the clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s subjective experience with the patient, which is highly valued by the phenomenological and psychodynamic traditions. We aimed at developing a valid and reliable instrument to measure such experience. First, 104 self-report items were developed, based on daily clinical practice and references from the literature on clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s subjective experience. Of these, 46 were retained after pilot testing and exclusion of items with poor psychometric properties. Thirteen psychiatrists and 527 first-contact patients participated in the validation study. Psychiatrists completed the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Assessment of Clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Subjective Experience&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (ACSE) instrument and the Brief Psychiatric Rating Scale (BPRS) after the visit and the Profile of Mood State (POMS) before and after it. The ACSE was completed again for 60 patients with stable BPRS scores over a short retest interval. Principal component analysis with orthogonal rotation was performed. The internal consistency and test-retest stability of ACSE factorially derived scales were calculated. Convergent validity was tested by examining the correlations between ACSE scores and change in POMS scores during the visit. Five factors (interpreted as tension, difficulty of attunement, engagement, disconfirmation, impotence) accounting for 57% of total variance were extracted. All ACSE scales showed high internal consistency and stability, and correlated with conceptually related POMS scales. The pattern of subjective experience identified by the ACSE is consistent with classical psychopathological descriptions and previous related studies. Despite limitations such as the relatively small number of psychiatrists studied and the exclusively self-report nature of the instrument, this study supports the validity and reliability of the ACSE and suggests that it may be a valuable tool for training, research and possibly diagnostic purposes.
Clinical Practice & Epidemiology in Mental Health
Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and t... more Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and treatment. A few factors have been recognized that affect it, such as the patient’s personality, the severity of psychopathology, and diagnosis. Other factors, such as patient’s and clinician’s gender, have not been specifically investigated. The aim of this study is to explore the impact of gender differences on the clinician’s subjective experience in a large sample of psychiatric patients. Methods: The study involved 61 psychiatrists and 960 patients attending several inpatient and outpatient psychiatric settings. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire after observing each patient for the first time. Results: In multivariate analysis, higher scores on the Difficulty in Attunement (p < 0.001), Engagement (p<0.05), and Impotence (p<0.01) scales were significantly associated with female clinician gender, whereas highe...
Phenomenology and The Cognitive Sciences, 2021
This chapter discusses the question of temporality from a phenomenological point of view, in whic... more This chapter discusses the question of temporality from a phenomenological point of view, in which the experience of lived time is regarded as a core feature of various manifestations of mental illness. The modern and widespread categorical nosology in psychiatry tends to segment a person into different behavioural criteria, whilst lacking a holistic comprehension of the person. Dimensional psychopathology offers a less anatomic vision of the patient; however, a phenomenological approach, beneficially integrated, could achieve a deeper understanding of the structural aspects of various mental disorders and maximise the efficacy of therapeutic intervention.
AIM The study aims at evaluating the resocializing effects of music therapy as add-on therapy in ... more AIM The study aims at evaluating the resocializing effects of music therapy as add-on therapy in the course of integrated, pharmacological and psychological, treatment. METHODS During a six months period, 24 patients belonging to a psychiatric Day Hospital were recruited and divided into 2 groups. An accurate music anamnesis was collected for each patient. Group 1 (n=11) received as add-on therapy 14 improvisational music therapy sessions on a weekly basis, while group 2 (n=13) received 7 improvisational music therapy sessions alternated with 7 listening music therapy sessions, on a weekly basis. The response to music therapy was evaluated at the beginning and at the end of the add-on therapeutic process through a music therapy observation form consisting of 9 variables. RESULTS In both groups there was a good response from patients affected by mood disorders as well as obsessive-compulsive disorder, while schizophrenic patients response was either absent or reduced. The improvement...
Psychopathology
Introduction: The last decade has witnessed a resurgence of interest in the clinician’s subjectiv... more Introduction: The last decade has witnessed a resurgence of interest in the clinician’s subjectivity and its role in the diagnostic assessment. Integrating the criteriological, third-person approach to patient evaluation and psychiatric diagnosis with other approaches that take into account the patient’s subjective and intersubjective experience may bear particular importance in the assessment of very young patients. The ACSE (Assessment of Clinician’s Subjective Experience) instrument may provide a practical way to probe the intersubjective field of the clinical examination; however, its reliability and validity in child and adolescent psychiatrists seeing very young patients is still to be determined. Methods: Thirty-three clinicians and 278 first-contact patients aged 12–17 years participated in this study. The clinicians completed the ACSE instrument and the Brief Psychiatric Rating Scale after seeing the patient, and the Profile of Mood State (POMS) just before seeing the patie...
Clinical Practice & Epidemiology in Mental Health
Background: A link between depression and insecure attachment has long been postulated. Although ... more Background: A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce. Objective: We aimed at testing the association between attachment insecurity and unipolar and bipolar depression. Methods: We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style. Results: Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Als...
Psychopathology
Despite the development and widespread diffusion of modern nosographic systems, the diagnosis of ... more Despite the development and widespread diffusion of modern nosographic systems, the diagnosis of schizophrenia continues to raise several epistemological issues. To address these issues, a number of researchers are currently pursuing the possibility of an integration between reliable, objective approaches and the intersubjective perspective in the clinical encounter. In the present article, we discuss Rümke's popular concept of praecox feeling, as introduced in 1941 and re-elaborated over the following 20 years. Our aim was to thoroughly analyze the author's original formulation and to identify the connections between his thinking and certain psychopathological developments, epistemological issues, and research perspectives on schizophrenia. The praecox feeling is presented by Rümke as a sensitive diagnostic tool for schizophrenia that is rooted in the peculiar subjective experience of the clinician when encountering a schizophrenic patient. This experience seems to be characterized by two essential dimensions: a subjective one, which reflects the failure of a clinician's empathic effort due to a fundamental alteration of the intersubjective space, a phenomenon related to schizophrenic autism, and a gestaltic, objective one, which is grounded in the clinician's implicit typifying process as a consequence of collecting recurrent clinical observations over the course of his/her professional experience. According to Rümke, the diagnostic use of the praecox feeling should be limited to the acute phases of the schizophrenic process, as the clinician's experience of an intersubjective struggle is attenuated in interactions with older, chronic patients. The multifaceted nature of Rümke's proposal seems to have contributed to some theoretical critiques and to inconclusive results from empirical investigations, leading to a progressive devaluation of the scientific and diagnostic validity of praecox feeling. The present analysis of the original concept suggests that a renewed research interest in the role of the clinician's subjective experience with regard to the schizophrenic patient could be helpful.
Research in Psychotherapy: Psychopathology, Process and Outcome
The present study aimed at examining the associations between specific elements of the therapeuti... more The present study aimed at examining the associations between specific elements of the therapeutic relationship and Short-Term Psychodynamic Psychotherapy (STPP) outcome. Notably, it focused on countertransference patterns and the quality of the therapeutic alliance evaluated early in treatment, as well as therapists’ subjective experiences in their first clinical interaction with patients, in relation to their symptom changes at the end of STPP. Twenty clinicians completed the Comprehensive Psychopathological Rating Scale to evaluate patients (N = 32)’ symptom severity at the beginning and end of STPP. They also completed the Assessment of Clinicians’ Subjective Experience (ACSE) to assess their subjective experiences of their patients at the first clinical assessment, as well as the Therapist Response Questionnaire (TRQ) and Working Alliance Inventory to evaluate their countertransference reactions and the therapeutic alliance at the sixth therapy sessions. The findings showed tha...
Frontiers in Psychiatry
Autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share clinical and gen... more Autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share clinical and genetic components that have long been recognized. The two disorders co-occur more frequently than would be predicted by their respective prevalence, suggesting that a complex, multifactor association is involved. However, DSM-5 maintains the distinction between ASD, with core social and communication impairments, and SSD, including schizophrenia (SCZ), with hallucinations, delusions, and thought disorder as essential features. ASD and SSD have common biological underpinnings that may emerge early in development and unfold over time. One of the hypotheses supporting the similarities in the social and cognitive disturbances of ASD and SSD relates to abnormalities in the ratio of excitatory to inhibitory cortical activity (E/I imbalance). E/I imbalance in neurodevelopmental disorders could be the consequence of abnormalities in genes coding for glutamatergic and GABAergic receptors or synaptic proteins followed by system derangements. SSD and ASD have been characterized as polygenic disorders in which to the onset and progression of disease is triggered by interactions among multiple genes. Mammalian target of rapamycin signaling is under intense investigation as a convergent altered pathway in the two spectrum disorders. Current understanding of shared and divergent patterns between ASD and SSD from molecular to clinical aspects is still incomplete and may be implemented by the research domain criteria approach.