Chiara De Panfilis | Università degli Studi di Parma (Italy) (original) (raw)
Papers by Chiara De Panfilis
International Journal of Social Psychiatry, Jul 5, 2010
Background and Aims: Few naturalistic studies have examined the course of borderline personality ... more Background and Aims: Few naturalistic studies have examined the course of borderline personality disorder (BPD) outside North American countries. The aim of this prospective study was to investigate remission rate, changes in the level of BPD psychopathology and outcome prediction in a sample ( n = 46) of Italian BPD outpatients over a two-year follow-up.Method: Two years after baseline, remission rate from BPD and changes in the severity of BPD psychopathology were investigated. Initial measures of borderline, comorbid Axis I and II psychopathology and clinical severity, as well as historical and socio-demographic variables, were used to predict the number of BPD criteria met at follow-up.Results: At the two-year interview, the mean number of BPD criteria endorsed decreased ( p = 0.04) and 12 participants (26.1%) fell below the diagnostic threshold for BPD. Borderline psychopathology at follow-up was predicted by the presence, at baseline, of substance use disorders and self-defeating personality traits, and by the absence of dependent traits ( R2= 0.409; p < 0.001). However, these results cannot be generalized to patients lost to follow-up (15 out of an initial sample of 61), who may exhibit a more severe psychopathology at baseline and therefore a poorer prognosis. Conclusions: Borderline individuals seeking treatment at Italian public psychiatric centres may show some improvement in BPD psychopathology over a two-year follow-up; however, the remission rate seems to be lower than that found in North American samples. Furthermore, outcome predictors overlap only partially with those detected by North American studies.
Neuroscience applied, 2022
European Psychiatry, 2014
Introduction: While several theoretical models imply that personality disorders (PD) show an alte... more Introduction: While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial. Objectives: investigating whether alexithymia is associated with PD regardless of psychopathology severity. Aims: 1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction. Methods: 167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects. Results: At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57). Conclusions: The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.
European Psychiatry, Mar 1, 2016
IntroductionDepression is an established risk factor for acute coronary syndrome (ACS), nonethele... more IntroductionDepression is an established risk factor for acute coronary syndrome (ACS), nonetheless the mechanisms underlying this association are still unclear and literature disagrees on the role played by anxiety. Moreover, most of the studies included subjects with a long lasting history of heart disease or recurrent depressive episodes that could bias the results.ObjectivesWe performed serial assessments of anxiety, depression and new cardiac events in a cohort of never-depressed patients in the two years after their first ACS.AimsClarify the role of anxiety and depression in predicting new cardiac events.MethodsTwo hundred and fifty-one consecutive patients completed the two-years follow-up. The presence of depression was evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and its severity with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected at baseline, when GRACE-score was calculated, and at 1, 2, 4, 6, 9, 12 and 24-months follow-ups.ResultsForty-two patients (16.7%) developed a second cardiac event and, of these, eighteen (42.9%) had a previous depressive episode. At Cox Regression, controlling for confounding clinical variables (e.g. GRACE-score), developing a first-ever depressive episode was a significant risk factor (OR = 2.38; 95%CI = 1.11–5.14; P = 0.027) whereas baseline anxiety was protective (OR = 0.56; 95%CI = 0.38–0.81; P= 0.002). The latter, moreover, moderated the effect of incident depression on new cardiac events.ConclusionOur results confirm the well-established detrimental effect of depression on cardiac prognosis and suggest clinicians to keep in mind anxious symptoms when facing a patient at his/her first ACS.Disclosure of interestThe authors have not supplied their declaration of competing interest.
American Journal of Psychotherapy
Assessment
The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on... more The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pa...
![Research paper thumbnail of The “Healthcare Workers’ Wellbeing [Benessere Operatori]” Project: A Longitudinal Evaluation of Psychological Responses of Italian Healthcare Workers during the COVID-19 Pandemic](https://attachments.academia-assets.com/120273370/thumbnails/1.jpg)
](Journal of Clinical Medicine
Background: COVID-19 forced healthcare workers to work in unprecedented and critical circumstance... more Background: COVID-19 forced healthcare workers to work in unprecedented and critical circumstances, exacerbating already-problematic and stressful working conditions. The “Healthcare workers’ wellbeing (Benessere Operatori)” project aimed at identifying psychological and personal factors, influencing individuals’ responses to the COVID-19 pandemic. Methods: 291 healthcare workers took part in the project by answering an online questionnaire twice (after the first wave of COVID-19 and during the second wave) and completing questions on socio-demographic and work-related information, the Depression Anxiety Stress Scale-21, the Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait Anger Expression Inventory-2, the Maslach Burnout Inventory, the Multidimensional Scale of Perceived Social Support, and the Brief Cope. Results: Higher levels of worry, worse working conditions, a previous history of psychiatric illness, being a nurse, older age, and avoidant and emotio...
International Journal of Environmental Research and Public Health, 2021
During the last year, the COVID-19 outbreak put all the healthcare workers around the world at ri... more During the last year, the COVID-19 outbreak put all the healthcare workers around the world at risk of physical and psychological sequelae. The general purpose of the present study was to assess the mental health of Italian healthcare workers during the COVID-19 outbreak and to identify high-risk groups. Here, we present results from the baseline assessment of the “Healthcare workers’ wellbeing (Benessere Operatori)” project on a sample of 1055 healthcare workers. Participants completed the Depression Anxiety Stress Scale-21, the Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait Anger Expression Inventory-2, and the Maslach Burnout Inventory. Healthcare workers who worked in COVID wards reported higher levels of anxiety, insomnia, post-traumatic stress, anger, and burnout, compared to those reported by the healthcare workers who worked in non-COVID wards. Moreover, nurses, both in COVID and non-COVID wards, were at higher risk of experiencing psychological ...
Psychiatry Research, 2021
Apparent comorbidity between Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) is a c... more Apparent comorbidity between Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) is a common condition, but its meaning has not been clarified yet. The present study aimed to evaluate the pattern of occurrence of obsessive-compulsive symptoms (OCS) in the different phases of BD. One hundred and sixty-five BD patients, 62 (37.5%) euthymic, 34 (20.6%) in hypomanic/manic phase, 43 (26%) in depressive phase and 26 (15.7%) in mixed state, were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Ruminative Response Scale (RRS). In the whole sample, the severity of OCS was associated to the severity of depressive symptoms. The highest severity of OCS (YBOCS total score) was observed in the mixed group and the lowest scores in the hypomanic/manic group. Our findings suggest that OCS in BD patients appear as a state-dependent phenomenon cycling with the mood phases, particularly exacerbating in the context of depressive and mixed states.
European Neuropsychopharmacology, 2018
European Psychiatry, 2017
ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functio... more ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptom (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.MethodSeventy-five patients affected by schizophrenia were administered the SCID-IV, the PANSS, the YBOCS and the SOFAS.The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high).ResultsIn both groups, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at higher levels of disorganization (Figure 1).ConclusionData suggest that in pati...
Journal of personality assessment, Jan 7, 2017
This article demonstrates the utility of a theory-guided psychodynamic approach to the assessment... more This article demonstrates the utility of a theory-guided psychodynamic approach to the assessment of personality and personality pathology based on the object relations model developed by Kernberg (1984). We describe a clinical interview, the Structural Interview (SI; Kernberg, 1984), and also a semistructured approach, the Structured Interview of Personality Organization (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004) based on this theoretical model. Both interviews focus on the assessment of consolidated identity versus identity disturbance, the use of adaptive versus lower level defensive operations, and intact versus loss of reality testing. In the context of a more clinically oriented assessment, the SI makes use of tactful confrontation of discrepancies and contradictions in the patient's narrative, and also takes into account transference and countertransference phenomena, whereas the more structured approach of the STIPO incorporates clinical judgment informed by clin...
European Psychiatry, 2016
IntroductionRecent studies have underlined the importance of considering the form of thoughts, be... more IntroductionRecent studies have underlined the importance of considering the form of thoughts, beyond their content, in order to achieve a better phenomenological comprehension of mental states in mood disorders. The subjective experience of thought overactivation is an important feature of mood disorders that could help in identifying, among patients with a depressive episode, those who belong to the bipolar spectrum.ObjectivesPatients with a diagnosis of bipolar disorder (BD) were compared with matched healthy controls (HC) on a scale that evaluates thought overactivation.AimsValidate the Italian version of a scale for thought overactivation (i.e. STOQ) in a sample of bipolar patients.MethodsThirty euthymic BD and 30 HC completed the Subjective Thought Overactivation Questionnaire (STOQ), the Ruminative Responses Scale (RRS), the Beck Depression Inventory-II (BDI-II) and global functioning (VGF).ResultsThe 9-items version of the STOQ has been back translated and its internal consi...
Journal of affective disorders, Jan 15, 2016
In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the per... more In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. 18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the...
European Psychiatry, 2014
Introduction: While several theoretical models imply that personality disorders (PD) show an alte... more Introduction: While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial. Objectives: investigating whether alexithymia is associated with PD regardless of psychopathology severity. Aims: 1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction. Methods: 167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects. Results: At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57). Conclusions: The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.
Personality disorders, 2015
This work aims to further validate the object-relations-based model of personality pathology asse... more This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernberg's model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed ...
Acta bio-medica : Atenei Parmensis, 2007
To detect pre-treatment psychopathological predictors of compliance and outcome in a behavioural ... more To detect pre-treatment psychopathological predictors of compliance and outcome in a behavioural weight-loss program for obesity. 68 consecutive obese outpatients were evaluated on a wide range of psychopathological variables before entering a behavioural weight reduction program. Baseline assessment included detection of psychiatric (Axis I) and personality (Axis II) disorders, anxiety and depression levels, temperament and character patterns, alexithymia, and eating attitudes. These variables were then tested as predictors of compliance and weight loss after eight months of active treatment. Baseline presence of Axis I diagnoses was found to enhance the likelihood of good compliance to treatment but to lower probability of good outcome. Different psychopathological (and specifically personality) predictors of outcome were found among patients with and without psychiatric disorders. These data suggest the need to perform a full psychiatric evaluation, including personality assessme...
International Journal of Social Psychiatry, Jul 5, 2010
Background and Aims: Few naturalistic studies have examined the course of borderline personality ... more Background and Aims: Few naturalistic studies have examined the course of borderline personality disorder (BPD) outside North American countries. The aim of this prospective study was to investigate remission rate, changes in the level of BPD psychopathology and outcome prediction in a sample ( n = 46) of Italian BPD outpatients over a two-year follow-up.Method: Two years after baseline, remission rate from BPD and changes in the severity of BPD psychopathology were investigated. Initial measures of borderline, comorbid Axis I and II psychopathology and clinical severity, as well as historical and socio-demographic variables, were used to predict the number of BPD criteria met at follow-up.Results: At the two-year interview, the mean number of BPD criteria endorsed decreased ( p = 0.04) and 12 participants (26.1%) fell below the diagnostic threshold for BPD. Borderline psychopathology at follow-up was predicted by the presence, at baseline, of substance use disorders and self-defeating personality traits, and by the absence of dependent traits ( R2= 0.409; p < 0.001). However, these results cannot be generalized to patients lost to follow-up (15 out of an initial sample of 61), who may exhibit a more severe psychopathology at baseline and therefore a poorer prognosis. Conclusions: Borderline individuals seeking treatment at Italian public psychiatric centres may show some improvement in BPD psychopathology over a two-year follow-up; however, the remission rate seems to be lower than that found in North American samples. Furthermore, outcome predictors overlap only partially with those detected by North American studies.
Neuroscience applied, 2022
European Psychiatry, 2014
Introduction: While several theoretical models imply that personality disorders (PD) show an alte... more Introduction: While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial. Objectives: investigating whether alexithymia is associated with PD regardless of psychopathology severity. Aims: 1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction. Methods: 167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects. Results: At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57). Conclusions: The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.
European Psychiatry, Mar 1, 2016
IntroductionDepression is an established risk factor for acute coronary syndrome (ACS), nonethele... more IntroductionDepression is an established risk factor for acute coronary syndrome (ACS), nonetheless the mechanisms underlying this association are still unclear and literature disagrees on the role played by anxiety. Moreover, most of the studies included subjects with a long lasting history of heart disease or recurrent depressive episodes that could bias the results.ObjectivesWe performed serial assessments of anxiety, depression and new cardiac events in a cohort of never-depressed patients in the two years after their first ACS.AimsClarify the role of anxiety and depression in predicting new cardiac events.MethodsTwo hundred and fifty-one consecutive patients completed the two-years follow-up. The presence of depression was evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and its severity with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected at baseline, when GRACE-score was calculated, and at 1, 2, 4, 6, 9, 12 and 24-months follow-ups.ResultsForty-two patients (16.7%) developed a second cardiac event and, of these, eighteen (42.9%) had a previous depressive episode. At Cox Regression, controlling for confounding clinical variables (e.g. GRACE-score), developing a first-ever depressive episode was a significant risk factor (OR = 2.38; 95%CI = 1.11–5.14; P = 0.027) whereas baseline anxiety was protective (OR = 0.56; 95%CI = 0.38–0.81; P= 0.002). The latter, moreover, moderated the effect of incident depression on new cardiac events.ConclusionOur results confirm the well-established detrimental effect of depression on cardiac prognosis and suggest clinicians to keep in mind anxious symptoms when facing a patient at his/her first ACS.Disclosure of interestThe authors have not supplied their declaration of competing interest.
American Journal of Psychotherapy
Assessment
The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on... more The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pa...
Journal of Clinical Medicine
Background: COVID-19 forced healthcare workers to work in unprecedented and critical circumstance... more Background: COVID-19 forced healthcare workers to work in unprecedented and critical circumstances, exacerbating already-problematic and stressful working conditions. The “Healthcare workers’ wellbeing (Benessere Operatori)” project aimed at identifying psychological and personal factors, influencing individuals’ responses to the COVID-19 pandemic. Methods: 291 healthcare workers took part in the project by answering an online questionnaire twice (after the first wave of COVID-19 and during the second wave) and completing questions on socio-demographic and work-related information, the Depression Anxiety Stress Scale-21, the Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait Anger Expression Inventory-2, the Maslach Burnout Inventory, the Multidimensional Scale of Perceived Social Support, and the Brief Cope. Results: Higher levels of worry, worse working conditions, a previous history of psychiatric illness, being a nurse, older age, and avoidant and emotio...
International Journal of Environmental Research and Public Health, 2021
During the last year, the COVID-19 outbreak put all the healthcare workers around the world at ri... more During the last year, the COVID-19 outbreak put all the healthcare workers around the world at risk of physical and psychological sequelae. The general purpose of the present study was to assess the mental health of Italian healthcare workers during the COVID-19 outbreak and to identify high-risk groups. Here, we present results from the baseline assessment of the “Healthcare workers’ wellbeing (Benessere Operatori)” project on a sample of 1055 healthcare workers. Participants completed the Depression Anxiety Stress Scale-21, the Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait Anger Expression Inventory-2, and the Maslach Burnout Inventory. Healthcare workers who worked in COVID wards reported higher levels of anxiety, insomnia, post-traumatic stress, anger, and burnout, compared to those reported by the healthcare workers who worked in non-COVID wards. Moreover, nurses, both in COVID and non-COVID wards, were at higher risk of experiencing psychological ...
Psychiatry Research, 2021
Apparent comorbidity between Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) is a c... more Apparent comorbidity between Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) is a common condition, but its meaning has not been clarified yet. The present study aimed to evaluate the pattern of occurrence of obsessive-compulsive symptoms (OCS) in the different phases of BD. One hundred and sixty-five BD patients, 62 (37.5%) euthymic, 34 (20.6%) in hypomanic/manic phase, 43 (26%) in depressive phase and 26 (15.7%) in mixed state, were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Ruminative Response Scale (RRS). In the whole sample, the severity of OCS was associated to the severity of depressive symptoms. The highest severity of OCS (YBOCS total score) was observed in the mixed group and the lowest scores in the hypomanic/manic group. Our findings suggest that OCS in BD patients appear as a state-dependent phenomenon cycling with the mood phases, particularly exacerbating in the context of depressive and mixed states.
European Neuropsychopharmacology, 2018
European Psychiatry, 2017
ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functio... more ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptom (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.MethodSeventy-five patients affected by schizophrenia were administered the SCID-IV, the PANSS, the YBOCS and the SOFAS.The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high).ResultsIn both groups, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at higher levels of disorganization (Figure 1).ConclusionData suggest that in pati...
Journal of personality assessment, Jan 7, 2017
This article demonstrates the utility of a theory-guided psychodynamic approach to the assessment... more This article demonstrates the utility of a theory-guided psychodynamic approach to the assessment of personality and personality pathology based on the object relations model developed by Kernberg (1984). We describe a clinical interview, the Structural Interview (SI; Kernberg, 1984), and also a semistructured approach, the Structured Interview of Personality Organization (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004) based on this theoretical model. Both interviews focus on the assessment of consolidated identity versus identity disturbance, the use of adaptive versus lower level defensive operations, and intact versus loss of reality testing. In the context of a more clinically oriented assessment, the SI makes use of tactful confrontation of discrepancies and contradictions in the patient's narrative, and also takes into account transference and countertransference phenomena, whereas the more structured approach of the STIPO incorporates clinical judgment informed by clin...
European Psychiatry, 2016
IntroductionRecent studies have underlined the importance of considering the form of thoughts, be... more IntroductionRecent studies have underlined the importance of considering the form of thoughts, beyond their content, in order to achieve a better phenomenological comprehension of mental states in mood disorders. The subjective experience of thought overactivation is an important feature of mood disorders that could help in identifying, among patients with a depressive episode, those who belong to the bipolar spectrum.ObjectivesPatients with a diagnosis of bipolar disorder (BD) were compared with matched healthy controls (HC) on a scale that evaluates thought overactivation.AimsValidate the Italian version of a scale for thought overactivation (i.e. STOQ) in a sample of bipolar patients.MethodsThirty euthymic BD and 30 HC completed the Subjective Thought Overactivation Questionnaire (STOQ), the Ruminative Responses Scale (RRS), the Beck Depression Inventory-II (BDI-II) and global functioning (VGF).ResultsThe 9-items version of the STOQ has been back translated and its internal consi...
Journal of affective disorders, Jan 15, 2016
In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the per... more In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. 18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the...
European Psychiatry, 2014
Introduction: While several theoretical models imply that personality disorders (PD) show an alte... more Introduction: While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial. Objectives: investigating whether alexithymia is associated with PD regardless of psychopathology severity. Aims: 1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction. Methods: 167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects. Results: At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57). Conclusions: The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.
Personality disorders, 2015
This work aims to further validate the object-relations-based model of personality pathology asse... more This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernberg's model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed ...
Acta bio-medica : Atenei Parmensis, 2007
To detect pre-treatment psychopathological predictors of compliance and outcome in a behavioural ... more To detect pre-treatment psychopathological predictors of compliance and outcome in a behavioural weight-loss program for obesity. 68 consecutive obese outpatients were evaluated on a wide range of psychopathological variables before entering a behavioural weight reduction program. Baseline assessment included detection of psychiatric (Axis I) and personality (Axis II) disorders, anxiety and depression levels, temperament and character patterns, alexithymia, and eating attitudes. These variables were then tested as predictors of compliance and weight loss after eight months of active treatment. Baseline presence of Axis I diagnoses was found to enhance the likelihood of good compliance to treatment but to lower probability of good outcome. Different psychopathological (and specifically personality) predictors of outcome were found among patients with and without psychiatric disorders. These data suggest the need to perform a full psychiatric evaluation, including personality assessme...