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ABSTRACT: Jealous love and morbid jealousy, although inextricably linked, cannot be considered the same: jealous love (trait jealousy) is the behavioral and cognitive-affective precondition of morbid jealousy (state jealousy). Love is jealous when it is devoured by the desire for the exclusive and total possession of the partner, whose unconditional and continued presence is avidly requested. This type of love, in addition, is permeated by the need to know what the other is thinking, in order to scrutinize every minimal flaw in the faithfulness of the partner even in his or her innermost thoughts and fantasies; in it, jealousy is virtually always present, even in the absence of a triggering event, because captative love, by its very nature, includes the expectation of a conflict which inevitably actually takes place in reality. Finally, jealousy emerges as an emotional event (jealous flash) in response to a more or less significant change in the behavior of the partner, and reveals to the jealous individual a dimension which was previously latent or inexistent. This intense and brief experience, leaves a more or less blurred memory behind, and tends to progressively repeat itself and take root as a feeling.
Acta bio-medica: Atenei Parmensis 01/2007; 77(3):137-46.
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ABSTRACT: In this naturalistic and prospective study, personality was assessed in patients with panic disorder (PD), in order to evaluate whether personality features negatively influence the outcome of pharmacological treatment.
Before drug treatment, PD was diagnosed with the Structured Clinical Interview for DSM-IV disorders and personality was assessed with the Structured Interview for DSM-IV Personality Disorders. Moreover, all patients were evaluated with the SCL-90, the Ham-A and Ham-D. Then, patients were randomly treated with paroxetine (33.5+/-13.3 mg/day) or citalopram (34.7+/-15.2 mg/day) and were followed at monthly intervals for 1 year. Absence of full and limited-symptom attacks, anticipatory anxiety, phobic avoidance and depression for 3 months was used to establish remission. The effect of personality traits on each symptom domain was evaluated.
Seventy-one patients completed the study. Remission rate was 76% for panic attacks and 46% for complete remission. When the effects of age, gender, age of onset and duration of PD, baseline SCL-90 phobic anxiety, Ham-A and Ham-D scores, Axis I comorbidity and the SIDP traits on remission were analyzed in a logistic regression, only borderline traits negatively influenced remission of panic attacks (OR=0.69; 95% CI=0.49-0.96; p=0.03), whereas the number of traits of each personality Cluster and the total number of SIDP traits did not affect the outcome of treatment.
This study suggests that in PD patients, borderline features may negatively influence the response to monotherapy with SSRI drugs; therefore, other treatment strategies (i.e., combination of SSRI with psychotherapy) are needed to obtain remission in these patients.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 10/2006; 30(7):1240-5. · 3.25 Impact Factor
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ABSTRACT: Research about personality factors involved in successful outcome after bariatric surgery has led to contrasting results. The reasons for such discrepancies may include the lack of assessment of adaptive personality traits and of psychiatric co-morbidity, which may limit the reliability of personality findings. This study aimed to provide exploratory data regarding preoperative personality dimensions and weight loss prediction 1 year after laparoscopic adjustable gastric banding (LAGB). Both normal and deviant personality patterns were assessed by means of the Temperament and Character Inventory (TCI). Moreover, co-morbid psychiatric disturbances were evaluated both categorically and dimensionally.
65 morbidly obese subjects applying for LAGB were evaluated preoperatively by means of the TCI, standardized diagnostic interview, rating scales and questionnaires to assess co-morbid psychopathology. After intake screening, 35 subjects (mean age 41.2, mean BMI 45.5) were accepted for and underwent LAGB. BMI reduction 1 year following LAGB was used as an outcome measure and entered as a dependent variable in a stepwise multiple regression analysis. TCI scores, presence and severity of eating, depressive and anxiety disorders, sex, age, level of education and BMI at baseline were tested as independent variables.
Preoperative TCI 'Persistence' scores explained >40% of variance of BMI reduction 1 year following LAGB, irrespective of preoperative BMI, age, gender, educational level, psychiatric co-morbidity, psychopathology severity and other temperament and character features.
Some personality dimensions, as measured by the TCI, may be involved in successful weight control after LAGB.
Obesity Surgery 07/2006; 16(7):842-7. · 3.29 Impact Factor
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ABSTRACT: A consistent amount of empirical research suggests that depression, besides interfering with quality of life and social functioning, may influence other symptom dimensions in schizophrenia, thus constituting an important domain for treatment strategies, outcome, and prognosis.
This study investigated the factorial structure of the Calgary depression scale for schizophrenia (CDSS) in a sample of schizophrenic patients and explored the relationships between such factors, major symptom dimensions and subjective experiences.
One hundred and sixty-one subjects were examined to assess the severity of schizophrenic symptoms (scored according to the five-dimensional model of Toomey et al. [28]), the distress due to the subjective experience of negative symptoms, and the degree of subjectively-felt cognitive-affective vulnerability (i.e. basic symptoms).
Principal component analysis revealed CDSS to include three main factors, namely: "depression-hopelessness" (factor I), "guilty idea of reference-pathological guilt" (factor II) and "early wakening" (factor III). Whereas the last factor did not correlate with any of the other psychopathological domains, the first two factors revealed multiple correlations with both diagnostic symptoms and subjective experiences.
The results confirm the threefold factorial structure of the CDSS previously reported by the authors of the scale and could shed further light on the psychopathological nature of the components of depression in schizophrenia. The specific correlation patterns with diagnostic and subjective psychopatholgy substantiate the clinical distinction between a general depression factor ("depression-hopelessness") and a cognitive-guilt factor ("guilty idea of reference-pathological guilt").
European Psychiatry 07/2006; 21(4):227-32. · 2.77 Impact Factor
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ABSTRACT: The phenomenon of self-centrality denotes a qualitative modification of the psychotic experience. Transitory experiences of self-reference have regularly been found in subjects in the prodromic phase and at the beginning of psychosis or in the post psychotic phase, and are specifically identified in the semeiotics of Basic Symptoms. However, self-centrality, in addition to being a morphological organizer in the psychotic crisis, also manifests itself in schizotypal personality disorders and in first-degree relatives of schizophrenics (where it is correlated to the degree of schizotypal traits). In these subjects, manifestations of self-centrality of a lesser intensity could be an indication of a latent vulnerability trait, which could modulate personal and psychopathological expressions of the schizotaxic diathesis.
Acta bio-medica: Atenei Parmensis 05/2006; 77(1):33-9.
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ABSTRACT: In this prospective study, Personality Disorders (PersD) were evaluated in patients with Panic Disorder (PD), before and after one year of pharmacotherapy to verify whether personality characteristics changed after treatment.
Sixty PD patients and 60 sex and age-matched normal controls participated in the study. All subjects were evaluated with the SCID-IV, the Structured Interview for DSM-IV Personality Disorders (SIDP), the SCL-90, the Ham-A and the Ham-D. Patients were treated with paroxetine or citalopram and were evaluated monthly for one year to assess the remission of symptoms. The SIDP was re-administered to the patients at the end of the study.
Before treatment, PD patients showed a higher prevalence (60%) of PersD than normal subjects (8%). After treatment, PersD rate decreased (43%) due to the reduction of the rate of paranoid, avoidant and dependent PersD. When the effect of the treatment on personality traits was evaluated, we found that avoidant traits decreased only in remitted patients, paranoid traits decreased both in remitted and in non-remitted patients, and dependent traits decreased only in patients with major depression comorbidity.
The small sample size and the short length of the follow-up period of our study suggest caution in the generalization of our results.
In our PD patients, an improvement of symptoms was associated with a reduction of paranoid, avoidant and dependent traits, with a normalization of paranoid traits and a persistence of avoidant and dependent characteristics. Therefore, our data suggest that in PD patients not only paranoid traits but also avoidant and dependent traits show, at least in part, a state phenomenon.
Journal of Affective Disorders 01/2006; 89(1-3):189-94. · 3.52 Impact Factor
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Journal of Clinical Psychopharmacology 07/2005; 25(3):276-7. · 4.10 Impact Factor
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Carlo Maggini
Acta bio-medica: Atenei Parmensis 05/2005; 76(1):53-9.
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ABSTRACT: In the present study, we evaluated whether patients with panic disorder (PD) in complete remission were more alexithymic than normal controls.
Fifty-two PD patients (both during the acute phase of the disorder and after at least 2 months of complete remission) and 52 age- and sex-matched normal subjects completed the Toronto Alexithymia Scale-20 and the Hamilton Rating Scales for Anxiety (Ham-A) and for Depression.
A higher rate of alexithymia was found in PD patients than in controls (3.8%) both during the acute phase (44.2%; p < 0.001) and after remission of the disorder (21.2%; p = 0.008). During remission, PD patients showed: (1) Ham-A scores significantly higher than controls (p < 0.001); (2) only an elevation of the 'difficulty in identifying feeling' (DIF) dimension of alexithymia, and (3) a positive relationship between Ham-A scores and DIF levels (p < 0.001).
After remission of panic attacks, phobic avoidance and anticipatory anxiety, PD patients are more alexithymic (even though the levels of alexithymia decreased after the resolution of the acute phase of PD) and anxious than controls. This finding might be explained by an overlap between cognitive aspects of PD and the DIF dimension of alexithymia, since alexithymic and anxious levels are positively related.
Psychotherapy and Psychosomatics 01/2005; 74(1):56-60. · 6.28 Impact Factor
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ABSTRACT: This research is an attempt to gain a comprehensive insight into alexithymia in schizophrenia. Previous studies offered clinically-descriptive and phenomenologically oriented suggestions regarding alexithymia putative contribution in shaping schizophrenic psychopathology. However, the factorial structure of the scales used to assess alexithymia had never been applied to a schizophrenic sample as a preliminary step to interpret results, thus assuming the purported dimensions of the alexithymia construct (i.e. difficulties identifying feelings, difficulties describing feelings, and externally oriented thinking) to be transnosographically stable. In order to explore the psychopathologic meaning and interrelations with other schizophrenic symptoms, we evaluated 76 chronic schizophrenic outpatients using the 20-item Toronto Alexithymia Scale, standardized measures of positive, negative, disorganized and depressive symptoms, social and physical anhedonia scales, and the Bonn Scale for the Assessment of Basic Symptoms. The principal component analysis ofTAS-20 items revealed a 4-factor structure with multiple correlations with psychotic, disorganized, depressive, anhedonic dimensions and basic symptoms. The data suggest that alexithymia in schizophrenia is more heterogeneous than was previously recognized, and has several components, some of which are more state-related, and others of which are more like trait features. Those components are specifically correlated with both overt and subjective dimensions of schizophrenic psychopathology.
Acta bio-medica: Atenei Parmensis 05/2004; 75(1):40-9.
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ABSTRACT: An increasing number of studies suggest the usefulness of both personality features and neurocognitive vulnerability as tools for isolating phenotypes associated with susceptibility to schizophrenia, however the clinical and heuristic topicality of self-experienced vulnerability has yet to be properly recognized. Biological relatives of schizophrenic patients (because of the familial/genetic load) constitute a promising and suggestive paradigm for addressing the psychopathological relationship between personality features and subjective experience of vulnerability. The current study found that 1st degree unaffected relatives of schizophrenics exceeded normal controls in schizotypal, paranoid, and borderline dimensions, and showed an overlap in the schizoid dimension of clinical Schizotypals (i.e. Schizotypal Personality Disorder Patients). Subsequent correlation analysis showed that schizotypal and schizoid traits are linked to specific domains of self-experienced vulnerability. Clinical heuristics is discussed.
Acta bio-medica: Atenei Parmensis 01/2004; 74(3):131-6.
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ABSTRACT: Wilhelm Weygandt's Uber die Mischzustände des manisch-depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity) describes and conceptualizes mixed states of mood, behavior, and thinking commonly found in manic-depressive disorders. These ideas emerged from Weygandt's service in the 1890s at the Psychiatric Clinic of the University of Heidelberg, directed by Emil Kraepelin. In the sixth (1899) edition of Kraepelin's influential textbook, the concept of manic-depressive illnesses underwent a fundamental shift from a complex group of syndromal subtypes to a single integrated disorder, widely known from the 1921 English translation of the eighth (1920) edition. In the 1899 edition, Kraepelin acknowledged Weygandt for a new section on mixed manic-depressive states within the new integrated view of manic-depressive disorder. We provide biographical notes on Weygandt, a little-known but historically important figure, as well as the first English translation of his monograph and interpretive summaries of his findings. We also consider whether Weygandt's important insight that the same person could be both manic and depressed not only at different times but even at the same time served as an important stimulus to Kraepelin's unified manic-depressive disorder concept, which survives as bipolar disorder a century later.
Harvard Review of Psychiatry 10(5):255-75. · 3.05 Impact Factor
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ABSTRACT: The principal concern of this paper lies in the exploration of the possible role of the subjective experience of language impairment in shaping schizophrenic symptomatology. A previous model embracing the basic symptom theory and the vulnerability paradigm hypothesized that (self-perceived) impairment of receptive and expressive language and alexithymia may play a relevant role in facilitating the development of a nonparanoid prototype of schizophrenia. The experimental protocol which led to this model [emphasizing the comprehensive notion of 'language capacity' as pathoplastic modulator of overt schizophrenic syndromes (i.e. pathoplastic model)] was replicated on a wider schizophrenic sample, assessing contextually with diagnostic symptoms, depressive symptoms, alexithymia, subjective experience of negative symptoms and hedonic capacity. Since schizophrenics with self-experienced language capacity impairment did not differ from other schizophrenics, as regards positive, negative and disorganized symptoms, but just in negative symptom-related distress, an alternative interpretation of the possible role of the subjective experience of language impairment in schizophrenic psychopathology is proposed (i.e. idioplastic hypothesis).
Psychopathology 36(1):17-22. · 1.82 Impact Factor
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ABSTRACT: The syndrome of manic-depressive insanity (MDI), as conceptualized by Emil Kraepelin a century ago, with later refinements, continues to dominate research and clinical practice with mood disorder patients. Current understanding of Kraepelin's views by Anglophones is heavily influenced by the late, highly developed, MDI concept represented in the 1921 partial English translation of the last complete edition of his textbook, the product of gradual development over several decades.
We reviewed all nine editions and revisions of Kraepelin's Textbook (1883-1926) and other writings by him to document the evolution of his views of MDI, and characterized salient developments within biographical and historical contexts.
We found support for the traditional impression that Kraepelin's clinical perception of similarities of various forms of periodic psychiatric disorders marked by fundamental dysregulation of excitation and inhibition of thought and behavior, as well as of mood--as distinct from chronic psychotic illnesses--encouraged his broad, mature concept of MDI. However, our findings indicate a complex evolution of Kraepelin's MDI concept in the 1880s and 1890s, his use of more creative and less empirical clinical methods than traditionally believed, and his considerable personal uncertainty about making clear distinctions among MDI, dementia praecox, intermediate conditions, and paranoid disorders--an uncertainty that persisted to the end of his career in the 1920s.
Kraepelin responded to a compelling international need for diagnostic order in nineteenth-century psychiatry, and effectively promoted his diagnostic proposals with a widely used and influential textbook. Though his methods were less empirical than is usually realized, his legacy includes analysis of large clinical samples to describe psychopathology and illness-course, along with efforts to define psychobiologically coherent and clinically differentiable entities, as steps toward defining psychiatric syndromes. Modern international "neo-Kraepelinian" enthusiasm for descriptive, criterion-based diagnosis should be tempered by Kraepelin's own appreciation of the tentative and uncertain nature of psychiatric nosology, particularly in classifying illnesses with both affective and psychotic features.
Harvard Review of Psychiatry 13(3):155-78. · 3.05 Impact Factor
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ABSTRACT: Emil Kraepelin proposed to separate psychiatric disorders with psychotic features into two major categories, dementia praecox (later schizophrenia) and manic-depressive insanity (later bipolar disorder and major depression). Over the past century, there have been many efforts to categorize conditions that do not fit readily in either group. These conditions include many cases of acute psychotic illnesses of limited duration, with recovery between recurrences. For some of these conditions, Karl Kleist proposed the term cycloid psychosis: acute features were psychotic, as in schizophrenia, but the course was episodic, as in manic-depression. His concept was later elaborated by Karl Leonhard and Carlo Perris, and validated by modern studies. Leonhard described three overlapping cycloid subtypes (anxiety-beatific, excited-inhibited confusional, and hyperkinetic-akinetic motility dysfunction forms); Perris proposed a more unitary syndrome with operational diagnostic criteria; and recent investigators have considered relatively affective versus thought-disordered subtypes. The cycloid concept is not explicitly included in standard international diagnostic schemes, but both DSM-IV and ICD-10 have broad categories for acute, recurrent psychotic disorders, whose validity remains insecure. We present two cases of probable cycloid psychosis, review the history of the concept, and propose that it be reconsidered as a clinically useful category whose validity and utility for prognosis and treatment can be further tested.
Harvard Review of Psychiatry 16(3):167-80. · 3.05 Impact Factor
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ABSTRACT: The purpose of this study is to examine the classic psychopathologic notion of depersonalization in the light of the Basic Symptom paradigm. A sample of 57 chronic schizophrenics was cross-sectionally assessed with the Bonn Scale for the Assessment of Basic Symptoms (BSABS) and contextually with specific scales testing positive, negative, depressive and alexithymic dimensions. In order to categorize depersonalized vs. nondepersonalized patients three specific BSABS items explicitly identifying the allo-/auto-/somatopsychic domains of depersonalization were used, according to the wernickian threefold definition. Depersonalized schizophrenics showed a semiological profile that was distinct from that of nondepersonalized schizophrenics (as regards basic, positive, depressive symptoms and alexithymia); patients with multiple co-occurring forms of depersonalization revealed higher levels of cognitive disturbance, lowering of stress threshold and greater alexithymia. Clinical and research implications are discussed.
Psychopathology 35(1):17-24. · 1.82 Impact Factor
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ABSTRACT: The study's aim was to empirically derive the psychopathological constellation associated with self-centrality (i.e. non-delusional self-referential attitude) by seeking an interpretation in the light of the 'Basic Symptoms Model' of schizophrenic psychopathology. Eighty-four patients with an established schizophrenic illness receiving maintenance treatment at the Psychiatry Section of the Parma University Neuroscience Department were examined. The Scales for the Assessment of Positive and Negative Symptoms, the Calgary Depression Scale and the Toronto Alexithymia Scale were administered to all subjects to determine levels of positive, disorganized, negative and depressive symptoms, as well as alexithymia. Subjective experiences, including non-delusional self-centrality, were explored by means of the Bonn Scale for the Assessment of Basic Symptoms. Logistic regression detected three different psychopathological domains (delusional, alexithymic, and basic body symptoms) strongly associated with self-centrality. Among these the most influential independent variable was basic body symptoms. These results suggest that impaired lived body experience (i.e. protopathic body disattunement) is a psychopathologic condition concomitant with the emergence of autocentric polarization of experience (i.e. self-centrality).
Psychopathology 37(2):69-75. · 1.82 Impact Factor
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ABSTRACT: Contemporary psychopathological research has shown that some qualitative anomalies of the first-person experiential givenness qualify the subjective experience of schizophrenia. Such essential clinical features of schizophrenia have recently been condensed into 7 phenomenologically coherent clusters derived from the Bonn Scale for the Assessment of Basic Symptoms (BSABS). The experimental intent of this study was to test whether subapophanic self-centrality (i.e. a protopathic nondelusional form of intersubjective spatial disattunement) empowers the discriminant capacity of such a set of subjective experiential disturbances among different diagnostic groups.
Three comparably sized samples of outpatients with schizophrenia, obsessive-compulsive or mood disorders were examined with the BSABS. Logistic regression analysis was performed with diagnosis as the outcome variable.
Elevated scores in self-perceived cognitive disorders and abnormal self-centrality were associated with DSM-IV diagnosis of schizophrenia. Self-centrality increased the discriminant capacity of the 7 designed a priori dimensions.
These findings confirm the previously reported aggregation of some subtle qualitative alterations of subjective experience in schizophrenia, and suggest that a careful consideration of autocentric disturbances of intersubjectivity might enrich current heuristics on schizophrenic experiential vulnerability.
Psychopathology 38(3):124-32. · 1.82 Impact Factor
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ABSTRACT: Abnormal neuropsychological and cognitive functions in nonpsychotic relatives of schizophrenics are currently the subject of intense interest, mainly because of attention being focused again on the theoretical construct of schizotaxia. Contextually, in recent years the issues of subjective experiences have once again become central and respectable topics in psychopathological research. Among self-experiential disturbances, basic symptoms (BS), stemming from Jaspersian phenomenological psychopathology, are considered the first, protopathic, subjective reverberation of the neurobiological deficit of schizophrenia. Thus BS are expected to be detectable in nonpsychotic relatives of schizophrenia patients. The aim of the present study was to compare the degrees of such anomalous subjective experiences, assessed in siblings of schizophrenic patients, schizophrenia spectrum patients (schizotypals and schizophrenics) and nonclinical controls. Different profiles of BS were obtained in the samples. An increasing gradient of BS ranging from nonclinical to clinical samples, with unaffected siblings in the intermediate position, occurred for some of the BS clusters (i.e. 'thought, language, perception and motor disturbances' and 'impaired bodily sensations'). Other BS clusters (i.e. 'disorders of emotion and affect' and 'increased emotional reactivity') turned out to be typical of the clinical subgroups, whereas an enhanced tolerance to normal stress significantly distinguished the sibling specimen from the other ones. The heterogeneity of these patterns suggests that BS constellations may be underpinned by different psychopathological processes and that cognitive and bodily BS may be clinical target phenotypes for schizotropic liability screening.
Psychopathology 37(1):23-8. · 1.82 Impact Factor
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ABSTRACT: The concept of mixed states was proposed at the end of last century by Kraepelin and Weygandt to confer untty to manic-depressive illness and to better differentiate this disease from dementia praecox. The concept has been further elaborated by the Hamburg and Vienna schools (Mentzos and Berner, respectively), and dichotomized in stable and unstable mixed states. Stable mixed states represent a condition of the synchronic copresence of symptoms of both polarities; unstable mixed states, or “mixed pictures,” are characterized by the rapid cycling of these symptoms. The former represent clinical expressions of bipolar disorder, and the latter represent trans-nosological conditions with multiple outcomes. Current North American nosology retains the original Kraepelinian concept of stable mixed states and ignores the concept of unstable mixed states, which is very close to the concept of ultradian cycling proposed by Kramlinger and Post in 1996.
Comprehensive Psychiatry.
