P Gaetano

Sapienza University of Rome, Roma, Latium, Italy

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Publications (13)40.64 Total impact

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    ABSTRACT: The authors' aim was to investigate the role of stressful events, perceived social support, attachment security, and alexithymia in triggering exacerbations of diffuse plaque psoriasis. Inpatients experiencing a recent exacerbation of diffuse plaque psoriasis (N=33) were compared with inpatients with skin conditions believed to have a negligible psychosomatic component (N=73). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia, and perceived social support were assessed with the Experiences in Close Relationships questionnaire, the Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support, respectively. Multiple logistic regression analysis was used to control for age, gender, education, marital status, and alcohol consumption. In relation to comparison subjects, the patients with psoriasis had lower perceived social support and higher attachment-related avoidance. Also, they were more likely to have high alexithymic characteristics. There were no differences between the patients with psoriasis and the comparison subjects in scores on the Experiences in Close Relationships anxiety scale, the total number of stressful events, and the number of undesirable, uncontrollable, or major events. Although caution should be applied in generalizing these findings to outpatients, this study suggests that alexithymia, attachment-related avoidance, and poor social support might increase susceptibility to exacerbations of diffuse plaque psoriasis, possibly through impaired emotional regulation. Several physiological mechanisms involving the neuroendocrine and the immune system might mediate the interplay between stress, personality, and diffuse plaque psoriasis.
    Full-text · Article · Nov 2005 · Psychosomatics
  • M Biondi · A Picardi · M Pasquini · P Gaetano · P Pancheri
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    ABSTRACT: Despite the high prevalence of bipolar spectrum disorders, most instruments currently available for the assessment of depression do not explore symptoms of 'activation' such as anger, irritability, aggressiveness, hostility, and psychomotor activation. Two samples of adults with unipolar depression were studied. They had no comorbid DSM-IV disorder, and they were free from antidepressant drugs. The first sample (n = 380) was assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. The second sample (n = 143) was assessed with the MMPI-2. Factor analysis was performed on SVARAD items and MMPI-2 clinical scales. In both samples, we obtained a three-factor solution with factors interpreted as a depressive dimension, an anxious dimension, and an activation dimension. The latter dimension appeared to be clinically relevant in 20-27% of patients. The presence of a comorbid disorder may have been missed in some cases. Also, some bipolar II patients might have been misdiagnosed as unipolar and included in the study. Further, our findings apply only to a selected psychiatric population, and it should be tested whether they generalize to other settings of care and other countries. Our results suggest that depressive mixed states are not rare even in patients diagnosed as unipolar, and that some unipolar patients might actually be 'pseudounipolar' and belong to the bipolar spectrum. More in general, our findings suggest that some depressed patients have prominent symptoms of activation that can easily go unnoticed using instruments that do not explore such symptoms. Detecting these symptoms has important treatment implications.
    No preview · Article · Mar 2005 · Journal of Affective Disorders
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    ABSTRACT: Current psychiatric classification systems underestimate the part played by anger and aggressiveness in unipolar depression. This study was designed to assess the relevance of anger, irritability, aggressiveness, hostility, and psychomotor activation in major depressive disorder. A total of 222 newly admitted consecutive outpatients with major depressive disorder (mean age 48.9 years, 64.4% females) were enrolled in the study. They had no comorbid axis I or II DSM-IV disorder, and they received no treatment with antidepressants in the preceding 2 months. They were assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. Principal component analysis was performed on SVARAD items. We obtained a three-factor solution accounting for 47.4% of total variance. The factors were interpreted as 'anger/irritability', 'depression', and 'anxiety', respectively. The anger/irritability dimension was clinically relevant in 23% of patients. Anger/aggressiveness was especially frequent (21.6%), whereas psychomotor activation was infrequent (0.9%). In depressive disorders, there are psychopathological dimensions other than depressed mood and anxiety that deserve greater clinical recognition and research. Our study suggests that one of these symptom clusters includes anger, irritability, aggressiveness, and hostility. The relevance of this dimension was not related to concurrent pharmacological treatment. Misdiagnosis of bipolar II disorder is also unlikely to explain our findings. Possibly, personality factors might at least partly explain the occurrence of anger and aggressiveness in several depressed patients. Attachment theory suggests that anger might also be conceived as part of the protest-despair-detachment reaction to a loss, either actual or symbolic.
    No preview · Article · Aug 2004 · Psychopathology
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    Preview · Article · Apr 2004 · The Journal of Clinical Psychiatry
  • A. Picardi · P. Gaetano · A. Toni · E. Caroppo · G. Arciero
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    ABSTRACT: Introduction. The construct of "personal meaning organisation" plays a key role in Guidano's model of the Self. A study has provided preliminary evidence of the validity of this construct as operationalized in the Personal Meaning Questionnaire (PMQ, named in italian QSP). We further tested its validity against criterion measures developed within other theoretical formulations in the area of personality. Methods. We studied 214 healthy subjects (63% females, 37% males, mean age 26.4). The criterion measures were established questionnaires assessing Cloninger's model of personality (TCI-125), the Big Five personality factors (BFQ), emotional recognition (TAS-20), and adult attachment style (ECR). Also, Spielberger's STAI and the Zung scale were used to measure anxiety and depression, respectively. The PMQ, the STAI, and the Zung were completed again after one month by 113 participants. Discriminant analysis was used to classify participants based on their PMQ scores. Then, the mean scores on criterion measures of participants with different organizations were compared. We also assessed internal consistency and reproducibility of PMQ scores, and their relationship with depression and anxiety. Results. Internal consistency (alpha 0.66-0.82) and test-retest reliability (intraclass correlation 0.70-0.83) were satisfactory. The QSP scores were largely unaffected by the level of depression and anxiety. For each personal meaning organization, the pattern of scores on the criterion measures was largely as hypothesised. Discussion. This study provided further evidence of reliability and validity of the PMQ, and hence of the theoretical model operazionalized in this instrument.
    No preview · Article · Mar 2004
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    ABSTRACT: To investigate the role of stressful events, social support, attachment security and alexithymia in triggering or exacerbating psoriasis. Outpatients experiencing a recent onset or exacerbation of psoriasis (n=40) were compared with outpatients with skin conditions in which psychosomatic factors are regarded as negligible (n=116). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and perceived social support were assessed with the ECR questionnaire, the TAS-20 and the MSPSS, respectively. The mean number of recently experienced life events, or of undesirable, uncontrollable or major events was not different between psoriatic patients and controls. The only stress measure that showed a slight trend towards an association with psoriasis was having experienced four or more stressful events in the preceding year. There was a statistical trend towards an association between alexithymia and psoriasis, whereas there were no significant differences between patients with psoriasis and controls with respect to perceived social support and attachment security. Subgroup analysis suggested that the role of all psychosomatic factors studied might be more important in certain clinical types, such as guttate and diffuse plaque psoriasis. Our findings provide only limited support for a role of psychosomatic factors in psoriasis. Future studies should investigate chronic and daily stressors in addition to major life events, include measures of stress appraisal and include specifically patients with a recent onset of disease.
    No preview · Article · Oct 2003 · Journal of Psychosomatic Research
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    ABSTRACT: Although the onset of alopecia areata has often been anecdotally linked with emotional stress, findings from the few controlled studies have not been univocal. The authors compared outpatients experiencing a recent onset of alopecia areata (N=21) with outpatients affected by skin conditions commonly believed as having a low psychosomatic component (N=102). Participants were administered Paykel's Interview for Recent Life Events, the Experiences in Close Relationships scale, the 20-item Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support. Multiple logistic regression was used to control for age and gender. The total number of recent life events (last 12 months) was not different between the alopecia patients and the comparison subjects. Also, the alopecia patients and the comparison subjects did not differ in terms of the number of undesirable or major events. The comparison subjects even experienced a greater number of uncontrollable events. Alopecia areata tended to be associated with high avoidance in attachment relationships, high alexithymic characteristics, and poor social support. The results suggest that personality characteristics might modulate individual susceptibility to alopecia areata.
    No preview · Article · Sep 2003 · Psychosomatics
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    ABSTRACT: Background. It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors. Methods: Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively. Results: Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis. Conclusions: These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress. Copyright (C) 2003 S. Karger AG, Basel.
    No preview · Article · May 2003 · Psychotherapy and Psychosomatics
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    ABSTRACT: Introduction. We performed a perspective study on a cohort of outpatients with unipolar depressive disorder in order to study adequacy of drug treatment, course and "drop-out". Methods. Sociodemographic and clinical data were collected as well as a physician-estimated compliance towards treatment, HDRS, GAF, and SVARAD scores. Prescriptive patterns were also extrapolated to evaluate adequacy of antidepressant treatment. Results. A total of 135 patients were consecutively enrolled (52 males and 83 females). 69 were affected by major depression (51%) and 46 by distymia (34%). SSRI were prescribed in 69% of cases while TCA in 16%. Only 10% of prescriptions were inadequate. According to operative definitions, 27% (n=37) of patients was a first level drop-out (dropped out of treatment immediately after the first visit), 23% (n=31) dropped-out later, 50% (n=67) were satisfactorily taken in charge, and only 31% of them (n=21) had a good outcome. Multiple logistic regression analysis showed that female gender, being unmarried and having a poor estimated compliance were significantly associated to dropping-out after the first visit. Indeed, subjects corresponding to these characteristics dropped-out in 87% of cases. Discussion. Prescription patterns are changing and now SSRI are the most prescribed antidepressants. Nevertheless, in spite of satisfying quality of prescriptions, high rate of drop-out as well as small rate of satisfactory outcomes are still reported. In our opinion, an effective way to shed light on the drop-out phenomenon would be that of collecting informations among those subjects dropped-out from the psychiatric service.
    No preview · Article · May 2003 · Rivista di Psichiatria
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    ABSTRACT: It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors. Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively. Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis. These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress.
    No preview · Article · Jan 2003 · Psychotherapy and Psychosomatics
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    ABSTRACT: Introduction. The construct of 'personal meaning organisation' is clinically valuable and plays a key role in Guidano's post-rationalist approach to cognitive psychotherapy. We tested the validity of this construct according to classical psychometric theory. Methods. A preliminary version of a self-rating questionnaire was constructed. The items were created in strict accordance with the theoretical descriptions of the four organisations. They describe a person's general way of feeling, thinking, and acting, with no reference to pychopathology. This questionnaire was administered to 482 healthy subjects. Of these, 41 were cognitive psychotherapy trainees who were also interviewed and received a 'clinical diagnosis' of personal meaning organisation. The MMPI L scale was administered to 167 subjects, to evaluate social desirability bias. The items were selected according to accepted psychometric criteria. The resulting instrument was called 'QSP', and consists of 68 items. We assessed factorial, and criterion validity and internal consistency. Stability of scores after 10 months was tested on 15 subjects. Results. Both internal consistency and stability were satisfactory (alpha=0.65-0.82, intraclass correlation coefficient 0.58-0.84). The factor structure was highly consistent with theory. Using scale scores as independent variables, discriminant function analysis correctly classified 75% of trainees. Discussion. This study provided evidence of reliability and validity for the QSP. The findings corroborate the theoretical hypothesis that there are some basic modalities of organising personal meanings, which manifest themselves as characteristic personality styles and may be identified also in healthy subjects.
    No preview · Article · Jan 2003 · Rivista di Psichiatria
  • P Pancheri · A Picardi · M Pasquini · P Gaetano · M Biondi
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    ABSTRACT: Agreement on the factor structure of the Hamilton Depression Rating Scale (HDRS) has not been consistent among studies, and some investigators argued that the scale's factor structure is not reliable. This study aimed at shedding more light on this debated issue. We studied 186 adults with unipolar depression (Major Depressive Disorder, n=80; Dysthymic Disorder, n=71; Depressive Disorder Not Otherwise Specified, n=25; Adjustment Disorder, n=10). They had no comorbid DSM-IV axis I or axis II disorders, and had received no treatment with antidepressant drugs in the previous 2 months. The factor structure of the scale was studied using the principal factor method, followed by oblique rotation. Factor scores were computed for each subject using the regression method. Using the scree-test criterion for factor extraction, we obtained a four-factor solution, explaining 43.8% of total variance. The four factors extracted were identified as (1) somatic anxiety/somatization factor; (2) a psychic anxiety dimension; (3) a pure depressive dimension; and (4) anorexia factor. Patients with Major Depressive Disorder scored significantly higher than patients with other diagnoses on the pure depressive dimension. These results need to be replicated in different cultures, using analogous factoring techniques. Though not exhibiting factorial invariance in the stricter sense of the term, the 17-item HDRS did exhibit a relatively reliable factor structure. Our analysis provides further evidence that the scale is multidimensional. However, as long as the multidimensional character of the scale is taken into account the scale should be able to play a useful role in clinical research.
    No preview · Article · Mar 2002 · Journal of Affective Disorders
  • A. Speca · M. Pasquini · A. Picardi · P. Gaetano · M. Biondi
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    ABSTRACT: Sexual brain dimorphism, besides resulting in psychological differences between the two sexes, could influence the expression of psychopathology. Objective. The aim of this study was to investigate the presence of any gender-related psychopathological differences in a sample of patients with psychiatric disorders. We decided to adopt a dimensional approach, due to the inability of a category approach in classifying psychopathological phenomena. Method. We carried-out a longitudinal investigation on a sample of 1120 consecutively admitted out-patients (586 men and 534 women) between May 1994 and December 1998 and received an axis I or II DSM-III-R or DSM-IV diagnosis, without restricting to any of the categories. We assessed all patients by means of the S.VA.RA.D. (Scale for Rapid Dimensional Assessment), a scale consisting of ten items, each investigating one psychopathological dimension. Results. Significant differences emerged on four of the ten dimensions investigated by the S.VA.RA.D., namely on the Apprehension/Worrying, where women scored 1.77 and men 1.61 (p < 0.01), on the Sadness/Demoralisation dimension, where women scored 1.65 and men 1.34 (p < 0.0001), on the Impulsiveness dimension, where men scored higher than women (0.69 vs. 0.53 [p < 0,01]) and on the Hyperthymia/Activation dimension, where men scored 0.24 and women 0.14 (< 0.001). Conclusions. It appears that in men motor activity, disinhibition, accelerated thought, irritability and the tendency towards behaving inadequately or poor control on behaviour prevail, whereas women on the contrary tend to privilege emotional behaviour, the sense of fear and anxiety, preoccupation, constraint, imminent danger, together with pessimism, reduction of interests and energy, lack of self-confidence. Furthermore, it should be remarked that a dimensional approach allowed in this study to identify and describe some common psychic functions independently from any category-based criterion.
    No preview · Article · Jan 2001 · Giornale Italiano di Psicopatologia