Aberrant Salience and Alexithymia in Subthreshold Psychotic Experiences among Adolescent Migrants in Italy: A Comparison with Native Italian Adolescents

IntroductionIn this decade in the Italian context, there has been a significant increase of the immigration phenomenon. Consistent data indicated higher risk of psychotic experiences among migrants. Poor work investigated clinical variables associated with stronger subthreshold psychotic experiences among this population of adolescents. Aberrant salience, the biased assignment of significance to otherwise innocuous stimuli, and alexithymia, the difficulty identifying/describing feelings are believed to have a role in the onset and maintenance of psychotic symptoms. No study evaluated whether they could moderate the relation between migrant status and psychotic experiences among in adolescence.ObjectivesThe current study investigated whether salience and alexithymia predicted more intense subthreshold psychotic experiences and moderated the effect of migrant status among migrant and native Italian adolescents.MethodsSeventy-three adolescents born in other countries than Italy and 75 native Italian adolescents (mean age = 17.57, SD = 2.08, 47.30% females) completed the aberrant salience inventory, the Toronto Alexithymia Scale-20 and the screening for psychotic experiences.ResultsMigrant adolescents had higher levels of subthreshold psychotic experiences (F = 10.65, P &lt; 0.01), alexithymia (F = 8.93, P &lt; 0.01) and salience (F = 4.38, P &lt; 0.05) than native Italian adolescents. A main effect of aberrant salience and alexithymia on subthreshold psychotic experiences emerged. An interaction effect between migrant status and alexithymia was found: migrant adolescents with stronger alexithymia had more intense subthreshold psychotic experiences.ConclusionsPublic health policies should consider migrant adolescents as a group at risk for stronger subthreshold psychotic experiences. Prevention programs could take into account alexithymia as a target of intervention for this population of adolescents.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Mindfulness Skills Deficits in Pathological Skin Picking Behaviours

IntroductionPathological Skin Picking (SP) is a psychiatric condition with a 2–5%-prevalence in the community and consists of repetitive picking behaviours associated to marked distress, which can cause significant skin damage. Research has evidenced a Focused SP subtype, typically occurring in response to negative emotions, an Automatic subtype, occurring without awareness during activities not related to the picking behavior, and a Mixed one. Mindfulness skills have been studied as a protective factor involved in the treatment of several psychiatric disorders. Studying Mindfulness deficits in SP might help to identify interventions tailored for specific subtypes of SP behaviours.ObjectivesThe current study examined the relationship between Mindfulness skills and pathological SP behaviours.AimsThe study aimed to investigate whether Mindfulness skills deficits uniquely predicted SP subtypes behaviours after controlling for general distress in a community sample.MethodsNinety-seven community individuals (mean age = 39.71, SD = 16.37, 59% females) completed measures of SP, Mindfulness skills and general distress (anxiety and depression).ResultsLower Mindfulness skills of Describing Internal Experiences (B = −0.12, P &lt; 0.05) and higher anxiety (B = 0.08, P &lt; 0.05) predicted more severe Automatic SP. Lower Mindfulness skills of Non-judging Inner Experiences (B = −0.12, P &lt; 0.05), higher anxiety (B = −0.12, P &lt; 0.05) and higher depression (B = −0.12, P &lt; 0.05) predicted more severe Mixed SP. Focused SP was not associated to Mindfulness skills and general distress.ConclusionsMindfulness skills deficits could be associated to Automatic and Mixed but not Focused SP. Future studies should investigate whether Mindfulness programs are effective for individuals reporting Automatic or Mixed SP behaviours.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

The truth behind "the bigger the better": muscle dysmorphia as an expression of cultural and social standard influence

Body Dysmorphic Disorder (BDD) is a complex scenario characterized by the excessive concern and preoccupation of an imaginary body defect or a slight physical anomaly. Since its inclusion in psycho-pathological nosography nearly thirty years ago, BDD evolution through the years has provided an indirect measure of how the sociocultural environment could influences body image perceptions. Multiple factors have collaborated in these changing parameters, with a major responsibility certainly ascribable to the entertainment business and its notable capability to promote and establish new standards in terms of beauty and physical attractiveness. Additionally, technological advancement and world-wide-web exponential enlargement have substantially contributed into the spreading of new ideas of the "healthy" and "attractive" male and female body. On one side, this complex amalgam of social, psychological and cultural factors have generated a wholesome drive to improve one's own body shape and reach new social status through this, with an increase of self-efficacy, self-esteem and other psychological features ascribed to an increased well-being. On the other hand, there have been some distortions in body image standard setting, with the onset of previously unimaginable pathological conditions like muscle dysmorphia (MD), a subtype of BDD also known as "reverse anorexia". In the last 20 years, several authors have reported evidence of body image disturbances in male and female weightlifters, with an MD prevalence higher than what could be expected, especially in non-professional bodybuilders and, more importantly, also in non-competing gyms customers. Moreover, a cultural-dependentmodulation of MD expression seems present, as we recently documented in a study on Italian professional and non-professional bodybuilders, where a different organization of MD symptoms have been found in respect to US bodybuilders. In this chapter, we will cover all principal features of BDD and MD, in terms of their diagnostic criteria and treatment opportunities, and subsequently discuss possible cultural and gender related differences linked to muscularity and physical attractiveness in modern society. © 2013 Nova Science Publishers, Inc

Exploring the Role of Dissociation Dimensions in Obsessive Compulsive Disorder

IntroductionIn the last decade, accumulating evidence has been produced on the role of dissociation in Obsessive Compulsive Disorder (OCD). Understanding which dissociation dimensions are specific to OCD could suggest the integration of therapeutic strategies for dissociation in the treatment of patients with OCD.ObjectivesThe current study explored the role of dissociation in a sample of patients with OCD, patients with anxiety disorders and healthy controls with the aim to understand which dissociation dimensions could be specific to OCD.MethodOne hundred seventy-one participants were included in the study (56% females, mean age = 35.96, SD = 12.61), of which 52 were patients with primary OCD, 59 were patients with Anxiety Disorders (AD), and 60 were healthy controls. The Dissociative Experiences Scale (DES), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were administered.ResultsPatients with OCD had significantly higher dissociative amnesia symptoms than patients with AD and health controls (F = 6.08, P &lt; 0.01) and higher depersonalization/derealization symptoms than healthy controls but not than patients with AD. Patients with OCD did not report significantly higher dissociative absorption than healthy controls and patients with AD.ConclusionsStrategies targeting dissociative amnesia and depersonalization/derealization symptoms in OCD are discussed. Future studies should examine which OCD subtypes are more strongly associated to dissociation dimensions.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Intolerance for Uncertainty is a Prognostic Factor of Negative Response After Intensive Inpatient CBT for Medication-resistant Obsessive-compulsive Disorder

IntroductionCognitive theories of Obsessive–Compulsive Disorder (OCD) have identified six types of beliefs, which have a role as vulnerability and maintaining factors: Inflated sense of responsibility, Threat overestimation, Importance of thoughts, Control of thoughts, Perfectionism and Intolerance for uncertainty. As previous research showed that strong obsessive beliefs are linked to severe OCD symptoms, it could be hypothesized that they act as prognostic factors of negative response after cognitive behavioural therapy (CBT). However, poor research investigated this aspect.ObjectivesThe aim of the current study was to examine which obsessive beliefs could predict a worse response after intensive CBT in a group of inpatients with medication-resistant OCD.MethodsForty inpatients [mean baseline Y-BOCS = 26.70, SD = 7.01] with medication-resistant OCD underwent 5-week intensive CBT including daily and prolonged exposure and response prevention (2.5 hours in the morning, 2.5 hours in the afternoon). All individuals have had inadequate symptom response after prior serotonin-reuptake inhibitor trials. The Y-BOCS, BAI, OBQ-87, and BDI-II were administered at baseline and post-treatment.ResultsInpatients who endorsed stronger intolerance for uncertainty, measured by higher scores on the OBQ-87 Intolerance for uncertainty scale, showed worse response after CBT, measured by having still higher Y-BOCS scores at post-treatment (β = 0.37, t = 2.48, r2 = 0.14, P &lt; 0.05). No effect of the other beliefs emerged.ConclusionsCurrent data demonstrated the role of intolerance for uncertainty as predictor of negative response after intensive CBT for resistant OCD in inpatient setting. Augmentation strategies should be introduced to improve outcomes of inpatients with intolerance for uncertainty.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Therapist-guided internet-based cognitive-behavioural therapy for adult obsessive-compulsive disorder: A meta-analysis

IntroductionCognitive-behavioural therapy (CBT) is the first-line psychological treatment for obsessive-compulsive disorder (OCD). However, most individuals suffering from OCD do not receive CBT. An innovative approach to improve access to evidence-based care is the use of the Internet to deliver effective treatments. Therapist-guided Internet-based cognitive-behavioural therapy (iCBT) involves the administration of structured online lessons that provide the same information and skills typically taught in clinician-administered CBT, often with email support from a therapist. Accumulating evidence on iCBT for OCD has been produced, but a meta-analysis has not been conducted.ObjectivesThrough meta-analytic methods, the present study summarized evidence on iCBT for OCD.AimsEfficacy on OCD symptoms and comorbid depression versus control conditions at post-treatment and follow-up was evaluated.MethodsA PRISMA meta-analysis was performed on randomized controlled trials. Treatments were classified as iCBT if they included CBT components for OCD (eg, exposure and response prevention) delivered through the Internet with or without email/phone support from a therapist.ResultsFour trials were included (n = 238), which were classified at low bias risk. At post-treatment iCBT outperformed control conditions with a high effect size on OCD symptoms (d = 0.85, P&lt;.05) and a medium on comorbid depression (d = 0.52, P&lt;.05). Treatment effects were stable at 4-month follow-up with a high effect size on OCD (d = 1.45, P&lt;.05), but not on comorbid depression (d = 0.33, P&lt;.05).ConclusionsiCBT seems a promising treatment modality for OCD. Further trials should assess log-term outcomes and effects on quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

The comorbidity of cluster C personality disorders in obsessive compulsive disorder as a marker of anxiety and depression severity

IntroductionComorbid Cluster C Personality Disorders (PDs) are the most prevalent PDs in Obsessive-Compulsive Disorder (OCD). Investigating clinical correlates associated to OCD with Cluster C PDs may allow identifying tailored treatment strategies.ObjectivesThe current study examined whether OCD with comorbid cluster C PDs is associated to more severe OCD symptoms, anxiety and depression relative to OCD with comorbid cluster B PDs or OCD alone.MethodsTwo hundred thirty-nine patients with OCD were included (mean age = 35.64, SD = 11.08, 51% females). Seventeen percent had a comorbid Cluster C PD, 8% had a comorbid Cluster B PD, and 75% had OCD alone. The Structured Clinical Interview for Axis II Disorders, Yale-Brown Obsessive Compulsive Scale, Beck Anxiety Inventory, Beck Depression Inventory-II were administered.ResultsPatients with comorbid Cluster C PDs reported more severe depression and anxiety than those with comorbid Cluster B PDs (F = 10.48, P &lt; 0.001) or with OCD alone (F = 9.10, P &lt; 0.001). Patients with comorbid Cluster C PDs had more severe OCD symptoms than those with OCD alone but not than those with comorbid Cluster B PDs (F = 3.12, P &lt; 0.05).ConclusionsOCD with Cluster C PDs could be a subtype with more severe anxiety and depression. These findings could be explained with the fact that Cluster C PDs are characterized by behaviours, which can be seen as maladaptive attempts to cope with anxiety and depression. Tailored treatment strategies for OCD with comorbid Cluster C PDs are discussed to target co-occurring anxiety and depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Group cognitive behavioural therapy for outpatients with obsessive-compulsive disorder in a psychiatric service in Italy

IntroductionGroup Cognitive Behavioural Therapy (GCBT) is a cost-effective modality of treatment alternative to individual Cognitive Behavioural Therapy (CBT). Despite several well-controlled trials demonstrated the efficacy of GCBT for Obsessive Compulsive Disorder (OCD), few studies evaluated the effectiveness of GCBT on outpatients attending routinary psychiatric services, and in Italy this topic appears understudied.ObjectivesThe current study evaluated the effectiveness of a GCBT protocol on OCD symptoms and comorbid depression and anxiety in a group of outpatients attending a psychiatric service in Italy.MethodTwenty outpatients with a diagnosis of OCD were included in the study and received 20 sessions of GCBT, consisting of psychoeducation on anxiety and OCD, relaxation training, in vivo/imaginal exposure and response prevention, cognitive restructuring for obsessive beliefs, cognitive defusion, and assertiveness training. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) were administered at pre- and post-treatment.ResultsTwo outpatients had a comorbid bipolar disorder, eight had a concurrent personality disorder. Ten outpatients were on concurrent antidepressants, five on antipsychotics. Three outpatients prematurely dropped out from treatment. Among completers, GCBT produced significant changes on OCD symptoms, anxiety and depression from pre- to post-treatment. The GCBT protocol was feasible and the outpatients reported high satisfaction judgements.ConclusionsFuture studies should investigate clinical predictors of best response after GCBT and assess maintenance of symptom changes at long-term follow-up.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec