Psychopathological dimensions and the clinician's subjective experience

Picardi, Angelo; Pallagrosi, Mauro; Fonzi, Laura; Biondi, Massimo

doi:10.1016/j.psychres.2017.08.079

Cited by 18 publications

(14 citation statements)

References 33 publications

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“…The patients included in this study come from a recently completed study performed at the psychiatric department of the Umberto I Policlinico Hospital, Sapienza University of Rome, and from three previous studies carried out in a sample of acute inpatient units spread across Italy ( 34 , 35 ), in a number of psychiatric inpatient and outpatient units in Rome ( 36 ), and in several community mental health centers distributed across Italy ( 37 ). A total of 830 adult patients aged 18–65, who were free from intellectual disability or severe cognitive impairment and were diagnosed with a major psychotic disorder (schizophrenia, paranoid, disorganized, catatonic, or undifferentiated type; delusional disorder; schizoaffective disorder; bipolar I disorder, current episode manic, or mixed with psychotic features; bipolar I or II disorder, current episode depressed with psychotic features; major depressive disorder with psychotic features) were included in the study.…”

Section: Methodsmentioning

confidence: 99%

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Delusional Themes Across Affective and Non-Affective Psychoses

et al. 2018

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The current debate about the diagnostic significance of delusion revolves around two positions. The neurocognitive position conceives delusion as a non-specific, though polymorphic, symptom. The psychopathological position views features of delusion such as content and structure as having meaningful connections with diagnostic entities. This study aims at contributing to this debate by examining the association between delusional themes and diagnosis in a sample of 830 adult psychotic patients. All diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria, and in 348 patients were established with the SCID-I. All patients were administered the Brief Psychiatric Rating Scale (BPRS). In each patient, the presence of somatic delusions and delusions of guilt, grandiosity, and persecution was determined by examining the scores on relevant BPRS items. Delusions of guilt were almost pathognomonic for a psychotic depressive condition (psychotic major depression 40%; psychotic bipolar depression 30%; depressed schizoaffective disorder 8%; bipolar and schizoaffective mixed states 6 and 7%, respectively). Only 1% of patients with schizophrenia and no patient with delusional disorder or bipolar or schizoaffective manic state showed such delusions. The difference between unipolar and bipolar depression and the other diagnostic groups was highly significant. Delusions of grandiosity characterized mostly patients with manic symptoms (bipolar mania 20%; bipolar mixed states 19%; manic schizoaffective disorder 10%). They were observed significantly more often in bipolar mania than in schizophrenia (7%). Persecutory delusions were broadly distributed across diagnostic categories. However, they were significantly more frequent among patients with schizophrenia and delusional disorder compared with depressed and manic patients. Somatic delusions were also observed in all diagnostic groups, with no group standing out as distinct from the others in terms of an increased prevalence of somatic delusions. Our findings suggest a middle position in the debate between the neurocognitive and the psychopathological approaches. On the one hand, the widespread observation of persecutory delusions suggests the usefulness of searching for non-specific pathogenic mechanisms. On the other hand, the association between some delusional contents and psychiatric diagnosis suggests that a phenomenological analysis of the delusional experience may be a helpful tool for the clinician in the diagnostic process.

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Section: Methodsmentioning

confidence: 99%

“…A total of 348 patients were administered the SCID-I. In the other studies ( 34 – 36 ), involving a total of 482 patients, the diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria.…”

Section: Methodsmentioning

confidence: 99%

Delusional Themes Across Affective and Non-Affective Psychoses

et al. 2018

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“…The reliability of the DSM and ICD systems on capture trauma and dissociative-related disorders has been greatly increased (for instance, through the introduction of complex PTSD in ICD-11), improving diagnostic agreement among clinicians and providing researchers with rigorous diagnostic standards. Nevertheless, the use of diagnostic categories of these classification systems risks producing an impoverished view of psychopathology and less clinical sensitivity and precision (Picardi et al., 2017).…”

Section: Traumatic-dissociative Dimension: Some Reflections On Its Usmentioning

confidence: 99%

The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Farina

Liotti²,

Imperatori

2019

Front. Psychol.

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Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the “traumatic-dissociative” dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.

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“…In fact, even though cultural diversity may entail a substantial variation in the interpersonal exchange, especially when there is a linguistic barrier, it is still unclear how profoundly it could affect the prereflective emotional and perceptual experience of the psychiatrist. Indeed, in our previous studies with the ACSE [25, 26, 59], the patient’s psychopathological condition emerged as the variable most strongly correlated with the clinician’s experience, while a number of aspects which contribute to the “cultural” dimension of the interaction (i.e., sex, age, education, and clinician’s expertise) seemed to play a minor role.…”

Section: Introductionmentioning

confidence: 99%

“…A small number of studies have empirically explored how the interpersonal climate of the psychiatric encounter may affect the diagnostic reasoning [21][22][23], and only recently an instrument for the standardized quantitative evaluation of the psychiatrist's subjective experience during patient assessment has been developed [24]. This instrument, named Assessment of Clinician's Subjective Experience (ACSE), describes and quantifies the clinician's experience along 5 dimensions (tension, difficulty in attunement, engagement, disconfirmation, and impotence), and has been successfully used in 2 studies exploring the relationship between the clinician's feelings and the patient's categorical [25] or dimensional diagnosis [26]. These studies have corroborated the above-mentioned considerations about the connection between the clinician's subjective experience and his or her diagnostic orientation, especially concerning patients with schizophrenia and cluster B personality disorder.…”

Section: Introductionmentioning

confidence: 99%

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

Fonzi¹,

Picardi

Monaco

et al. 2020

Psychopathology

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Introduction: The clinical encounter is still at the core of the psychiatric evaluation. Since the diagnostic process remains basically clinical in nature, several authors have addressed the complexity of the clinical reasoning process and highlighted the role played by intersubjective phenomena and clinician’s feelings. Some recent studies have supported the view of a significant link between the clinician’s subjective experience during the assessment and the diagnosis made. In a globalized world, this issue requires a careful reflection, since cultural differences may affect the intersubjective atmosphere of the encounter, which may indirectly influence the clinician’s thinking. Methods: We used a previously validated instrument, named Assessment of Clinician’s Subjective Experience (ACSE), to compare the clinician’s subjective experience during the evaluation of Italian patients with the subjective experience of the same clinician during the assessment of foreign patients. The 2 patient groups (n = 42 each) were individually matched for known potential confounders (age, sex, categorical diagnosis, and clinical severity). Results: We found no significant differences in mean scores on all ACSE dimensions (tension, difficulty in attunement, engagement, disconfirmation, and impotence), which suggests that cultural diversity did not substantially affect the clinician’s subjective experience. However, the lack of information about the native country and linguistic proficiency of about a quarter of foreign patients may have limited the possibility to detect subtle or specific differences, especially with regard to the clinician’s empathic attunement. Conclusions: Although further investigation is needed, our preliminary findings may have significant implications for the reflection upon the clinician’s empathic experience as well as pragmatic consequences for the act of psychiatric diagnosis in the cross-cultural encounter.

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Psychopathological dimensions and the clinician's subjective experience

Cited by 18 publications

References 33 publications

Delusional Themes Across Affective and Non-Affective Psychoses

Delusional Themes Across Affective and Non-Affective Psychoses

The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

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