The Inter-Rater Reliability and Validity of the Italian Translation of the Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders Module I and Module II: A Preliminary Report on Consecutively Admitted Psychotherapy Outpatients.

To evaluate the reliability and convergent validity of the Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD) Module I and Module II, 88 adult psychotherapy participants were administered the Italian translations of the SCID-5-AMPD Module I and Module II, Level of Personality Functioning Scale-Brief Form (LPFS-BF), Level of Personality Functioning Scale-Self Report (LPFS-SF), Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4+ (PDQ-4+), and Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) relying on a Williams crossover design. SCID-5-AMPD Module I and Module II showed excellent inter-rater reliability. In terms of convergent validity, meaningful associations were observed between SCID-5-AMPD Module I scores and self-report measures of Criterion A; similarly, SCID-5-AMPD Module II trait scores were meaningfully related to PID-5 trait scores. As a whole, our preliminary findings supported the clinical utility of DSM-5 AMPD.

Interview-based ratings of DSM-IV Axis II/DSM-5 Section II Personality Disorder symptoms in consecutively admitted insomnia patients: A comparison study with consecutively admitted psychotherapy patients matched on age and gender.

BACKGROUND: Selected personality features may represent important predisposing as well as perpetuating factors for insomnia, and previous studies stressed the importance to assess personality disorders in insomnia patients. METHODS: In order to evaluate the relationships between DSM-IV Axis II/DSM-5 Section II Personality Disorders (PDs) and insomnia, a sample of 171 consecutively admitted insomnia patients and a sample of 171 psychotherapy patients, matched on age and gender were administered the Italian translation of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II). Among insomnia patients, 52.0% (n = 89) received at least one DSM-IV Axis II/DSM-5 Section II PD diagnosis according to SCID-II assessment. RESULTS: Any PD base rate estimate in our insomnia patient sample was significantly and markedly higher than the median and mean base rate estimates for any PD in the general population. Within-group analyses showed that Narcissistic, Not otherwise specified PD, Histrionic PD, and Borderline PD represented the most frequently diagnosed-both dimensionally and categorically-DSM-IV Axis II/DSM-5 Section II PD features in our insomnia patient sample. When continuously-scored PDs were considered, insomnia patients showed a significantly lower number of Paranoid and Borderline PD features than psychotherapy patients; however, the corresponding effect size estimates suggested that these differences were modest. None of the categorically-scored PDs significantly differentiated insomnia patients from psychotherapy patients. CONCLUSIONS: As a whole, our findings seemed to suggest that personality dysfunction may play a role in insomnia, while stressing the need for a dimensional approach to the assessment of maladaptive personality traits even in insomnia patients.

Long-term clinical effect of group cognitive behavioral therapy for insomnia: a case series study.

OBJECTIVE: Cognitive-behavioral therapy for insomnia (CBT-I) is recognized as the first-choice intervention for insomnia. One of the best-known advantages of CBT-I in comparison with pharmacotherapy is its long-term effect. However, only few studies have assessed its benefits with follow-up periods of longer than three years. In this clinical case series study we aimed to describe the long-term effects of group CBT-I after a mean 7.8 ± 1.6 years of follow-up (range 4-10 years). METHODS: A total of 292 insomnia disorder (ID) patients were consecutively enrolled at the Sleep Disorders Center of San Raffaele Hospital, Milan; 123 patients (82 (66.7%) females and 41 (33.3%) males, mean age 40.59 ± 11.89 years) completed the follow-up evaluation within a range of 4-10 years. RESULTS: In the 258 patients who completed the treatment, insomnia severity index (ISI) total score improved significantly as well as all variables of the sleep diaries. Using ISI as the primary outcome, we demonstrated that the effect of CBT-I is maintained up to 10 years after the end of treatment. Furthermore, we found that patients that used only CBT-I techniques to deal with relapses were the ones with better outcomes, in particular compared to the patients that re-used medications. CONCLUSION: To the best of our knowledge this is the longest follow-up evaluation in the literature, both for group and individual CBT-I. These findings have an important clinical implication both suggesting and confirming that CBT-I can be considered the treatment of choice for insomnia.

Reliability, Factor Structure, and Associations With Measures of Problem Relationship and Behavior of the Personality Inventory for DSM-5 in a Sample of Italian Community-Dwelling Adolescents.

In order to assess the reliability, factorial validity, and criterion validity of the Personality Inventory for DSM-5 (PID-5) among adolescents, 1,264 Italian high school students were administered the PID-5. Participants were also administered the Questionnaire on Relationships and Substance Use as a criterion measure. In the full sample, McDonald's ω values were adequate for the PID-5 scales (median ω = .85, SD = .06), except for Suspiciousness. However, all PID-5 scales showed average inter-item correlation values in the .20-.55 range. Exploratory structural equation modeling analyses provided moderate support for the a priori model of PID-5 trait scales. Ordinal logistic regression analyses showed that selected PID-5 trait scales predicted a significant, albeit moderate (Cox & Snell R2 values ranged from .08 to .15, all ps < .001) amount of variance in Questionnaire on Relationships and Substance Use variables.

Systems Training for Emotional Predictability and Problem Solving Program and Emotion Dysregulation: A Pilot Study.

The aim of this study was to assess the observed changes on emotion dysregulation obtained through the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program. The sample is composed of 24 subjects with a personality disorder with borderline features. All participants filled out the Difficulties in Emotion Regulation Scale (DERS). There was a significant decrease in the DERS total score at the end of the treatment and at 6-month follow-up. Friedman test showed a significant decrease in suicide attempts and hospitalizations over time. The analysis of the DERS subscales showed that "goals" and "impulse" were the two dimensions on which the treatment acted and the changes were stable over time. STEPPS is associated with an improvement in emotion regulation and a reduction in the number of hospitalizations and suicide attempts. The treatment seems to act on the behavioral dimensions of emotion dysregulation like the ability to control impulsive behaviors and to achieve goals.

Validation study of the Italian version of the Insomnia Severity Index (ISI).

To test the factorial structure of the Italian version of the Insomnia Severity Index (ISI) using a confirmatory approach and to assess its psychometric properties. ISI questionnaire was completed by 272 patients (average age 41.28, range 18-73) with insomnia diagnosis performed by a sleep medicine physician and retrospectively enrolled in the study. All patients underwent Cognitive Behavioral Treatment for Insomnia (CBT-I) and completed sleep diaries before starting the treatment. Data from sleep diaries were analyzed for assessing concurrent validity of the ISI. Confirmatory factor analysis (CFA) for ordinal Likert-type items was applied to compare four competing models proposed in the literature. 244 patients, out of the 272, completed the ISI at the end of CBT-I. A comparison of ISI score before and after treatment was performed. The CFA analysis confirmed the presence of three main factors conceptualized as severity and impact of the disease along with sleep satisfaction. Significant correlations of the first three items of the questionnaire, investigating three different subtypes of insomnia, and the subjective measures from the sleep diaries were found, thus supporting the concurrent validity of the test. Sleep efficiency (SE) had a significant inverse correlation with the severity and satisfaction factors and with ISI's total score. After CBT-I treatment, a significant reduction of ISI's scores was observed, thus confirming the effectiveness of the CBT-I treatment. The internal reliability coefficient was 0.75. The ISI questionnaire maintains good psychometric properties in the Italian version, thus confirming that this instrument is reliable for detecting insomnia severity and identifying patients' symptoms.

Systems Training for Emotional Predictability and Problem Solving (STEPPS): program efficacy and personality features as predictors of drop-out -- an Italian study.

In this study we present a clinical application of the STEPPS model in an Italian sample of severely affected patients with borderline personality disorder (BPD) or personality disorder (PD) with prominent borderline features in comorbidity with a mood disorder. The aims of this work are: 1) to confirm our preliminary results in a larger sample and at a 12-month follow-up, and 2) to identify predictors of drop-out vs completion of STEPPS in order to understand which characteristics of patients make them suitable or not for this treatment. The sample is composed of 32 subjects recruited from a population of inpatients of the Mood Disorders Center, Department of Clinical Neurosciences, Hospital San Raffaele-Turro, Milan. To confirm STEPPS efficacy at 12-month follow-up, we selected the following outcome criteria: reduction in the number of hospitalizations related to self-harm acts; reduction in the number of suicidal attempts; reduction of perceived emotional intensity levels; changes in cognitive filter scores; changes in the scores on self-report questionnaires. To identify predictors of drop-out vs completion, we analysed the following variables: demographic features (sex, marital status, school level achieved, and job status); Axis-I diagnosis; Axis-II categorical and dimensional diagnosis; and personality features. Seventeen (53%) subjects completed the treatment successfully. The drop-out rate was 47%. Patients who completed the program show a significant decrease in the number of hospitalizations, both at the end of the treatment and at 12-month follow-up. Friedman ANOVA test shows a significant decrease in suicidal attempts during and after STEPPS, and at 12-month follow-up. Analysis of drop-outs showed no significant differences with regard to sex, marital status, school level and job status between the two groups. Axis-I and Axis-II categorical diagnoses did not discriminate between the two groups. Those patients who dropped differ significantly from completers in histrionic personality traits and magical thinking index, given by the interaction between low scores in Self-Directedness and high scores in Self-Transcendence.

Pramipexole versus ropinirole: polysomnographic acute effects in restless legs syndrome.

BACKGROUND: Pramipexole and ropinirole have become the first-line treatment for restless legs syndrome. The aim of this study was to perform the first direct comparison between these two molecules in restless legs syndrome. METHODS: A double-blind, placebo-controlled, double-night and prospective investigation was carried out in 45 consecutive naïve patients with idiopathic restless legs syndrome. Each patient underwent two consecutive full-night polysomnographies: the first baseline recording was performed without premedication and, before the second recording, first group received a single oral dose of 0.25 mg pramipexole, second group a single oral dose of 0.5 mg ropinirole, and the remaining patients received placebo. RESULTS AND DISCUSSION: Both dopamine agonists improved restless legs syndrome symptoms and markedly suppressed periodic leg movements during sleep compared to placebo, without significant differences between pramipexole and ropinirole. No significant side effects, except for mild morning nausea (2 patients treated with ropinirole, 3 with pramipexole, and 1 with placebo), were reported.

Alexithymia and attachment insecurities in impulsive aggression.

The aims of this study were to develop a new measure of impulsive aggressiveness, and to assess whether this measure was associated with deficits in mentalized affectivity and adult attachment styles in a sample of 637 non-clinical participants. Extending Fonagy and Bateman's (2004) hypothesis, the mediating role of poor affectivity mentalization in the relationship between insecure attachment styles and impulsive aggression was also evaluated. Selected insecure attachment styles (R2(adjusted) = .18, p < .001) and deficits in mentalized affectivity (R(2)(adjusted) = .25, p < .001) were significantly associated with impulsive aggressiveness. The overall regression model accounted for roughly 33% of the variance in impulsive aggressiveness. Mentalization deficits significantly mediated the effects of attachment styles on impulsive aggressiveness, although effect size measures suggested that only partial mediation occurred.

Reliability and validity of the Italian version of the Temperament and Character Inventory-Revised in an outpatient sample.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Temperament and Character Inventory-Revised (TCI-R) in an outpatient sample. METHOD: The TCI-R was administered to 404 consecutively admitted subjects. The TCI-R scale 1-month test-retest reliability and TCI-R/TCI convergent validity were assessed in 2 independent subsamples. RESULTS: The TCI-R scales showed adequate Cronbach alpha values and acceptable 1-month test-retest reliability coefficients. Although many TCI-R facets showed factorial complexity, factor analysis results were consistent with the 7-factor structure of the TCI-R scales. The predictive validity of TCI-R profiles for personality disorder diagnoses was confirmed, with different combinations of temperament dimensions being associated with specific personality disorders. CONCLUSIONS: The TCI-R was a reliable and valid instrument for assessing temperament and character features, at least among Italian outpatients. The TCI-R psychometric properties support its clinical usefulness in the assessing of personality psychopathology.