Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder.

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.

Can personality traits influence occupational stress in multiple sclerosis patients? A one-year longitudinal study.

Recent studies suggest that patients with Multiple Sclerosis (MS) might be at risk of unemployment due to physical and psychological symptoms. Furthermore, MS patients appear to be more exposed to a higher level of occupational stress, which might be linked to some personality characteristics. Our aim was to ascertain, by means of a longitudinal study, whether changes in occupational stress can be predicted by some personality traits, which could thereby become potential targets of therapeutic interventions. This study describes the longitudinal results of a previous work on occupational stress and personality traits in MS patients. Twenty MS patients were reevaluated one year after the baseline assessment. The statistical comparison between the baseline and follow-up visits showed a significant change in the scores on some Occupational Stress Inventory (OSI) subscales-Locus of control total (LOC-tot) and Involvement coping strategies (CI). While Neuroticism and Openness might predict changes in LOC-tot, Conscientiousness appeared to be important in the development of CI at one year. The findings indicate that certain personality traits can influence some longitudinal changes in occupational stress, thus making them useful in predicting stress at workplace.

The Italian validation of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS) and the application of the Cognitive Impairment Index scoring procedure in MS patients.

Cognitive dysfunction occurs in almost 50-60% of patients with multiple sclerosis (MS) even in early stages of the disease and affects different aspects of patient's life. Aims of the present study were (1) to introduce and validate an Italian version of the minimal assessment of cognitive functions in MS (MACFIMS) battery and (2) to propose the use of the Cognitive Impairment Index (CII) as a scoring procedure to define the degree of impairment in relapsing-remitting (RRMS) and secondary-progressive (SPMS) patients. A total of 240 HC and 123 MS patients performed the Italian version of the MACFIMS composed by the same tests as the original except for the Paced Auditory Serial Addition Test. The CII was derived for each score of the 11 scales for participants of both groups. The results of the study show that cognitive impairment affects around 50% of our sample of MS patients. In RRMS group, only the 15.7% of patients reported a severe impairment, while in the group of SPMS, the 51.4% of patients felt in the "severely impaired" group. Results are in line with previously reported percentages of impairment in MS patients, showing that the calculation of the CII applied to the Italian version of the MACFIMS is sensitive and reliable in detecting different degrees of impairment in MS patients.

A more in-depth interpretation of MMPI-2 in MS patients by using Harris and Lingoes subscales.

Multiple Sclerosis (MS) is frequently associated with neuropsychiatric abnormalities. The aim of our study was to discriminate between psychosomatic disturbances and MS physically-related symptoms using the Harris-Lingoes subscales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Forty-six MS out-patients (35 females; mean age = 44.5); and 82 healthy volunteers (62 females; mean age = 46.5) were evaluated with MMPI-2 questionnaire. The frequency distribution of MMPI-2 clinical scales with high scores (> = 65) and the related Harris-Lingoes subscales were analyzed for both MS patients and healthy control subjects. Data analysis showed elevated scores in 47.8% of the patients mainly on MMPI-2 clinical scales 1, 2, and 3. The Harris-Lingoes subscales analysis allowed us to isolate and identify physical symptoms contributing to elevation of MMPI-2 clinical scales, reduce the occurrence of false positives (MMPI-2 clinical scales elevations mainly due to MS physical disability) and provide a more detailed description of psycho-emotional symptoms of MS patients. In conclusion, our study shows the utility of Harris-Lingoes subscales analysis when MMPI-2 is used for psychological assessment of MS patients.

[Domestic accidents in patients with multiple sclerosis: proposal and application of questionnaires for their detection]. / Gli incidenti domestici nei pazienti con Sclerosi Multipla: proposta e applicazione di questionari per la loro rilevazione.

OBJECTIVES: Domestic accidents are an important topic as for different viewpoints: for the people that could be victim of them, for the health and economic systems. It could be imagined that people affected by neurological diseases, such as Multiple Sclerosis (MS), could incur into domestic accidents more frequently than people in the general population. Aim of the present work is to introduce a survey's questionnaire for registering occurrence and characteristics of domestic accidents in a population with particular features such as MS patients. METHODS: In 2011, a first edition of this survey questionnaire was already proposed and then applied with a sample of MS patients (QuID). RESULTS: A subsequent newest version of the test (QuID-II) has then been proposed, based on the information collected and on the limits showed by that first edition. CONCLUSIONS: With this new version deepen information can be collected on the characteristics, the biological, environmental and behavioural risk factors for the occurrence of domestic accidents, and this could be useful in planning prevention programs.

Adverse working events in patients with multiple sclerosis.

Multiple sclerosis (MS) and working status have recently arisen great interest. Fatigue, physical disability, cognition, and psychological disturbances have been linked to unemployment, as well to accidents during daily activities. The aim of our study was to determine frequency of different types of accidents at workplace (AWE) and possible clinical differences among employed (MSe) and unemployed (MSu) MS patients. Sixty MS patients (31 employed, 29 unemployed) and twenty healthy control subjects were recruited. All employed participants were requested to complete an ad-hoc questionnaire to collect AWE and related risks occurring at workplace in the past 2 months. Physical, cognitive, mood, and fatigue evaluations were also assessed. Illness and bumps along with risk of bumps and near falls resulted the most frequent AWE and risks occurring in MSe. Interestingly, those AWE were mostly observed among subjects with anxiety, depression, and cognitive fatigue rather than depending on severity of physical impairment. Moreover, psychological aspects, like anxiety and anger, seemed to play a crucial role in determining AWE. This study provides data on AWE occurrence and suggests possible mechanisms underlying negative events at workplace in MS. This might be important for planning strategies of AWE prevention in MS patients.

Regression-Based Norms for the Brief Visuospatial Memory Test-Revised in Italian population and application in MS patients.

OBJECTIVE: The Brief Visuospatial Memory Test-Revised (BVMT-R) is one of the most widely used tests for the assessment of learning and memory in the visual/spatial domain. The aim of this study was to use multiple regression to derive normative data for the use of BVMT-R in an Italian population. METHOD: We employed a regression-based norms procedure to maximally utilize a relatively small sample while controlling for a variety of demographic factors in addition to age. Additionally, we used these norms to compare the performance of Italian healthy controls with patients diagnosed with multiple sclerosis (MS), thereby providing evidence of the method's validity. RESULTS: A total of 200 healthy volunteers and 70 MS patients participated in this study and completed the BVMT-R according to the published procedures. Regression-based norms were generated for the Italian sample and are presented herein. CONCLUSIONS: Using these norms, the performance of the MS patients was found to be significantly worse than that of the controls.

Occupational stress and personality traits in multiple sclerosis: A preliminary study.

Multiple Sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system, causing a wide range of neurological and psychological symptoms. Impairment of ambulation and cognition in particular are associated with work difficulties and unemployment. Although many aspects of work status have been investigated in MS, there are no reports on factors that predict the development of occupational stress, prior to job loss. The aim of this preliminary study was to ascertain if personality traits predispose MS patients to occupational stress. We evaluated 26 MS patients using physical disability scales and self-report questionnaires focused on mood, fatigue, and personality [measured with the NEO Five Factor Inventory]. The primary outcome measure was the Occupational Stress Indicator [OSI]. Results showed significant positive correlations (p<.05) between high neuroticism, and occupational stress. Conversely, low extraversion and conscientiousness were also associated with job stress. The direction of these correlations was consistent with prior research showing that high neuroticism, and low extraversion and conscientiousness, are risk factors for MS disease severity as evidenced by brain atrophy, cognitive impairment and adaptation in MS. We are developing interventions to help patients cope with these maladaptive personality dispositions in the hope that employment may be maintained.

A Preliminary Investigation of Abnormal Personality Traits in MS Using the MCMI-III.

Neuropsychiatric abnormalities are frequently reported in patients with multiple sclerosis (MS). Previous studies have investigated the neurotic aspects of psychopathology, and the importance of the personality structure underlying neurotic symptoms has only recently been reconsidered. The aim of our study was to investigate the frequency and type of personality profiles in MS using the Millon Clinical Multiaxial Inventory-III (MCMI-III). We evaluated 77 nondemented patients with MS using physical disability scales and self-report questionnaires focused on mood, fatigue, and personality. In our cohort study, we found a personality scale score greater than 85 in 62.3% of enrolled participants. In particular, high scores on the Histrionic and Narcissistic scales emerged, respectively, in 20.8% and 15.6% of the sample. The presence of moderate abnormal elevation scores in MCMI personality scales in MS does not seem to be influenced by age, the Expanded Disability Status Scale score, disease course, or disease duration. Our research study focused on the importance of identifying personality maladaptation in patients with MS.

Assessing clinical correlates of self-rated disability in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is associated with significant impairment. OBJECTIVE: The objective of this article is to identify and compare clinical measures that can predict self-rated disability in patients with MS using the World Health Organization Disability Assessment Schedule II (WHODAS-II). METHODS: Patients with MS and healthy controls were consecutively recruited at one center. Patients were evaluated for cognitive function assessment, neurological status, perceived disability, mood, fatigue and disease duration. Controls underwent neuropsychological evaluation only. Data were analyzed using multivariate regression. RESULTS: WHODAS-II total score was predicted by fatigue (p < 0.001) and neurological status (p < 0.05). Student's t test comparisons between published WHODAS-II normative data and the enrolled cohort of patients with MS showed significantly worse (p < 0.05) scores for patients on mobility, self-care, life activities, participation and total score domains, but not in cognition. Group differences between patients with MS (n = 61) and controls (n = 61) were significant in all cognitive measures except one verbal memory test subscale. Memory function correlated best with the social participation domain of the WHODAS-II. CONCLUSIONS: Self-reported disability in patients with MS was most strongly influenced by fatigue and to a lesser extent by physical disability. Although cognitive function does affect self-assessment of disability, this is not captured by patients on the WHODAS-II cognitive domain.

Validation of the World Health Organization Disability Assessment Schedule II (WHODAS-II) in patients with multiple sclerosis.

BACKGROUND: The World Health Organization Disability Assessment Schedule (WHODAS-II) is a widely used generic assessment instrument for health and disability. However, a specific psychometric evaluation for this scale in multiple sclerosis (MS) is lacking. This study is aimed at the assessment of the psychometric properties of the WHODAS-II in MS with Cronbach's α and modern Rasch-model analyses. METHODS: The WHODAS-II was administered to 136 consecutively recruited MS patients. Several indexes of fit to the Rasch model were evaluated in order to assess internal construct validity. Internal consistency was assessed with Cronbach's α and the Person Separation Index (PSI). External validity was evaluated by analyzing correlations between the WHODAS-II and the Multiple Sclerosis Quality of Life-54 (MSQoL-54). RESULTS: Classical reliability indexes (Cronbach's α and intraclass correlation) showed good to excellent reliability for most of the subscales and for the total scale (α = 0.93). The total scale both with (36 items) or without (32 items) work items reached good fit to the Rasch model (PSI = 0.83). However, analysis of the subscales could resolve only four subscales out of seven. CONCLUSIONS: The WHODAS-II is a reliable and valid instrument for the assessment of patient-reported disability in MS, with some limitations including some item redundancy and questionable reliability of some subscales.

The California Verbal Learning Test-II: normative data for two Italian alternative forms.

The aim of this study was to develop two versions of the California Verbal Learning Test-II (CVLT-II) and to administer them to a large sample of healthy controls representative of the normal Italian population for sex, age, and education levels. Two hundred and eighty healthy controls entered the study and were randomly assigned to one of the two forms of CVLT-II. No significant difference emerged between the two forms. Considering the significant weight of sex, age and education level, a regression model was developed through which it was possible to calculate the adjusted scores. The lower tolerance limits were also calculated.

Domestic accidents and multiple sclerosis: an exploratory study of occurrence and possible causes.

PURPOSE: Domestic accidents are widespread, but no data are available on their occurrence in pathological populations such as patients with multiple sclerosis (MS). Aim was to investigate domestic habits and occurrence of different types of domestic accidents and near falls in a sample of MS patients compared with healthy controls and to determine whether patients' domestic accidents are linked to any disease characteristics. METHOD: Descriptive survey of 50 patients and 50 healthy controls. Participants were administered an ad-hoc questionnaire to collect data on domestic habits and accidents they had in the past 2 months. Their physical and neuropsychological functioning, mood and fatigue were also assessed. RESULTS: Results showed that patients spend most of their time at home with caregivers. No differences emerged for total number of domestic accident types, but there were differences in bumps and near falls. The latter seem to be linked to patients' walking ability and to bowel/bladder functioning and the former to reasoning ability and fatigue. CONCLUSIONS: This study provides the first data on the occurrence of domestic accidents and possible causes in MS patients. It encourages further studies on the topic, with the final goal of designing preventive and rehabilitation strategies.