Assessment of Interpersonal Motivation in Transcripts (AIMIT): an inter- and intra-rater reliability study of a new method of detection of interpersonal motivational systems in psychotherapy.

Assessing Interpersonal Motivations in Transcripts (AIMIT) is a coding system aiming to systematically detect the activity of interpersonal motivational systems (IMS) in the therapeutic dialogue. An inter- and intra-rater reliability study has been conducted. Sixteen video-recorded psychotherapy sessions were selected and transcribed according to the AIMIT criteria. Sessions relate to 16 patients with an Axis II diagnosis, with a mean Global Assessment of Functioning of 51. For the intra-rater reliability evaluation, five sessions have been selected and assigned to five independent coders who where asked to make a first evaluation, and then a second independent one 14 days later. For the inter-rater reliability study, the sessions coded by the therapist-coder were jointly revised with another coder and finally classified as gold standard. The 16 standard sessions were sent to other evaluators for the independent coding. The agreement (κ) was estimated according to the following parameters for each coding unit: evaluation units supported by the 'codable' activation of one or more IMS; motivational interaction with reference to the ongoing relation between patient and therapist; an interaction between the patient and another person reported/narrated by the patient; detection of specific IMS: attachment (At), caregiving (CG), rank (Ra), sexuality (Se), peer cooperation (PC); and transitions from one IMS to another were also scored. The intra-rater agreement was evaluated through the parameters 'cod', 'At', 'CG', 'Ra', 'Se' and 'PC' described above. A total of 2443 coding units were analysed. For the nine parameters on which the agreement was calculated, eight ['coded (Cod)', 'ongoing relation (Rel)', 'narrated relation (Nar)', 'At', 'CG', 'Ra', 'Se' and 'PC'] have κ values comprised between 0.62 (CG) and 0.81 (Cod) and were therefore satisfactory. The scoring of 'transitions' showed agreement values slightly below desired cut-off (0.56). Intra-rater reliability was very good (κ values for Cod = 0.90; κ for all IMS = 0.78). Data seem to support the validity of the AIMIT method in terms of reliability, and encourage to further implementation of the AIMIT approach.

Risk factors in the early family life of patients suffering from dissociative disorders.

OBJECTIVE: To test the hypothesis that not only intrafamiliar childhood abuses inflicted to the patient, but also major losses or other severe life events suffered by the mother within 2 years of patient's birth, are risk factors for the development of dissociative disorders (DDs). METHOD: A multicentric case-control study of 52 cases and 146 controls. RESULTS: We estimated a crude odds ratio (OR) of 2.6 (adjusted 1.9) for mothers' losses or other severe life events experienced within 2 years of patient's birth, and a crude OR of 7.6 (adjusted 7.2) for patient's early traumatic experiences. CONCLUSION: Mother's losses or other severe life events within 2 years of patient's birth and patient's traumatic experiences during childhood are risk factors for the development of dissociative disorders. A possible explanation of these findings is that disorganized or insecure attachment may increase susceptibility to traumatic experiences and propensity to dissociation in adult life.

Treatment of major depressive disorder in primary care in Rome, Italy.

This study describes the treatments that 253 patients affected by major depressive disorder, according to DSM-III-R criteria, received by their general practitioner prior to their referral to the outpatients clinic of the Department of Psychiatry of the University of Rome "La Sapienza". Out of 253 study subjects only 97 had received prescriptions of antidepressant drugs. In about 50% of these cases (corresponding to 27.4% of the study population) prescribed dosages were inadequate. In 34.7% of subjects who sought medical help antidepressants were not prescribed and other psychotropic drugs (mostly benzodiazepines) or pseudodrugs were used. In 6% of cases no treatment was prescribed. Over one third of the outpatients had been ill for over one year prior to their referral to a psychiatrist. Remedial actions are considered.

Noradrenergic and dopaminergic interrelation in schizophrenia.

Growth hormone (GH) and prolactin (PRL) responses to the acute administration of clonidine (150 micrograms) and apomorphine (0.5 mg) were investigated in parallel in 20 drug-free subchronic and chronic schizophrenic patients and in nine control subjects. Neither basal levels of the two hormones nor their mean responses to both stimuli differed significantly between the two groups. However, eight patients had blunted GH responses to clonidine and seven to apomorphine; only two patients showed blunted GH responses to both stimuli. The blunted GH response to apomorphine correlated with the chronicity of the disorder. A greater than normal GH response to clonidine stimulation was observed in paranoid patients. Significant correlations were observed between negative symptoms and GH responses to clonidine (negative), between negative symptoms and PRL responses to apomorphine (positive), and between positive symptoms and PRL responses to apomorphine (negative).