Pathological Narcissism, Negative Parenting Styles and Interpersonal Forgiveness among Psychiatric Outpatients.

BACKGROUND: Pathological narcissism has previously been investigated with regard to negative parenting and interpersonal forgiveness, but inconsistent findings have been obtained in relation to its two phenotypic forms - grandiosity and vulnerability. Moreover, the role of negative parenting in the lack of forgiveness within narcissistic pathology has not been explored thus far. The aim of the current research was to investigate the complex relations among pathological narcissism, negative parenting, and interpersonal forgiveness in psychiatric outpatients. SUBJECTS AND METHODS: A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were enrolled in this study. The participants filled out the Pathological Narcissism Inventory (PNI), the Tendency to Forgive Scale (TTF), the Measure of Parental Styles (MOPS), and the Depression, Anxiety, Stress Scales (DASS21). RESULTS: Narcissistic grandiosity and narcissistic vulnerability were positively correlated with mothers' and fathers' negative parenting, but this association was significantly stronger in the case of narcissistic vulnerability. Only narcissistic vulnerability was related to interpersonal forgiveness. In the mediation analysis, negative parenting was not directly related to interpersonal forgiveness, however, this association became significant after introducing narcissistic vulnerability. Narcissistic vulnerability served as a full mediator of the mothers' and fathers' negative parenting - interpersonal forgiveness relationships. CONCLUSIONS: Narcissistic vulnerability seems to be more strongly related to negative parenting and interpersonal forgiveness than narcissistic grandiosity, while it also represents one of the underlying mechanisms of the negative parenting - interpersonal forgiveness relationship. The clinical implications of these findings are discussed in relation to pathological narcissism and lack of forgiveness.

Clinical Challenges in Patients with First Episode Psychosis and Cannabis Use: Mini-Review and a Case Study.

The influence of cannabis use on the occurrence, clinical course and the treatment of the first psychotic episode (FEP) is well documented. However, the exact link is still not clearly established. The aim of this article is to review and report the noticed increase in the number of hospitalizations of young people with a clinical appearance of severe psychotic decompensation following cannabis consumption and to show the clinical challenges in treatment of the FEP. The case study describes the clinical course of a five selected patients with a diagnosis of the FEP and positive tetrahydrocannabinol (THC) urine test who were hospitalized in a similar pattern of events. They all have a history of cannabis consumption for at least 6 years in continuity and were presented with severe psychomotor agitation, disorganisation, confusion and aggression at admission. Although the chosen drug to treat all patients was atypical antipsychotic and benzodiazepines, the course of the disorder and the clinical response to therapy were noticeably different in each patient. The clinical presentation of FEP in cannabis users can be atypical and highly unpredictable from mild psychotic symptoms to severe substance intoxication delirium. In clinical practice clinicians treating new onset psychosis need to be watchful for cannabis and synthetic cannabinoids induced psychosis. Pharmacotherapeutic interventions include prompt and adequate use of the benzodiazepine, second-generation antipsychotic, and mood-stabilizers. Further research in the pharmacotherapy of cannabis-induced psychosis is required.

Efficacy of Center for Integrative Psychiatry Multimodal Early Intervention Services in Early-Phase Psychosis on Hospital Readmission.

BACKGROUND: Growing body of evidence has opened new opportunities to enhance treatment outcomes during early-phase psychosis (EPP). The objective of this study was to evaluate the effect of the Centre for integrative psychiatry (CIP) multimodal Early Intervention Services (EIS) on time to relapse in the patients with early-phase psychosis (EPP) during 12 and 24 month period. SUBJECTS AND METHODS: We performed a retrospective cohort study on the sample of 454 EPP patients (duration of the diagnosed disorder ≤5 years) admitted to Psychiatric Hospital "Sveti Ivan", Zagreb Croatia, from January 2, 2015, to December 5, 2018, for the acute treatment of EPP. The end of follow up was March 5, 2019. The primary outcome was the time to rehospitalization because of relapse during the 12 months from the hospital discharge. Independent variable was the EIS. RESULTS: We analyzed 454 EPP patients, 260 in EIS group and 194 in no EIS group. After the adjustment for twenty possible confounding factors using the Cox proportional hazard regression, patients who received EIS had significantly and clinically relevantly lower hazard for rehospitalization because of relapse during the first 12 months (HR=0.39; CI95% 0.21-0.61; p<0.001), and during the first 24 months from the hospital discharge (HR=0.56; CI95% 0.39-0.80; p=0.003; sequential Holm-Bonferroni corrected pcorr=0.004). CONCLUSIONS: Our study indicated efficacy of the CIP multimodal EIS in patients with EPP demonstrated through the time to the hospital readmission because of relapse during the 12 and 24 months from the hospital discharge. These results strongly support the need for implementation of multimodal EIS in all patients with EPP.