Uniwersyteckie Czasopisma NaukoweThe use of multidimensional assessment in developmental age: How evaluation of the emotional-autonomic state can facilitate the differential diagnosis in psychopathology. Description of two case studies
Słowa kluczowe:
clinical cases, psychophysiology, differential diagnosis, developmental age, multidimensional assessmentAbstrakt
Background:
Mental suffering involves cognitive, behavioral, and emotional aspects, which can manifest explicitly or remain implicit. The use of different clinical tools may allow the collection of information deriving from different channels. In the field of clinical psychopathology, there is scientific evidence regarding the use of psychophysiological parameters to identify emotional conditions characterized by hyperarousal or hypoarousal and thus favor the differential diagnosis.
Participants and procedure:
Our work describes two case studies demonstrating that a multidimensional assessment can comprehensively help the differential diagnosis.
Results:
The first case concerns a child (9 years old) brought to an assessment for behavioral disorders. The psychological tests high-lighted irritability and mood alteration as prevalent concerning the behavioral manifestations (outbursts of anger, etc.). Additionally, a psychophysiological evaluation confirmed the depressive state characterized by a condition of psychophysical exhaustion. The second case concerns a girl (14 years old) diagnosed with major depressive disorder by a psychiatrist who treated her with psychotropic drugs. The antidepressants worsened her symptoms to the point of being the cause of suicidal attempts. The multidimensional evaluation documented the presence of hyperarousal at an emotional and autonomic level, a characteristic known in the literature to be a precursor of suicidal ideation.
Conclusions:
These case studies represent clear examples of how only a multidimensional assessment can describe the entire suffering of the person and support their health through a personalized intervention.
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Bibliografia
Achenbach, T. M. (2001). CBCL (Child Behavior Checklist 4-18). Adattamento italiano e standardizzazione a cura di M. Molteni e A. Frigerio [CBCL (Child Behavior Checklist 4-18). Italian adaptation and standardization by M. Molteni and A. Frigerio]. IRCCS Medea.
American Psychiatric Association (2023). The diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR). APA Publishing.
Arias, J. A., Williams, C., Raghvani, R., Aghajani, M., Baez, S., Belzung, C., Booij, L., Busatto, G., Chiarella, J., Fu, C. H., Ibanez, A., Liddell, B. J., Lowe, L., Penninx, B. W. J. H., Rosa, P., & Kemp, A. H. (2020). The neuroscience of sadness: a multidisciplinary synthesis and collaborative review. Neuroscience and Biobehavioral Reviews, 111, 199–228. https://doi.org/10.1016/j.neubiorev.2020.01.006
Barbaranelli, C., Caprara, G. V., & Rabasca, A. (1998). Big Five Questionnaire Child (BFQ-C). Manual. Organizzazioni Speciali.
Bertolotti, G., Zotti, A. M., Michielin, P., Vidotto, G., Sanavio, E. (1990). A computerized approach to cognitive behavioural assessment: an introduction to CBA-2.0 primary scales. Journal of Behavior Therapy and Experimental Psychiatry, 21, 21–27. https://doi.org/10.1016/0005-7916(90)90045-m
Bonnet, A., & Naveteur, J. (2004). Electrodermal activity in low back pain patients with and without co-morbid depression. International Journal of Psychophysiology, 53, 37–44. https://doi.org/10.1016/j.ijpsycho.2004.01.004
Bornstein R. F. (2017). Evidence-based psychological assessment. Journal of Personality Assessment, 99, 435–445. https://doi.org/10.1080/00223891.2016.1236343
Byrne D. G. (1975). A psychophysiological distinction between types of depressive states. The Australian and New Zealand Journal of Psychiatry, 9, 181–185. https://doi.org/10.3109/00048677509159846
Cacioppo, J. T., Tassinary, L. G., & Berntson, G. G. (2010). Handbook of psychophysiology (2nd ed.). Cambridge University Press.
Caspi, A., Hariri, A. R., Holmes, A., Uher, R., & Moffitt, T. E. (2010). Genetic sensitivity to the environment: The case of the serotonin transporter gene and its implications for studying complex diseases and traits. The American Journal of Psychiatry, 167, 509–527. https://doi.org/10.1176/appi.ajp.2010.09101452
DeYoung, C. G., Carey, B. E., Krueger, R. F., & Ross, S. R. (2016). Ten aspects of the Big Five in the Personality Inventory for DSM-5. Personality Disorders, 7, 113–123. https://doi.org/10.1037/per0000170
Dormal, V., Vermeulen, N., & Mejias, S. (2021). Is heart rate variability biofeedback useful in children and adolescents? A systematic review. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 62, 1379–1390. https://doi.org/10.1111/jcpp.13463
Falkenberg, I., Kohn, N., Schoepker, R., & Habel, U. (2012). Mood induction in depressive patients: a comparative multidimensional approach. PloS One, 7, e30016. https://doi.org/10.1371/journal.pone.0030016
Fraguas, R., Jr, Marci, C., Fava, M., Iosifescu, D. V., Bankier, B., Loh, R., & Dougherty, D. D. (2007). Autonomic reactivity to induced emotion as potential predictor of response to antidepressant treatment. Psychiatry Research, 151, 169–172. https://doi.org/10.1016/j.psychres.2006.08.008
França, K., & Lotti, T. M. (2017). Psycho-neuro-endocrine-immunology: a psychobiological concept. Advances in Experimental Medicine and Biology, 996, 123–134. https://doi.org/10.1007/978-3-319-56017-5_11
Fuller, G. D. (1979). Biofeedback: Methods and procedures in clinical practice. Biofeedback Press.
Hassan, R., MacMillan, H. L., Tanaka, M., & Schmidt, L. A. (2020). Psychophysiological influences on personality trajectories in adolescent females exposed to child maltreatment. Development and Psychopathology, 32, 1390–1401. https://doi.org/10.1017/S0954579419001342
Heaton, R. K. (1981). A manual for the Wisconsin Card Sorting Test. Psychological Assessment Resources.
Lader, M. H. (1975). The psychophysiology of anxious and depressed patients. In D. C. Fowles (Ed.), Clinical applications of psychophysiology (pp. 12–41). Columbia University Press.
Lader, M. H. (1983). Anxiety and depression. In A. Gale & J. A. Edwards (Eds.), Physiological correlates of human behavior (pp. 155–167). Academic Press.
Le Noury, J., Nardo, J. M., Healy, D., Jureidini, J., Raven, M., Tufanaru, C., & Abi-Jaoude, E. (2015). Restoring Study 329: Efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ, 351, h4320. https://doi.org/10.1136/bmj.h4320
Lu, C. Y., Zhang, F., Lakoma, M. D., Madden, J. M., Rusinak, D., Penfold, R. B., Simon, G., Ahmedani, B. K., Clarke, G., Hunkeler, E. M., Waitzfelder, B., Owen-Smith, A., Raebel, M. A., Rossom, R., Coleman, K. J., Copeland, L. A., & Soumerai, S. B. (2014). Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ, 348, g3596. https://doi.org/10.1136/bmj.g3596
Noble, P., & Lader, M. (1971). The symptomatic correlates of the skin conductance changes in depression. Journal of Psychiatric Research, 9, 61–69. https://doi.org/10.1016/0022-3956(71)90008-2
Öhman, A., Hamm, A., & Hugdahl, K. (2000). Cognition and the autonomic nervous system: Orienting, anticipation, and conditioning. In J. T. Cacioppo, L. G. Tassinary, & G. G. Berntson (Eds.), Handbook of psychophysiology (2nd ed., pp. 533–575). Cambridge University Press.
Orsini, A., & Picone, L. (2006). WISC-III: Contributo alla taratura italiana [WISC-III: Italian version of Wechsler Intelligence Scale for Children]. Organizzazioni Speciali.
Palomba, D. (2023). Prospettive della psicofisiologia clinica [Perspectives on clinical psychophysiology]. Carocci.
Pierini, D., Rolandi, S., & Bertolotti, G. (2013). L’assessment psicofisiologico nel contesto clinico [Psychophysiological assessment in clinical settings]. Psicoterapia Cognitiva e Comportamentale, 19, 355–380.
Prunas, A., Sarno, I., Preti, E., Madeddu, F., & Perugini, M. (2012). Psychometric properties of the Italian version of the SCL-90-R: a study on a large community sample. European Psychiatry, 27, 591–597. https://doi.org/10.1016/j.eurpsy.2010.12.006
Pruneti, C., Donalizio, M., Calugi, S., & Baracchini-Muratorio, G. (2001). Scala di valutazione degli Stati Depressivi: Valutazione fattoriale su un campione di 2300 adolescenti [Depressive states rating scale: Factorial evaluation on a sample of 2300 adolescents]. Giornale di Neuropsichiatria dell’Età Evolutiva, 21, 357–364.
Pruneti, C., Fontana, F., Carrozzo, E., & Fante, C. (2011). Autonomic reactivity emotions and stress response in psychopathology. Applied Psychophysiology and Biofeedback, 36, 217–229.
Pruneti, C., Cosentino, C., Sgromo, D., & Innocenti, A. (2014). Skin conductance response as a decisive variable in individuals with a DSM-IV TR axis I diagnosis. JMED Research, 2014, 565009.
Pruneti, C., Saccò, M., Cosentino, C., & Sgromo, D. (2016). Relevance of autonomic arousal in the stress response in psychopathology. Journal of Basic & Applied Sciences, 12, 176–184. https://doi.org/10.6000/1927-5129.2016.12.26
Pruneti, C., & Guidotti, S. (2021). Depression states, behavioral, and cognitive components in developmental age: Factorial analysis of a short assessment tool. Mediterranean Journal of Clinical Psychology, 9, 1–26. https://doi.org/10.6092/2282-1619/mjcp-2842
Pruneti, C., Ferrari, S., & Guidotti, S. (2023a). A narrative review of heart rate variability as a good index of psychophysical health in athletes and in biofeedback training. Journal of Clinical Sport Psychology. https://doi.org/10.1123/jcsp.2022-0016
Pruneti, C., Fiduccia A., & Guidotti, S. (2023b). Electrodermal activity moderates the relationship between depression and suicidal ideation in a group of patients with anxiety and depressive symptoms. Journal of Affective Disorders Reports, 14, 100673, https://doi.org/10.1016/j.jadr.2023.100673
Riddle, M. A., King, R. A., Hardin, M. T., Scahill, L., Ort, S. I., Chappell, P., Rasmusson, A., & Leckman, J. F. (1990). Behavioral side effects of fluoxetine in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 1, 193–198. https://doi.org/10.1089/cap.1990.1.193
Roberts, A. G., & Lopez-Duran, N. L. (2019). Developmental influences on stress response systems: Implications for psychopathology vulnerability in adolescence. Comprehensive Psychiatry, 88, 9–21. https://doi.org/10.1016/j.comppsych.2018.10.008
Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K., Wang, P. S., & Cuthbert, B. N. (2010). Developing constructs for psychopathology research: Research domain criteria. Journal of Abnormal Psychology, 119, 631–639. https://doi.org/10.1037/a0020909
Sarchiapone, M., Gramaglia, C., Iosue, M., Carli, V., Mandelli, L., Serretti, A., Marangon, D., & Zeppegno, P. (2018). The association between electrodermal activity (EDA), depression and suicidal behaviour: a systematic review and narrative synthesis. BMC Psychiatry, 18, 22. https://doi.org/10.1186/s12888-017-1551-4
Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 5, 1040. https://doi.org/10.3389/fpsyg.2014.01040
Shaffer, F., & Meehan, Z. M. (2020). A practical guide to resonance frequency assessment for heart rate variability biofeedback. Frontiers in Neuroscience, 14, 570400. https://doi.org/10.3389/fnins.2020.570400
Sirigatti, S., & Pancheri, P. (2001). Minnesota Multiphasic Personality Inventory-Adolescent. Italian adaptation. Giunti Psychometrics.
Sirigatti, S., & Stefanile, C. (2001). Il 16PF-5: Adattamento italiano [The 16PF-5: Italian adaptation]. Organizzazioni Speciali.
Stegagno, L. (2008). Psicofisiologia. Dalla genetica comportamentale alle attività cognitive [Psychophysiology. From behavioral genetics to cognitive activities]. Zanichelli.
Sudol, K., & Mann, J. J. (2017). Biomarkers of suicide attempt behavior: Towards a biological model of risk. Current Psychiatry Reports, 19, 31. https://doi.org/10.1007/s11920-017-0781-y
Tulisiak, A. K., Klein, J. A., Harris, E., Luft, M. J., Schroeder, H. K., Mossman, S. A., Varney, S. T., Keeshin, B. R., Cotton, S., & Strawn, J. R. (2017). Antidepressant prescribing by pediatricians: a mixedmethods analysis. Current Problems in Pediatric and Adolescent Health Care, 47, 15–24. https://doi.org/10.1016/j.cppeds.2016.11.009
US Food and Drug Administration (2004). Suicidality in children and adolescents being treated with antidepressant medications. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
