Clinical Neuropsychiatry最新文献

{"title":"Gender Dysphoria and Neurodevelopmental Disorders: Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) Among Adults with Gender Dysphoria and Their Clinical Phenotype.","authors":"Chiara Cecchelli, Corinna Moradei, Carlotta Cocchetti, Giacomo Grassi","doi":"10.36131/cnfioritieditore20250608","DOIUrl":"10.36131/cnfioritieditore20250608","url":null,"abstract":"<p><strong>Objective: </strong>Despite the increasing amount of data showing the presence of high association between gender dysphoria (GD) and autism spectrum disorders, less is known on the association between GD and other neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD). The aim of this study was to examine the prevalence and clinical features of ADHD in a group of adults with a primary diagnosis of GD.</p><p><strong>Method: </strong>A sample of 81 consecutive adults newly diagnosed with GD were assessed using standardized self-report measures evaluating GD severity, mood and anxiety symptoms, and ADHD. GD participants with associated ADHD were compared to participants without ADHD regarding gender dysphoria symptoms, mood and anxiety symptoms, and functional impairment.</p><p><strong>Results: </strong>We found a 33.3% prevalence of ADHD among GD individuals. Those with GD and ADHD had a significantly higher lifetime prevalence of psychiatric co-occurrence-particularly borderline personality disorder and cannabis use disorder- along with greater mood (U = 3.805, p < .001) and anxiety symptoms (U = 3.717, p < .001), and more severe functional impairment (U = -3.233, p = .001) compared with GD individuals without ADHD. No group differences emerged in GD symptom severity.</p><p><strong>Conclusions: </strong>Findings indicate that GD individuals show high prevalence of ADHD and that individuals with both GD and ADHD appear to represent a more complex subpopulation with heightened depressive and anxiety symptoms and increased functional impairment. These results underscore that the presence of ADHD is frequent and appears to exert an important clinical impact on individuals with GD; therefore, ADHD should be routinely screened for in this population.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 6","pages":"507-516"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling Teen Social Networking Sites Users: Developmental, Identity, and Psychological Issues.","authors":"Francesca Gioia, Valentina Boursier","doi":"10.36131/cnfioritieditore20250603","DOIUrl":"10.36131/cnfioritieditore20250603","url":null,"abstract":"<p><strong>Objective: </strong>in the last decades, social networking sites (SNSs) use among adolescents has dramatically increased, feeding the adolescents' needs. However, younger users might be more vulnerable to problematic social networking. Scholar research increasingly highlighted the need to explore the underlying mechanisms of problematic use of SNSs. Difficulties in emotion regulation, general distress, experiences of shame, and specific motivations for SNSs use might represent risk factors for problematic social networking. On the contrary, other variables adolescence-related and potentially involved in problematic SNSs use (emptiness, boredom, emotional autonomy, and self-concept clarity) need further exploration.</p><p><strong>Method: </strong>the present person-centered study aimed at profiling SNSs teen users (13-19 years) based on their (problematic) social networking, by comparing their SNSs-related behaviors and motivations, emotional dysregulation, distress symptoms, emptiness, boredom, shame, self-concept clarity, and emotional autonomy.</p><p><strong>Results: </strong>the study involved 774 Italian adolescents (57% females; mean age = 15.74 ± 1.62 years) and four different profiles characterized by unique patterns of (problematic) social networking were identified through the latent profile analysis (LPA): (1) non-problematic SNSs users, (2) at-risk SNSs users, (3) problematic SNSs users, and (4) defended SNSs users (ntp=218; AIC=39125.44; BIC=39988.37; SSABIC=39296.00; entropy=.97; LMP-LRT p <.05; BLRT p <.05).</p><p><strong>Conclusions: </strong>concerning the emerging profiles, problematic and non-problematic SNSs users displayed the highest and lower levels of risk factors related to social networking, respectively. The so-called \"Defended\" profile might include participant adolescents who defensively avoided thinking about the psychological and emotional experiences of SNSs use, showing very low levels in all the variables exploring SNSs-related behaviors and motivations, and psychological risk.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 6","pages":"454-464"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stratifying the Inflamed Endotype in Difficult-to-Treat Depression: A Roadmap from Biomarkers to Precision Immunopsychiatry.","authors":"Walter Paganin","doi":"10.36131/cnfioritieditore20250610","DOIUrl":"10.36131/cnfioritieditore20250610","url":null,"abstract":"<p><p>Difficult-to-treat depression (DTD) extends beyond pharmacological non-response to encompass persistent symptoms, disability, and functional impairment despite optimal therapeutic strategies. This opinion advances a paradigm-shifting thesis: a biologically distinct inflammatory endotype exists within DTD, characterized by low-grade systemic inflammation (hs-CRP ≥3 mg/L), where treatment failure reflects a fundamental mechanistic mismatch between the pathogenic driver (neuroinflammation) and conventional monoaminergic interventions. We propose a precision stratification workflow: screen with hs-CRP, confirm and phenotype using a parsimonious cytokine panel (IL-6, TNF-α, IL-1β), and align interventions to underlying biology. Therapeutic options include targeted anti-inflammatory agents, neuromodulation, psychotherapy, lifestyle modifications, and digital monitoring. Assessment should prioritize patient-centered outcomes: functioning, quality of life, and cognition alongside symptom reduction. We outline pragmatic implementation within phased-care and public health systems, emphasizing equitable biomarker access and biomarker-enriched clinical trials. Reframing DTD through neuroinflammation transforms clinical heterogeneity from an obstacle into an opportunity: biomarker-guided precision care that matches mechanism to intervention, improving outcomes for patients whose depression has proven refractory to standard approaches.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 6","pages":"529-539"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Circulating Cytokines and Psychosomatic Syndromes in Patients with Mood Disorders.","authors":"Mario Altamura, Livia Ficarella, Ivana Leccisotti, Rossana Laurello, Michele Carapellese, Benedetta Vai, Francesco Benedetti, Antonello Bellomo","doi":"10.36131/cnfioritieditore20250605","DOIUrl":"10.36131/cnfioritieditore20250605","url":null,"abstract":"<p><strong>Objective: </strong>elevated levels of pro-inflammatory cytokines are frequently observed in mood disorders, but their relationship with psychosomatic symptomatology remains underexplored. This study aimed to examine whether interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are associated with psychosomatic syndromes in patients with major depression (MD) and bipolar depression (BD), and whether these associations are moderated by sex.</p><p><strong>Method: </strong>seventy-seven outpatients with MD or BD were assessed using the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) and the Patient Health Questionnaire-15 (PHQ-15) to evaluate psychosomatic symptoms. Depression and mania severity were measured with the Beck Depression Inventory-II (BDI-II) and the Mania Rating Scale (MRS). Circulating levels of IL-6 and TNF-α were analyzed. Associations were tested using multivariate regression and mediation analyses, controlling for demographic and health-related variables.</p><p><strong>Results: </strong>both IL-6 and TNF-α were significantly associated with psychosomatic syndromes (as per DCPR-R) and PHQ-15 scores. IL-6, in particular, showed a strong association with persistent somatization (PS). These relationships remained significant after adjusting for affective-cognitive depressive symptoms and potential confounders. No significant moderating effect of sex was identified. Mediation analyses suggested that psychosomatic syndromes mediate the relationship between inflammatory cytokines and depressive symptomatology.</p><p><strong>Conclusions: </strong>findings suggest that the link between inflammation and mood disorders is more closely related to psychosomatic syndromes than to mood symptoms alone. Elevated IL-6 levels may reflect somatization processes within depression rather than being directly pro-depressive. Psychosomatic syndromes may thus represent a key clinical and therapeutic target in mood disorders with elevated inflammation.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 6","pages":"474-484"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Psychopathological Domains of Attachment Trauma: A Proposal for a Clinical Conceptualization.","authors":"Benedetto Farina, Adriano Schimmenti","doi":"10.36131/cnfioritieditore20250501","DOIUrl":"10.36131/cnfioritieditore20250501","url":null,"abstract":"<p><p>This article provides a critical review of the concept of attachment trauma, proposing an expanded definition that reflects its psychopathogenic dynamics and clinical outcomes. The first aim of the review is to define attachment trauma and differentiate it from related constructs. Attachment trauma is conceptualized as a condition emerging within primary attachment relationships, characterized by prolonged failures in caregiving and/or ongoing abuse. These relationships create recurrent, inescapable threats, leading to significant disruptions in the child's physiological, socio-emotional, and cognitive development. The second aim of the review is to explore attachment trauma as a permeating psychopathological dimension that may underpin a broad spectrum of mental disorders manifesting in adulthood, including complex posttraumatic stress disorder, dissociative disorders, and borderline personality disorder. Recognizing attachment trauma in adults poses clinical challenges due to its complex and pervasive nature, often presenting with a constellation of symptoms across multiple domains, such as dysregulation of arousal, disintegration of higher-order cognitive processes, emotional and impulse dyscontrol, detachment and dissociative reactions, dysfunctional self and relational representations, impairments in mentalization, maladaptive compensatory strategies, and epistemic mistrust. The third objective of the review is to integrate the recognition of attachment trauma into clinical practice, emphasizing the identification of its impacts based on clinical presentation. The review highlights key therapeutic interventions, including the establishment of a safe therapeutic relationship, regulation of emotions and arousal, modification of pathogenic beliefs, addressing detachment symptoms and dissociated self-states, promotion of mentalization and epistemic trust, and the processing of both implicit and explicit traumatic memories. These interventions aim to repair the psychological damage caused by attachment trauma, fostering integration and healthier relational patterns.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"351-373"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Developments: Towards an Increasingly Integrated Conceptualization.","authors":"Maria Paola Boldrini, Giovanni Tagliavini","doi":"10.36131/cnfioritieditore20250515","DOIUrl":"10.36131/cnfioritieditore20250515","url":null,"abstract":"<p><p>Farina and Schimmenti's proposal, which directs attention in the field of complex trauma treatment toward the central role of attachment trauma (AT), is both timely and highly valuable. Their contribution immediately invites deeper reflection and gives rise to two distinct sets of questions. The first concerns issues of diagnostic assessment: how can clinicians reliably identify and differentiate the specific features of attachment trauma within the broader spectrum of complex trauma presentations? The second pertains to the future development of clinical practice and research, calling for renewed efforts aimed at integrating this promising AT-oriented perspective into the broader domains of case formulation and conceptualization. Such integration could refine our diagnostic tools and expand the theoretical and practical frameworks through which complex trauma is understood and treated.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"426-427"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Psychopathological Domains of Attachment Trauma: A Commentary.","authors":"Frank M Corrigan, Hannah Young","doi":"10.36131/cnfioritieditore20250505","DOIUrl":"10.36131/cnfioritieditore20250505","url":null,"abstract":"<p><p>The contribution by Farina & Schimmenti (2025) highlights the impact of childhood maltreatment on adult health. Deep Brain Reorienting (DBR), a neurophenomenological approach, proposes that attachment traumas derive from two primary experiences: shock and pain. Shock, often pre-affective, precedes emotions such as fear or anger and can take different forms (implosive, impact). When it dissipates, a deep pain emerges, linked to loneliness, rejection, and existential emptiness. DBR aims to slow down the shock-pain-affect sequence, separating its components to reduce emotional overload and promote regulation. This allows pathological beliefs of unworthiness to be reworked and contradictory attachment patterns to be addressed. The therapy also addresses dissociative symptoms, differentiated into supracortical, intracortical, neurochemical, and structural forms, reducing fragmentation of the self. In conclusion, DBR hypothesizes that attachment traumas result from alterations in midbrain mechanisms of orientation and affective regulation, compromising attachment development, mentalization, and self-esteem.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"387-391"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferring Attachment Trauma from Clinical Symptoms and Dynamics: A Challenge for Scientists, a Gift for Therapists and Their Patients.","authors":"Martin J Dorahy","doi":"10.36131/cnfioritieditore20250507","DOIUrl":"10.36131/cnfioritieditore20250507","url":null,"abstract":"<p><p>Farina and Schimmenti bring together a wealth of research data and clinical experience to link the attachment trauma literature with specific symptoms and dynamics in adult patients. Of their many observations and insights, they suggest that attachment trauma should be inferred by clinicians in cases where patients present these specific phenomenological markers, even if the patients' themselves are not aware of such historical experiences. This theorizing provokes a research agenda that challenges scientists to carefully investigate its veracity, to guide accurate clinical reasoning. From the perspective of a therapist with their patient, the framing of attachment trauma as the etiological foundation of a specific collection of complex symptoms and dynamics offers a relational buffer in what is often a very complicated therapeutic journey. The gift of such theorizing is particularly evident in managing ruptures and countertransferential reactions to facilitate relational repair and re-instigate of empathic attunement. This commentary explores the challenge to researchers and the gift to therapists' and their patients' that Farina and Schimmenti's causal inference provides.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"394-396"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Some Additional Curiosity About When Adaptation to Developmental Adversity Becomes a Trauma.","authors":"Richard A Chefetz","doi":"10.36131/cnfioritieditore20250504","DOIUrl":"10.36131/cnfioritieditore20250504","url":null,"abstract":"<p><p>The concept of attachment trauma is provocative and stimulates an effort to seek additional definitions of trauma that are more congenial toward understanding the mental injury occurring to a particular individual rather than to a broad population where the focus is on \"the size of the bang.\" What really constitutes an experience of trauma? When does the normative adaptation to adversity that is part of the infant attachment paradigm cross over the line and become attachment trauma? Are there biological considerations in this kind of event or are there only psychodynamic considerations, relational activities? In this brief communication these questions are explored in relation to a multiple self-state psychology of mind that is consistent with Bowlby's exploration of segregated subsystems, detachment, and deactivation.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"384-386"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attachment Trauma and its Legacies Across Development: A Clinical Commentary.","authors":"Ana M Gomez, Jillian Hosey","doi":"10.36131/cnfioritieditore20250509","DOIUrl":"10.36131/cnfioritieditore20250509","url":null,"abstract":"<p><p>This commentary offers a critical and appreciative examination of Farina and Schimmenti's contribution to the understanding of attachment trauma as a pervasive, developmentally formative phenomenon. It discusses the authors proposal of an \"attachment trauma frame\" articulated through three core objectives, extending the conceptualization of trauma and attachment trauma beyond event-based models through an exploration of compelling facets, contributions, and important cautions. Further child specific considerations pertaining to importance of the psychological and neurobiological consequences of attachment trauma within clinical practice with children and families are offered. This work calls for developmentally and relationally attuned systems of care that address the broader intersubjective and systemic ecosystems in which children develop. It concludes with a call for future research to deepen intersectional and culturally responsive understandings of attachment trauma across diverse populations.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":"22 5","pages":"400-402"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}