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Clinical trials on Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone intervention for alcohol use disorder (AUD) showed promising outcomes. Improvements in difficulties with emotion regulation (DER) played a mediating role on abstinence maintenance. However, the effect of DER, together with specific coping strategies, have not been considered yet in the treatment of clinical features associated to AUD and concurrent substance use disorders (CO-SUDs). The current study aims at investigating changes in the number of consecutive days of abstinence (CDA), severity of AUD and CO-SUDs (Shorter PROMIS Questionnaire; SPQ alcohol, prescription, illicit drugs subscale), DER (Difficulties in Emotion Regulation Scale; DERS) and coping strategies (DBT Way of Coping Checklist; DBT-WCCL) during a 3-month DBT-ST program for the treatment of AUD and CO-SUDs. Furthermore, four independent multiple parallel mediational models were estimated considering scores of CDA/SPQ, DERS and DBT-WCCL dimensions as dependent, independent and mediators variables respectively. One-hundred eight individuals with a primary diagnosis of AUD were consecutively admitted. The results showed significant and moderate to large improvements in CDA, severity of AUD, CO-SUDs and DER. The analyses detected significant improvements in the use of DBT Skills. The changes in DER predicted decreases in SPQ scores. The changes in DBT-WCCL scores were mediators of the previous relationships, considering SPQ alcohol and prescription drugs subscales. These findings support the implementation of DBT-ST as a stand-alone intervention for the treatment of AUD and CO-SUDs. DER together with coping strategies are relevant therapeutic mechanisms in the treatment of clinical features related to SUDs., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Co-occurrence of substance use disorders (CO-substance use disorders) among individuals with alcohol use disorder (AUD) is largely recognized as a critical clinical issue. However, the specific clinical variables involved are still unclear. The recent findings are controversial in pointing out the unique contribution of both impulsivity and emotion dysregulation on CO-substance use disorders. Furthermore, the co-variation between AUD and other substance use disorders includes different aspects of maladaptive personality functioning (i.e., overall severity and specific features). Therefore, this study aims at clarifying the role of impulsivity, emotional dysregulation, and severity of personality pathology on CO-substance use disorders among treatment-seeking individuals with AUD. Methods: One hundred ninety-three treatment-seeking individuals with AUD (DSM-IV-TR) were consecutively recruited. Impulsivity (Barratt Impulsiveness Scale [BIS-11]), emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS]), and personality pathology (Structured Clinical Interview for DSM-IV Axis II Personality Disorder [SCID-II]) were assessed after a 2-week detoxification period. The analyses were based on several stepwise forward logistic regressions. The total score of BIS-11 and DERS together with the number of SCID-II criteria were considered, in following the order, as independent variables controlling for the comorbidity with other lifetime Axis I disorders. CO-substance use disorders was the dependent variable (i.e., any CO-substance use disorders, benzodiazepine and cannabis/cocaine use disorders). Results: The number of SCID-II criteria was the only significant predictor of overall CO-substance use disorders, odds ratio ( OR ) = 1.16; 95% confidence interval (CI) [1.07, 1.26], p < .01, and cannabis/cocaine use disorders, OR  = 1.19; 95% CI [1.08, 1.31], p < .01. On the contrary, DERS total score was the most robust predictor of benzodiazepine use disorder, OR  = 1.02; 95% CI [1.01, 1.04], p < .01, albeit the severity of maladaptive personality functioning was also significantly associated with this disorder, OR  = 1.09; 95% CI [1.00, 1.18], p < .05. Conclusions: The severity of maladaptive personality pathology represents one of the main aspects involved in CO-substance use disorders among individuals with AUD. This dimension predicts the CO-substance use disorders above and beyond specific personality dimensions and other psychiatric conditions. Therefore, personality functioning should be precisely assessed and personality pathology should be addressed in the framework of AUD treatments for promoting effective long-term outcomes.

Background: Many experimental studies have evaluated Linehan's biological emotional vulnerability in Borderline Personality Disorder (BPD). However, some inconsistencies were observed in operationalizing and supporting its components. This study aims at clarifying which aspects of Linehan's model are altered in BPD, considering a multimodal evaluation of processes concerned with emotional responsiveness (self-report, psychophysiology and eye-tracking)., Methods: Forty-eight socio-emotional pictures were administered to 28 participants (14 BPD, 14 Healthy Controls, HCs), gender- and age-matched, by employing two different lengths of stimuli exposure (5 s and 15 s)., Results: Our results supported the hypersensitivity hypothesis in terms of faster physiological responses and altered visual processing. Furthermore, hypersensitivity was associated with detailed socio-emotional contents. Hyperreactivity assumption was not experimentally sustained by physiological and self-report data. Ultimately, the slow return to emotional baseline was demonstrated as an impaired emotional modulation., Conclusions: Our data alternatively supported the hypersensitivity and the slow return to emotional baseline hypotheses, postulated by Linehan's Biosocial model, rather than the hyperreactivity assumption. Results have been discussed in light of other BPD core psychopathological processes., Competing Interests: This study was conducted in line with the American Psychological Association’s Ethical Standards for Research and Publication. The protocol of this study was submitted to IRCCS San Raffaele hospital ethics committee. Informed consent was obtained from all individual participants included in the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Diffusion MRI tractography allows in-vivo characterization of white matter architecture, including the localization and description of brain fibre bundles. However, some primary bundles are still only partially reconstructed, or not reconstructed at all. The acoustic radiation (AR) represents a primary sensory pathway that has been largely omitted in many tractography studies because its location and anatomical features make it challenging to reconstruct. In this study, we investigated the effects of acquisition and tractography parameters on the AR reconstruction using publicly available Human Connectome Project data. The aims of this study are: (i) using a subgroup of subjects and a reference AR for each subject, define an optimum set of parameters for AR reconstruction, and (ii) use the optimum parameters set on the full group to build a tractography-based atlas of the AR. Starting from the same data, the use of different acquisition and tractography parameters lead to very different AR reconstructions. Optimal results in terms of topographical accuracy and correspondence to the reference were obtained for probabilistic tractography, high b-values and default tractography parameters: these parameters were used to build an AR probabilistic tractography atlas. A significant left-hemispheric lateralization was found in the AR reconstruction of the 34 subjects.

The auditory system of mammals is dedicated to encoding, elaborating and transporting acoustic information from the auditory nerve to the auditory cortex. The acoustic radiation (AR) constitutes the thalamo-cortical projection of this system, conveying the auditory signals from the medial geniculate nucleus (MGN) of the thalamus to the transverse temporal gyrus on the superior temporal lobe. While representing one of the major sensory pathways of the primate brain, the currently available anatomical information of this white matter bundle is quite limited in humans, thus constituting a notable omission in clinical and general studies on auditory processing and language perception. Tracing procedures in humans have restricted applications, and the in vivo reconstruction of this bundle using diffusion tractography techniques remains challenging. Hence, a more accurate and reliable reconstruction of the AR is necessary for understanding the neurobiological substrates supporting audition and language processing mechanisms in both health and disease. This review aims to unite available information on the macroscopic anatomy and topography of the AR in humans and non-human primates. Particular attention is brought to the anatomical characteristics that make this bundle difficult to reconstruct using non-invasive techniques, such as diffusion-based tractography. Open questions in the field and possible future research directions are discussed.

The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.

Background: Theoretical frameworks postulate that mindfulness represents a relevant therapeutic process in substance use disorders (SUDs), especially in treating difficulties with emotion regulation (DER). Nonetheless, it remains unclear how mindfulness dimensions, particularly self-regulation of attention and acceptance attitudes, are implicated in the well-validated relationship between DER and SUDs. It is also uncertain whether mindfulness is considered a common protective factor for SUDs., Objectives: To investigate the mediating role of mindfulness in the relationships between DER and SUDs among treatment-seeking patients with alcohol use disorder (AUD)., Methods: Two related domains of mindfulness were evaluated: (a) self-regulation of attention (Mindful Attention Awareness Scale, MAAS) and (b) acceptance attitudes (Five Facet Mindfulness Questionnaire, FFMQ, nonjudging, and nonreactivity subscales)). Two-hundred and forty-four (149 males and 95 females) participants with AUD were assessed. Mindfulness, DER, and SUD severity (alcohol, benzodiazepines, and other drugs) were assessed after a 2-week detoxification period. Three independent multiple parallel mediational models, controlling for the heterogeneity of sample characteristics, were proposed., Results: MAAS and FFMQ nonjudging were significant mediators of the relationship between DER and AUD severity. Mindfulness dimensions and DER were not related to other drug use disorders. DER represented a relevant factor in explaining the severity of benzodiazepine use disorder, although mindfulness was not significantly related to it., Conclusion: Mindfulness appears to be a protective factor for DER effects on AUD. Future research should evaluate additional dysfunctional processes to clarify how unique dimensions are implicated in the development and maintenance of different SUDs.

Background: Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it., Objectives: The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation., Methods: We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program., Results: Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation., Conclusions: This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.

Background: Selected personality features may represent important predisposing as well as perpetuating factors for insomnia, and previous studies stressed the importance to assess personality disorders in insomnia patients., Methods: In order to evaluate the relationships between DSM-IV Axis II/DSM-5 Section II Personality Disorders (PDs) and insomnia, a sample of 171 consecutively admitted insomnia patients and a sample of 171 psychotherapy patients, matched on age and gender were administered the Italian translation of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II). Among insomnia patients, 52.0% (n = 89) received at least one DSM-IV Axis II/DSM-5 Section II PD diagnosis according to SCID-II assessment., Results: Any PD base rate estimate in our insomnia patient sample was significantly and markedly higher than the median and mean base rate estimates for any PD in the general population. Within-group analyses showed that Narcissistic, Not otherwise specified PD, Histrionic PD, and Borderline PD represented the most frequently diagnosed-both dimensionally and categorically-DSM-IV Axis II/DSM-5 Section II PD features in our insomnia patient sample. When continuously-scored PDs were considered, insomnia patients showed a significantly lower number of Paranoid and Borderline PD features than psychotherapy patients; however, the corresponding effect size estimates suggested that these differences were modest. None of the categorically-scored PDs significantly differentiated insomnia patients from psychotherapy patients., Conclusions: As a whole, our findings seemed to suggest that personality dysfunction may play a role in insomnia, while stressing the need for a dimensional approach to the assessment of maladaptive personality traits even in insomnia patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Neuroplasticity following sensory deprivation has long inspired neuroscience research in the quest of understanding how sensory experience and genetics interact in developing the brain functional and structural architecture. Many studies have shown that sensory deprivation can lead to cross-modal functional recruitment of sensory deprived cortices. Little is known however about how structural reorganization may support these functional changes. In this study, we examined early deaf, hearing signer and hearing non-signer individuals using diffusion MRI to evaluate the potential structural connectivity linked to the functional recruitment of the temporal voice area by face stimuli in deaf individuals. More specifically, we characterized the structural connectivity between occipital, fusiform and temporal regions typically supporting voice- and face-selective processing. Despite the extensive functional reorganization for face processing in the temporal cortex of the deaf, macroscopic properties of these connections did not differ across groups. However, both occipito- and fusiform-temporal connections showed significant microstructural changes between groups (fractional anisotropy reduction, radial diffusivity increase). We propose that the reorganization of temporal regions after early auditory deprivation builds on intrinsic and mainly preserved anatomical connectivity between functionally specific temporal and occipital regions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

DSM-5 has included within the substance-related and addictive disorders diagnostic category behavioral addictions, such as gambling disorder. Some scholars also considered ICD-11 compulsive sex as a behavioral addiction. Furthermore, an addiction model of dysfunctional eating behaviors has been proposed. Consistently, the existence of common addiction mechanisms related to substance and non-substance related disorders has been hypothesized. Nevertheless, this approach was called into question, especially considering alternative processes which might be implicated in such conditions. This study aims to compare these opposite theoretical positions concerning substance- and nonsubstance related disorders, investigating the latent structure of addictive behaviors among alcohol use disorder (AUD) individuals. Addictive behaviors were self-reported assessed using the Shorter PROMIS Questionnaire (SPQ). We recruited 456 (59.2% male; 40.8% female) AUD treatment-seeking patients. Two latent structures were tested using a confirmatory factor analytic approach. We compared a one-factor (i.e., common addiction mechanisms) with a two-factor solution (i.e., dysregulation of reward processing systems and maladaptive coping strategies). The two-factor solution showed adequate goodness-of-fit indexes. Specifically, dysregulation of the reward processing systems dimension predicted the SPQ illicit and prescription drugs, gambling, and sex subscales. Conversely, the maladaptive coping strategies dimension predicted the SPQ compulsive buying, binge eating and food restriction subscales. The latent dimensions significantly correlated with each other. Compulsive sex might be preliminarily considered as a behavioral addiction. AUD individuals might show complex patterns of maladaptive behaviors functionally related to different latent processes. Differential treatment approaches are suggested to treat these conditions.

The acoustic radiation is a compact bundle of fibers conveying auditory information from the medial geniculate nucleus of the thalamus to the auditory cortex. Topographical knowledge of this bundle in primates is scarce and in vivo diffusion-based tractography reconstructions in humans remains challenging, especially with the most widely used MRI acquisition protocols. Therefore, the AR represents a notable anatomical omission in the neurobiological investigation of acoustic and linguistic functional mechanisms in humans. In this study, we combine blunt micro-dissections and advanced diffusion tractography methods to provide novel insights into the topographical anatomy of this bundle in humans. Evidences from ex vivo blunt micro-dissection in three human (two right) hemispheres are compared to the 3D profile of this bundle as reconstructed by tractography techniques in four healthy adult data sets provided by the Human Connectome Project. Both techniques show the unique trajectory of the AR, a transversal course from the midline to the lateral convexity of the posterior temporal lobe. Blunt dissections demonstrated three portions of this bundle that we defined as the genu, stem, and fan, revealing the intimate relationships that each of these components has with neighboring association and projection pathways. Probabilistic tractography and ultra-high b values provided results comparable to blunt micro-dissections and highlighted the main limitations in tracking the AR. This is, to our knowledge, the first ex vivo/in vivo integrated study providing novel and reliable information about the precise anatomy of the AR, which will be important for future investigations in the neuroscientific, clinical, and surgical field.

Introduction: The current study aims to evaluate if and to what extent mindfulness-based interventions (MBIs) could promote an incremental effectiveness compared to interventions usually provided in clinical practice to treat Alcohol and Drugs Use Disorders. In line with this aim, we accomplished a meta-analytic review of randomized and nonrandomized controlled trials, considering primary and secondary outcomes that comprehensively operationalize treatment efficacy., Methods: We conducted the online research up to August 31st 2017. Adequate procedures for Cohen's d computation were applied. Heterogeneity indexes, moderators, bias of publication, and Orwin's fail-safe number were also estimated., Results: Thirty-seven studies were included (n = 3,531 patients). We observed null effect sizes for attrition rate and overall mental health. Small effect sizes were detected in abstinence, levels of perceived stress, and avoidance coping strategies. Moderate effect sizes were revealed in anxiety and depressive symptoms. Large effect sizes were associated to levels of perceived craving, negative affectivity, and post-traumatic symptoms., Conclusion: MBIs seemed to show clinically significant advantages compared to other clinical approaches in relation to specific primary and secondary outcomes. Conversely, treatment retention was independent of the therapeutic approach., (© 2018 S. Karger AG, Basel.)

Pure Word Deafness (PWD) is a rare disorder, characterized by selective loss of speech input processing. Its most common cause is temporal damage to the primary auditory cortex of both hemispheres, but it has been reported also following unilateral lesions. In unilateral cases, PWD has been attributed to the disconnection of Wernicke's area from both right and left primary auditory cortex. Here we report behavioral and neuroimaging evidence from a new case of left unilateral PWD with both cortical and white matter damage due to a relatively small stroke lesion in the left temporal gyrus. Selective impairment in auditory language processing was accompanied by intact processing of nonspeech sounds and normal speech, reading and writing. Performance on dichotic listening was characterized by a reversal of the right-ear advantage typically observed in healthy subjects. Cortical thickness and gyral volume were severely reduced in the left superior temporal gyrus (STG), although abnormalities were not uniformly distributed and residual intact cortical areas were detected, for example in the medial portion of the Heschl's gyrus. Diffusion tractography documented partial damage to the acoustic radiations (AR), callosal temporal connections and intralobar tracts dedicated to single words comprehension. Behavioral and neuroimaging results in this case are difficult to integrate in a pure cortical or disconnection framework, as damage to primary auditory cortex in the left STG was only partial and Wernicke's area was not completely isolated from left or right-hemisphere input. On the basis of our findings we suggest that in this case of PWD, concurrent partial topological (cortical) and disconnection mechanisms have contributed to a selective impairment of speech sounds. The discrepancy between speech and non-speech sounds suggests selective damage to a language-specific left lateralized network involved in phoneme processing., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

In order to assess the reliability, factorial validity, and criterion validity of the Personality Inventory for DSM-5 (PID-5) among adolescents, 1,264 Italian high school students were administered the PID-5. Participants were also administered the Questionnaire on Relationships and Substance Use as a criterion measure. In the full sample, McDonald's ω values were adequate for the PID-5 scales (median ω = .85, SD = .06), except for Suspiciousness. However, all PID-5 scales showed average inter-item correlation values in the .20-.55 range. Exploratory structural equation modeling analyses provided moderate support for the a priori model of PID-5 trait scales. Ordinal logistic regression analyses showed that selected PID-5 trait scales predicted a significant, albeit moderate (Cox & Snell R 2 values ranged from .08 to .15, all ps < .001) amount of variance in Questionnaire on Relationships and Substance Use variables.

Several authors have studied dissociation within the borderline personality disorder (BPD) population and postulated 3 dissociative subgroups. Conversely, other authors suggest that dissociation may play a central role in the development of trauma-related disorders and specifically in BPD. Nevertheless, the role of dissociation in BPD seems to be controversial. Our aim is to perform a meta-analytic review of the literature to evaluate the extent of dissociation in BPD compared to other psychopathological disorders to clarify its role in this specific condition. Ten eligible studies resulted in a total of 2,035 subjects. Results show that levels of dissociation are higher in BPD than in other psychiatric disorders in general, although this difference is moderate and the heterogeneity of effect sizes is large. In particular, individuals with BPD seem to show higher levels of dissociation than those with several psychiatric and personality disorders but not dissociative disorders or posttraumatic stress disorder. These findings support the fact that dissociation is not specifically a core feature of BPD and, in addition, sustain the existence of a continuum of severity within the psychiatric population. Nevertheless, the current work has several limitations related to the paucity of studies included, the heterogeneity of control groups, their clear definition, and the statistical robustness of the results. In addition, our conclusions require future research in order to explain the role of different forms of dissociation and their etiological factors among the psychiatric population. Eventually, we invite clinicians and researchers to systematically evaluate dissociation in order to reach a better diagnosis for a more specific treatment indication.

To extend the evidence on the reliability and construct validity of the Five-Factor Model Rating Form (FFMRF) in its self-report version, two independent samples of Italian participants, which were composed of 510 adolescent high school students and 457 community-dwelling adults, respectively, were administered the FFMRF in its Italian translation. Adolescent participants were also administered the Italian translation of the Borderline Personality Features Scale for Children-11 (BPFSC-11), whereas adult participants were administered the Italian translation of the Triarchic Psychopathy Measure (TriPM). Cronbach α values were consistent with previous findings; in both samples, average interitem r values indicated acceptable internal consistency for all FFMRF scales. A multidimensional graded item response theory model indicated that the majority of FFMRF items had adequate discrimination parameters; information indices supported the reliability of the FFMRF scales. Both categorical (i.e., item-level) and scale-level regression analyses suggested that the FFMRF scores may predict a nonnegligible amount of variance in the BPFSC-11 total score in adolescent participants, and in the TriPM scale scores in adult participants.

The interaction between biological and environmental factors (especially adverse childhood experiences, ACEs) plays a crucial role in the development and maintenance of borderline personality disorder (BPD). These factors act influencing BPD core features such as pervasive instability in affect regulation, impulse control, social cognition, and interpersonal relationships. In line with this perspective, abnormalities in social cognition and related neurobiological underpinnings could mediate the relationship between ACEs and psychopathological manifestations in adulthood. In a sample of 14 females, functional connectivity (FC) analyses were performed modeling the interaction between ACEs and corticolimbic dysregulation during emotional processing and its relationship with BPD symptom severity. ACEs were associated with a dampening of the negative FC between (1) the right amygdala (Amy) and right dorsolateral prefrontal cortex (DLPFC) and between (2) the left Amy and bilateral DLPFC, right precuneus, left cerebellum and left dorsomedial prefrontal cortex during emotional processing. The connectivity between right Amy and DLPFC mediates the relationship between childhood adversities and BPD symptomatology. Furthermore, the negative FC between Amy and DLPFC, postcentral gyrus, the vermis of cerebellum and precuneus was also associated with BPD symptom severity, with a weaker negative coupling between Amy and these regions being related to a worse BPD psychopathology. Our results confirm the role of ACEs in contributing to social cognition impairments in BPD and related symptomatology from a neurobiological perspective., (© 2018 S. Karger AG, Basel.)

To assess the internal consistency, factor structure, and construct validity of the Italian translation of the Youth Psychopathic Traits Inventory-Short Version (YPI-S), both the YPI-S and its full version, the YPI, as well as self-reports of delinquency, aggression, and Big Five domains, were administered to two independent samples (N = 868 and N = 881) of Italian community, nonreferred adolescents. The internal consistency of the YPI-S was adequate, and confirmatory factor analyses showed a good fit of the theoretical three-factor model of the YPI-S in both samples. Hierarchical regression models suggested the same pattern of associations with self-report measures of delinquency and aggression for the YPI-S and YPI, although the YPI was a better predictor of Big Five domains than the YPI-S. The findings support the internal consistency, factor validity, and construct validity of the YPI-S., (© The Author(s) 2015.)

To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.

In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.

The present study aims to evaluate the psychometric properties of the Italian version of the Perfectionistic Self-Presentation Scale (PSPS) in 447 nonclinical adult volunteers (63.5% female; mean age = 36.89 years). In our sample the PSPS total score and PSPS scales showed adequate internal consistency reliability estimates, and both the dimensionality analyses and WLSMV exploratory structural model supported the original three factors structure for PSPS items. We found a significant correlation between perfectionistic self-presentation and pathological narcissism and a significant role of attachment patterns in explaining the differences between these two constructs. Perfectionistic participants were characterized by avoidant and anxiety attachment styles, while narcissistic participants reported an anxiety style only. As a whole, our findings support the hypothesis that the Italian version of the PSPS is a reliable measure of perfectionist self-presentation in an adult community sample. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

In order to evaluate if measures of DSM-5 Alternative PD Model domains predicted interview-based scores of general personality pathology when compared to self-report measures of DSM-IV Axis II/DSM-5 Section II PD criteria, 300 Italian community adults were administered the Iowa Personality Disorder Screen (IPDS) interview, the Personality Inventory for DSM-5 (PID-5), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Multiple regression analyses showed that the five PID-5 domain scales collectively explained an adequate rate of the variance of the IPDS interview total score. This result was slightly lower than the amount of variance in the IPDS total score explained by the 10 PDQ-4+ scales. The PID-5 traits scales performed better than the PDQ-4+, although the difference was marginal. Hierarchical regression analyses revealed that the PID-5 domain and trait scales provided a moderate, but significant increase in the prediction of the general level of personality pathology above and beyond the PDQ-4+ scales.

Gambling Disorder (GD) is an addictive disorder resulting in significant impairment in occupational and social functioning. The aim of the present study was to investigate the relationship of GD risk to adaptive and maladaptive personality dimensions in a sample of nonreferred Italian gamblers. The authors found the risk for GD to show significant associations with the Openness and Conscientiousness scales of the Big Five Inventory (BFI); however, these effects were not significant after controlling for alcohol and drug use. GD risk showed significant associations with the Detachment and Antagonism domains of the Personality Inventory for DSM-5 (PID-5), as well as with the PID-5 facet scales of Hostility, Callousness, Deceitfulness, Manipulativeness, Irresponsibility, and (low) Rigid Perfectionism, even when controlling for alcohol and drug use. Maladaptive personality dispositions may serve as risk factors for pathological gambling, even beyond their impact on frequently concomitant problems with alcohol and other drugs.

To assess how the maladaptive personality domains and facets that were included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Alternative Model of Personality Disorders relate to adult attachment styles, 480 Italian nonclinical adults were administered the Personality Inventory for DSM-5 (PID-5) and the Attachment Style Questionnaire (ASQ). To evaluate the uniqueness of the associations between the PID-5 scales and the ASQ scales, the participants were also administered the Big Five Inventory (BFI). Multiple regression analyses showed that the ASQ scales significantly predicted both PID-5 domain scales and BFI scales; however, the relationships were different both qualitatively and quantitatively. With the exception of the PID-5 risk taking scale (adjusted R(2) = 0.02), all other PID-5 trait scales were significantly predicted by the ASQ scales, median adjusted R(2) value = 0.25, all ps < 0.001. Our findings suggest that the maladaptive personality domains and traits listed in the DSM-5 Alternative Model of Personality Disorders show meaningful associations with adult attachment styles.

A number of studies have reported data suggestive of a significant association between attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). However, the nature of this relation is not fully understood. This study aimed to evaluate if the relation between retrospectively assessed ADHD symptoms and adult BPD features is moderated by participants' gender and mediated by emotion dysregulation and impulsivity. Two hundred seventeen outpatients meeting DSM-IV criteria for at least one personality disorder (PD) consecutively admitted to the Clinical Psychology and Psychotherapy Unit of the Scientific Institute H San Raffaele of Milan, Italy, were administered Italian versions of the following instruments: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Wender Utah Rating Scale (WURS), Difficulties in Emotion Regulation Scale (DERS), and the Barratt Impulsiveness Scale-11 (BIS-11). Moderation analyses revealed a significant association between ADHD and BPD symptoms among only female (vs. male) outpatients. Furthermore, in the female subsample, mediation analyses revealed that both impulsivity and emotion dysregulation fully mediated the relationship between retrospectively assessed ADHD symptoms and current BPD features., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The recent advent of diffusion imaging tractography has opened a new window into the in vivo white-matter anatomy of the human brain. This is of particular importance for the connections of the auditory system, which may have undergone substantial development in humans in relation to language. However, tractography of the human auditory pathways has proved to be challenging due to current methodologic limitations and the intrinsic anatomic features of the subcortical connections that carry acoustic information in the brainstem. More reliable findings are forthcoming from tractography studies of corticocortical connections associated with language processing. In this chapter we introduce the reader to basic principles of diffusion imaging and tractography. A selected review of the tractography studies of the auditory pathways will be presented, with particular attention given to the cerebral association pathways of the temporal lobe. Finally, new diffusion methods based on advanced model for mapping fiber crossing will be discussed in the context of the auditory and language networks., (© 2015 Elsevier B.V. All rights reserved.)

The past 25 years have shown major advances in the studies of personality disorders. This collaborative article by the presidents, past and present, of ISSPD reflects on the progress within several significant areas of studies, i.e., assessment, neuroscience, treatment, prevention, advocacy, and mental health policy.

The major aim of this study was to evaluate the factor structure of the Italian translation of the Levenson Self-Report Psychopathy Scale (LSRP) in a sample of 740 community dwelling adult participants. Hull method, minimum average partial analysis and quasi-inferential parallel analysis techniques were used to identify a three-factor solution that appeared broadly consistent with previous work. The three factors exhibited reliability coefficients >0.70, and the three-factor structure was adequately reproduced across gender, educational level and civil status strata (median congruence coefficients = 0.94, 0.93 and 0.95 respectively) and remained largely unchanged when the effect of participants' age was controlled for (median factor score correlation = 0.99). Although Factor 3 in our study was demarcated mainly by reverse-keyed items, the LSRP factors yielded meaningful relations with retrospective measures of antisocial behaviour in adolescence and HEXACO personality traits and were conceptually consistent with the triarchic model of psychopathy of Patrick, Fowles and Krueger (2009)., (Copyright © 2014 John Wiley & Sons, Ltd.)

To understand the similarities and differences in personality traits and moral disengagement associated with pathological narcissism and psychopathy, 740 Italian active community members who voluntarily participated in the study were administered the Italian versions of the Pathological Narcissism Inventory, the Levenson Self-Report Psychopathy Scale, the HEXACO Personality Inventory, and the Moral Disengagement Scale. Hierarchical regression analyses showed that low Honesty-Humility and Antagonism (i.e., low Agreeableness) were personality traits common to both pathological narcissism and psychopathy, whereas low Conscientiousness was only related to psychopathy. Different associations with the HEXACO-PI scales and facets were observed for narcissistic grandiosity and narcissistic vulnerability, as well as for primary psychopathy and secondary psychopathy. Moral disengagement represented a common feature of pathological narcissism and psychopathy that was related to narcissistic vulnerability and to primary and secondary psychopathy, but not to narcissistic grandiosity.

Background: Contemporary theorists have suggested that impulsivity and emotion dysregulation are two of the core features of BPD. The aim of this study was to evaluate the relationships between Borderline Personality Disorder (BPD) features, impulsivity, and emotion dysregulation in adolescence., Methods: 1,157 nonclinical adolescents were administered the Borderline Personality Inventory, following which three groups of adolescents with high (high-BPD; n = 29), average (average-BPD; n = 31), and low (low-BPD; n = 31) levels of BPD features were selected. Participants in these three groups were administered the UPPS-P Impulsive Behavior Scale (UPPS-P) and the Difficulties in Emotion Regulation Scale (DERS)., Results: UPPS-P Negative and Positive Urgency scales, as well as the DERS total score, significantly discriminated high-BPD adolescents from both other groups. The differences in UPPS-P Negative and Positive Urgency between high-BPD adolescents and both control groups remained significant when partialing out the variance associated with the DERS; However, when partialing out the variance associated with Positive and Negative Urgency, high-BPD adolescents reported significantly higher DERS scores than only the low-BPD control group (and not the average-BPD group). Finally, although the differences in Positive Urgency between high-BPD adolescents and both control groups remained significant when partialing out the variance associated with Negative Urgency, the between group differences in Negative Urgency did not remain significant when controlling for the variance associated with Positive Urgency., Conclusions: These findings highlight the relevance of both emotion dysregulation and two dimensions of impulsivity (negative and positive urgency) to BPD features in adolescence, providing evidence for a unique association between BPD features and Positive Urgency in particular. These findings add to the literature in this area, suggesting that the tendency to act rashly in the context of intense positive affect may have unique relevance to BPD features in adolescence.

Objective: The aim of this study was to evaluate the electromyographic activity of both the temporalis and masseter muscles and the mastication type of patients with skeletal unilateral posterior crossbite before and after orthodontic treatment and speech therapy., Methods: A total of 14 patients with skeletal unilateral posterior crossbite (eight females and six males), between 6-13 years of age, underwent electromyographic evaluation of their masseter and temporalis muscles in mandibular rest, habitual mastication and isometry. The subjects were assessed with regard to mastication type before and after orthodontic treatment and speech therapy. The data obtained during mandibular rest and habitual mastication were normalized in terms of the mean values of isometry. The Student's t-test was used for paired samples to compare the mean values of electromyographic activity (p < 0.05)., Results: The masseters during habitual mastication presented higher electromyographic activity after both treatments (p = 0.0458). There was no significant difference between the contralateral masseters in terms of mandibular rest or habitual mastication before or after either treatment (p > 0.05). During habitual mastication, after the treatments, the temporalis muscle on the malocclusion side showed higher electromyographic activity than the contralateral side (p = 0.0263). Prior to therapy, all of the patients exhibited chronic unilateral mastication (n = 14) and 13 patients exhibited bilateral mastication after treatment., Conclusions: Orthodontic intervention combined with myofunctional therapy in patients with skeletal unilateral posterior crossbite provided an increase in the electromyographic activity of the masseter and temporalis muscles during mandibular rest and habitual mastication, with predominantly bilateral mastication.

Introduction: The colorectal cancer screening program in the Local Health Unit n. 6 of Livorno is running since July 2000 and is meant to residents, aged between 50 and 70, who are invited to perform the test for faecal occult blood every 2 years. The aim of this work is an evaluation of the screening activity in the period 2000-2011., Methods: The evaluation is based on the analysis of the main quality indicators formulated by GISCoR (Italian Group for Colorectal screening)., Results: The screening activity extension reached 93% in 2006 and 100% in 2009. The compliance level was maintained above the acceptable GISCoR value (> 45%) with a maximum of 54.9%. Values around 80% were recorded for the compliance to colonoscopy. The detection rate (DR) for cancer and advanced adenoma showed, as expected, the highest values in the early years and then move on values consistently lower than the regional average. In 2011, the raw DR for cancer was 0.9 x 1000 and the raw DR for advanced adenoma 5.3 x 1000. The distribution by stage at diagnosis of screen-detected carcinomas shows that 58.1% of these were identified at stage I while the proportion of cases in stage III+ is 19.5%., Conclusions: The overall analysis shows a good performance of the program. The proportion of colonoscopies performed on the total number of positive subjects remains a critical point of the system. The distribution by stage of screen-detected cancers shows an excellent diagnostic anticipation of the screening program.

In order to assess the internal consistency, factor structure, and ability to recover DSM-IV personality disorders (PDs) of the Personality Inventory for DSM-5 (PID-5) scales, 710 Italian adult community dwelling volunteers were administered the Italian translation of the PID-5, as well as the Italian translation of the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Cronbach's alpha values were >.70 for all PID-5 facet scales and greater than .90 for all PID-5 domain scales. Parallel analysis and confirmatory factor analysis supported the theoretical five-factor model of the PID-5 trait scales. Regression analyses showed that both PID-5 trait and domain scales explained a substantial amount of variance in the PDQ-4+ PD scales, with the exception of the Passive-Aggressive PD scale. When the PID-5 was administered to a second independent sample of 389 Italian adult community dwelling volunteers, the basic psychometric properties of the scale were replicated. In this second sample, the PID-5 trait and domain scales proved to be significant predictors of psychopathy measures. As a whole, the results of the present study support the hypothesis that the PID-5 is a reliable instrument which is able to recover DSM-IV PDs, as well as to capture personality pathology that is not included in the DSM-IV (namely, psychopathy).

The present study aimed to test if measures of emotion dysregulation and impulsivity additively predicted dimensional scores of borderline personality disorder assessed using the Borderline Personality Disorder Scale of the Personality Diagnostic Questionnaire-4+ in two independent samples of Italian nonclinical adolescents. Hierarchical regression analyses showed that three dimensions of emotion dysregulation (difficulties controlling impulsive behaviours when distressed, limited access to effective emotional regulation strategies and lack of emotional clarity) were significantly associated with BPD features in both samples. Further, impulsivity scores accounted for a significant amount of additional variance in BPD features above and beyond emotion dysregulation., (Copyright © 2013 John Wiley & Sons, Ltd.)

A number of studies have reported data suggestive of a significant association between ADHD and BPD, nevertheless, the nature of this relation has not been fully understood yet. In our study, we tried to evaluate if the relationship between retrospectively assessed ADHD symptoms and adult BPD features could mediated by selected temperament/personality traits. Four hundred forty-seven in- and outpatients consecutively admitted to the Clinical Psychology and Psychotherapy Unit of the Scientific Institute H San Raffaele of Milan, Italy, were administered the Italian versions of the following instruments: Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II), Wender Utah Rating Scale (WURS), Temperament and Character Inventory-Revised (TCI-R), Barratt Impulsiveness Scale-11 (BIS-11), and Aggression Questionnaire (AQ). Our mediation analyses showed that the combination of impulsivity, aggression, novelty seeking, and juvenile conduct problems completely mediate the relationship between retrospectively assessed ADHD symptoms and current BPD features., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Metacognition is a multi-facet psychological construct; deficits in metacognitive abilities are associated to low social functioning, low quality of life, psychopathology, and symptoms. The aim of this study was to describe and develop a valid and reliable interview for assessing metacognition., Methods: The semi-structured interview, based on the author's theory model of the metacognition construct, is described. The Metacognition Assessment Interview (MAI) is an adaptation of the Metacognition Assessment Scale (MAS) and evaluates how the subject is interviewed used metacognition during his own real life experiences elicited by the interviewer. A user manual was developed to assist the interview and scoring procedure., Results: Exploratory factor analysis and confirmatory factor analysis revealed preliminary evidence of a two factor-hierarchical structure, with two lower-order scales, representing the two main theoretical domains of the metacognitive function, "the Self" and "the Other", and one single higher-order scale that we labelled metacognition. Contrary to the authors' prediction the existence of the four distinct dimensions under the two domains was not confirmed. The MAI and its two domains demonstrated acceptable levels of inter-rater reliability and internal consistency., Conclusions: The MAI appears to be a promising instrument for assessing metacognition. Future psychometric validation steps and clinical directions are discussed., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: To study mastication and swallowing disorders in patients with temporomandibular disorders (TMD)., Objective: To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery., Materials and Methods: Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration., Results: During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%)., Conclusion: TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients.

Objectives: This study aims to assess the relationships between measures of mindfulness, self-report, and interview measures of personality disorders (PDs) in a sample of 111 consecutively admitted adult outpatients., Results: When PDs were assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0, borderline and histrionic PD, as well as the overall number of PD criteria met by each participant, were significantly predicted by mindfulness measures. When the Personality Diagnostic Questionnaire-4+ (PDQ-4+) scale scores were entered in the regression equations as dependent variables, only the obsessive-compulsive PD seemed to be unrelated with mindfulness. The Mindful Attention Awareness Scale total score and the Five Facet Mindfulness Questionnaire Act with Awareness scale were consistent, negative, and nonredundant predictors of PDQ-4+ dimensionally assessed PDs., Conclusion: As a whole, our findings support the hypothesis that low levels of mindfulness play a significant role in personality psychopathology, and particularly in borderline PD., (© 2012 Wiley Periodicals, Inc.)

The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (<30 years, 30-39 years, 40-49 years, and >50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p < .001). Attachment scales were significant predictors of BPD features across all age groups, but different scales were relevant in different age groups. Our results suggest that in nonclinical populations, BPD may represent a complex constellation of personality traits and disturbed attachment patterns.

The aim of this study was to assess whether mindfulness mediates the association between attachment dimensions and features of Borderline Personality Disorder (BPD) in a sample of 501 Italian high-school students. Low scores on Confidence and high scores on Need for Approval and Preoccupation with Relationships attachment scales was significantly related to the number of BPD features (adjusted R(2) = .2, p < .001). Further, mindfulness scores were negatively associated with Need for Approval and Relationships as Secondary attachment scales (adjusted R(2) = .14, p < .001). Finally, mindfulness scores were negatively associated with the number of BPD features (adjusted R(2) = .15, p < .001). Mediation analyses showed that the relationship between Need for Approval and BPD was completely mediated by the mindfulness effects. Our results in non-clinical adolescents are consistent with Bateman and Fonagy's (2004) hypothesis that the link between attachment disturbances and BPD features may be mediated by deficits in mentalization, at least as these are operationalized by low mindfulness.

Background: Although adverse events have been consistently described to precede and potentially precipitate the onset of panic disorder, there is no information about their ability to alter the individual reactivity to inhaled carbon dioxide, a putative intermediate phenotype of susceptibility to panic disorder., Method: Seven-hundred twelve subjects belonging to the general population-based Norwegian Institute of Public Health Twin Panel underwent a 35% CO(2)/65% O(2) inhalation challenge test and interview-based lifetime assessments of DSM-IV panic disorder, separation anxiety disorder, childhood parental separation/loss, major life events, adverse events of suffocative nature and common stressful life events. Regression models were applied to predict global subjective anxiety and DSM-IV panic symptoms after 35% CO(2)/65% O(2) inhalation., Results: The responses to the challenge measured as semicontinuous variables were predicted by symptoms of childhood separation anxiety, childhood parental loss, common stressful events, major life events, suffocative events and the female gender. The role of most of these predictors was confirmed and held true after the exclusion of subjects with lifetime panic attacks/disorder from the analyses., Conclusions: Several factors which have been reported by previous clinical studies to influence the individual susceptibility to develop panic disorder seem to affect the individual reactivity to inhaled carbon dioxide in people from the general population. Some elements of risk may impact simultaneously upon the individual liability to panic and exaggerated sensitivity to hypercapnia.

In recent years, there has been increasing acknowledgment of the multidimensionality of narcissism and that different types of narcissism may relate differently to other domains of functioning. Similarly, aggression-a frequently discussed correlate of narcissism-is a heterogeneous construct. In this study, the relations of proactive and reactive aggression with overt and covert manifestations of narcissism were examined in a sample of 674 Italian high school students (mean age=15.5 years, SD=2.1 years). Overt narcissism was positively related to both proactive and reactive subtypes of aggression, whereas covert narcissism related only to reactive aggression. Vanity, Authority, Exhibitionism, and Exploitativeness were the components of overt narcissism related to Proactive Aggression (all remained unique correlates when controlling for Reactive Aggression), whereas Reactive Aggression was associated with the Exhibitionism, Superiority, and Entitlement subscales (only the latter was uniquely related when controlling for Proactive Aggression).

Purpose of Review: Although researchers continue to investigate the multifarious etiologic, anatomical, physiological, and pathological factors of dry eye, successful treatment remains a challenge., Recent Findings: Dry eye prevalence is substantial across populations and the term 'dry eye' is used to describe numerous causes and varied pathophysiologies. Advanced study of the physiological aspects of the ocular anatomy (e.g. cornea and conjunctiva, tear film, eyelids) allows improved understanding of the mechanisms involved in dry eye and the impact of different causes on these entities. Sophisticated diagnostics are being developed to efficiently identify dry eye. Management options include a variety of novel agents in the pipeline., Summary: The development of improved etiological understanding and diagnostics for dry eye, as well as emerging therapeutics, will likely allow targeted therapy in the future.

The aims of this study were to develop a new measure of impulsive aggressiveness, and to assess whether this measure was associated with deficits in mentalized affectivity and adult attachment styles in a sample of 637 non-clinical participants. Extending Fonagy and Bateman's (2004) hypothesis, the mediating role of poor affectivity mentalization in the relationship between insecure attachment styles and impulsive aggression was also evaluated. Selected insecure attachment styles (R2(adjusted) = .18, p < .001) and deficits in mentalized affectivity (R(2)(adjusted) = .25, p < .001) were significantly associated with impulsive aggressiveness. The overall regression model accounted for roughly 33% of the variance in impulsive aggressiveness. Mentalization deficits significantly mediated the effects of attachment styles on impulsive aggressiveness, although effect size measures suggested that only partial mediation occurred.

Five independent studies were used to test the hypothesis that a reliable 2-factor structure underlies the Reactive-Proactive Aggression Questionnaire (RPQ) items and that the 2 scales show distinct patterns of association with personality and bullying behavior measures. Study 1 (N = 1,447) gave evidence of a clear 2-factor structure of RPQ items with factor loading matrices closely matching reactive (congruence coefficient = .90) and proactive (congruence coefficient = .91) models of item assignment. The RPQ 2-factor structure was consistently replicated in Study 2 (N = 662), as well as across the remaining 3 studies. In Study 3 (N = 536), Neuroticism differentiated reactive and proactive forms of aggression. In Study 4 (N = 674), self-reports of bullying behaviors were selectively correlated with proactive aggression. Findings confirm and extend the differential correlates of proactive-reactive aggression and also support the psychometric properties of the RPQ in a different cultural context. Finally, in Study 5 (N = 347), the RPQ scales showed adequate 2-month test-retest reliability. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Background: Sirolimus (SRL) can increase the risk of wound complications. In this study, we investigated the impact of steroids when added to SRL, in this side effect., Methods: One hundred and forty-eight patients entered prospective studies comparing early (fifth day) with late (sixth month) steroid withdrawal. All patients were on SRL, added either to Tacrolimus (n = 56) or to cyclosporine (n = 97). At 15th day after transplantation, 68 patients were on steroids (On-St group) and 80 were not (Off-St group). Wound complications considered were as follows: dehiscence, lymphocele, wound leakage, hematoma and seromas. Risk factors under analysis were as follows: body mass index, diabetes, rejection, creatininemia, length of dialysis before transplantation, recipient age, being on steroids at 15th day, SRL levels., Results: The overall incidence of wound complications was significantly lower in Off-St group than in On-St group: 18.8% vs. 45.6%, respectively (p < 0.0004). In detail, lymphocele: 5.0% vs. 32.3% (p < 0.0001); dehiscence 0% vs. 10.3% (p < 0.009), leakage 6.2% vs. 8.8% (p = NS), seromas 1.4% vs. 7.5% (NS). At multivariate analysis, the addition of steroids to SRL increases 4.2-fold the risk for wound complications., Conclusions: Early steroid withdrawal is effective in preventing both the incidence and the severity of wound-healing complications because of SRL regime, even when started with a loading dose.

The benefits of kidney transplantation over dialysis on patient survival have been demonstrated without considering the outcomes of patients with graft loss. To determine whether mortality after graft failure reduced the transplantation advantage in patient survival, we retrospectively reviewed the outcomes of 918 first-deceased renal transplant recipients from May 1979 to August 2005. Patient survivals were 88% and 72% at 10 and 20 years; cancer (26%) and cardiovascular disease (25%) were the major causes of death. Graft survivals were 72% and 50% at 10 and 20 years; chronic rejection was the major cause of graft loss (50%). Patient outcomes after return to dialysis were reviewed in 224 of 240 patients. The survivals were 97%, 83%, and 70% at 1, 5, and 10 years, respectively; cardio-cerebrovascular disease (56%), infections (9%), cachexia (9%), and cancer (8%) were the major causes of death. Mortality correlated with patient age at transplantation (P< .001). Re-listed patients (96 of 224) were younger (32+/-10 vs 43+/-11 years; P< .001), had a shorter dialysis period pretransplant (3.2+/-3.1 vs 4.3+/-3.9 years; P< .03), and a better survival at 10 years (98% vs 56%; P< .001). Ten-year mortality for patients who returned to dialysis was 20% higher than for patients with a functioning graft (P< .001). The reduction in overall patient survival was 2.2% at 10 years (P=NS), 5% at 15 years (P=NS), and 14% at 20 years (P< .05). The same results have been demonstrated for patients >50 years at transplantation. In conclusion, the mortality rate after return to dialysis did not influence the long-term benefits of kidney transplantation.

Recent literature has shown that adherence to HAART is a multi-faceted phenomenon, which involves both behavioural and psychological features. Therefore, the results obtained so far, though promising, have not yet unambiguously identified the factors that could predict non-adherence. Since any support for strengthening the adherence should take into account the HIV+ patients' perception of both their state of health and their relational style, this study tried to identify some psychological characteristics involved in the adherence phenomenon. A self-administered battery of tests including the Attachment Style Questionnaire (ASQ) and the Multidimensional Health Locus of Control Form-C (MHLC-C) was administered to an Italian sample. Results showed significant gender differences between non-adherent and adherent subjects. Specifically, the psychological profile of non-adherent males seemed focused less on relational aspects and perceived relevance of physicians and of 'significant other people', whilst that of non-adherent females seemed more 'relationship-oriented'. This study means to encourage clinicians to plan specific, gender-focused support for enhancing adherence.

In the last few years, highly active antiretroviral therapy (HAART) has resulted in a remarkable decrease in HIV-related morbidity and mortality. This "new deal" encouraged clinical research in investigating patients' manifest behaviours and their beliefs regarding their health status, which likely influence not only their treatment-linked behaviours but also their quality of life. Locus of control has been shown to be a construct that can predict and explain health-related behaviours. The Multidimensional Health Locus of Control Form C (MHLC-C) is a condition-specific locus of control scale that can be easily adapted for use with any medical or health-related condition. With the aim to enhance the knowledge about the HIV+ patients' point of view of their complex health condition, this study preliminarily investigated the psychometrics properties of the MHLC-C Italian version and its generalizability across samples defined both by being adherent or not and by gender. Two more samples of chronic patients (Cardiac Surgery and Cancer) were enrolled to better characterize the HIV+ patient's MHLC-C profile. The results showed the validity, reliability and generalizability of the 4-factor structure of MHLC-C. More interestingly, HIV+ subjects revealed a peculiar pattern of beliefs regarding their health condition that clinicians should take into account when managing patients' complex bio-psychosocial condition.