Psychopathological Functioning Levels (PFLs) and their possible relevance in psychiatric treatments: a qualitative research project

Abstract

BackgroundSymptoms description is often not enough to provide clinicians with guidelines for treatments and patients’ clinical history does not represent an exhaustive source of data. Psychopathological dysfunctions are known to relate to the core disturbances that underlie different forms of psychopathology so the identification of such dysfunctions could be helpful for treatments. Some tools are available although highly complex and lengthy. This study aimed to provide clinicians with an easy-to-administer instrument able to capture different levels of impairment in psychopathological functioning, namely the Psychopathological Functioning Levels – Rating Scale (PFL-RS).MethodsThe Psychopathological Functioning Level - Research and Training Committee (PFL-RTC) has been established in Turin since 2002 including psychiatrists and clinical psychologists with extensive clinical and research experience. Our research was grounded on the Qualitative Research Criteria (QRC) 1-7 and conducted with subsequent steps in order to identify those core psychopathological dysfunctions to be rated by this tool.ResultsFrom 2002 until 2014, 316 outpatients were administered the clinical interview on at least two different occasions. Diagnoses were mixed and included: Schizophrenic and Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, Post- Traumatic Stress Disorder, Somatic Symptoms Disorders, Eating Disorders and Personality Disorders. Focus groups were conducted to identify those psychopathological dysfunctions which needed to be rated, according to two Phenomenological Selection Criteria (PhSC) and four Etiopathogenetic Selection Criteria (EtSC). As a result, five dysfunctional areas emerged: Identity (ID); Comprehension (CO); Negative Emotions (NE); Action-Regulation (AR); Social Skills (SS). After checking such dimensions for consistency with the existing instruments, 7 levels of severity were identified for each area. Finally, a provisional Italian schedule of Psychopathological Functioning Levels – Rating Scale (PFL-RS) was obtained and checked for semantic comprehension and then administered gathering preliminary data.ConclusionsPsychopathological dysfunctions underlying mental disorders have been recognized in the present study with the PFL-RS. This instrument seems promising to inform in a specific way treatments strategies and goals, specifically concerning psychotherapy. Notwithstanding, further research is needed in order to confirm validity, sensitivity and reliability of this instrument.

Associations between patient personality, symptomatic change and therapy dropout

“…The individualization of treatment based on structural vulnerabilities and personality configuration is necessary since the mere knowledge about the diagnostic status of a patient does not provide information about aetiology or guidance concerning relevant reinforcing variables (Ehrenthal & Benecke, 2019). Our results are in line with studies reported by Ferrero et al (2016), in which an individualized treatment adapted to the patients psychopathological functioning led to better outcomes than treatment as usual. It is also supported by a study by Huber et al (2017) that showed that depressive symptomatology and general psychiatric distress at 3‐year follow‐up were significantly predicted by pre‐treatment to post‐treatment changes in personality functioning.…”

“…In contrast to the aforementioned studies, our study proposes a more detailed investigation on personality structure, personality configuration and the classification of dropout for patients who improved sufficiently versus those who were dissatisfied (Brown et al, 2015; de la Parra, Gómez‐Barris, et al, 2018; Simon et al, 2012). These findings are consistent with other studies who predict therapy outcome through patient personality structure (Ferrero et al, 2016; van Vreeswijk et al, 2019), but further research with respect to different types of personality such as the anaclitic (dependent) and introjective (self‐critic) personality configuration (Blatt & Felsen, 1993) is needed.…”

Demonstrating the reliability of transdiagnostic mHealth Routine Outcome Monitoring in mental health services using experience sampling technology

“…Moreover, ROM instruments should map several outcome domains, including psychopathology, daily life functioning, personal recovery, and quality of life [3, 12]. Unfortunately, current ROM implementations mainly focus on psychopathology [13], disregarding the other outcome domains. In addition, measures of psychopathology, expressed as total scores from traditional technical scales, do not reflect outcomes that are important to patients [14, 15].…”

Combined therapy versus usual care in the treatment of depressed cancer patients with pain

“…This technique has been described in a previous study [25] and has been used within a range of settings to treat various disorders [26][27][28] analysis. Cardinal variables were described by using the mean and standard deviation.…”