Pelizza Lorenzo, Bonazzi Federica, Scaltriti Sara, Milli Bruna, Giuseppina Chierici
CSM Guastalla Reggio Emilia Mental Health Department.
Acta Biomed. 2014 May 9;85(1):18-29.
The term "brittle" is used to described an uncommon subgroup of type I diabetics whose lives are disrupted by severe glycaemic instability with repeated and prolonged hospitalization. Psychosocial problems are the major perceived underlying causes of brittle behaviour. Aim of this study is a systematic psychopathological assessment of brittleness using specific parameters of general psychopathology and personality traits following the multiaxial format (axis I and II) of the current DSM-IV-TR diagnostic criteria for mental disorders.
Patients comprised 21 brittle type I diabetics and a case-control group of 21 stable diabetics, matched for age, gender, years of education, and diabetes duration. General psychopathology and the DSM-IV-TR personality traits/disorders were assessed using the Syptom Checklist-90-R (SCL-90-R) and the Millon Clinical Multiaxial Inventory-III (MCMI-III).
The comparison for SCL-90-R parameters exclusively revealed higher scores in "Phobic Anxiety" subscale in brittle diabetics. No differences in all the other SCL-90-R primary symptom dimensions and in the three SCL-90-R global distress indices were observed between the two diabetic groups, as well as in the all MCMI-III clinical syndrome categories corresponding to DSM-IV-TR specific psychiatric disorders. However, brittle patients presented lower scores in MCMI-III compulsive personality traits and higher scores in paranoid, schizoid, schizotypal, antisocial, borderline, narcissistic, avoidant, dependent, depressive, and passive-aggressive personality traits.
In this study, brittle diabetics show no differencies in terms of global severity of psychopathological distress and axis I specific DSM-IV-TR diagnoses in comparison with non-brittle subjects (except for phobic anxiety). Differently, brittle diabetics are characterized from less functional and maladaptive personality features and suffer more frequently and intensively from specific pathological personality traits of all DSM-IV-TR clusters.
“脆性”一词用于描述Ⅰ型糖尿病患者中的一个不常见亚组，他们的生活因严重的血糖不稳定以及反复和长期住院而受到干扰。心理社会问题被认为是脆性行为的主要潜在原因。本研究的目的是按照当前精神障碍诊断与统计手册第四版修订版（DSM-IV-TR）精神障碍诊断标准的多轴格式（轴Ⅰ和轴Ⅱ），使用一般精神病理学和人格特质的特定参数对脆性进行系统的心理病理学评估。
研究对象包括21例脆性Ⅰ型糖尿病患者以及一个由21例稳定型糖尿病患者组成的病例对照组，两组在年龄、性别、受教育年限和糖尿病病程方面相匹配。使用症状自评量表90修订版（SCL-90-R）和米隆临床多轴问卷第三版（MCMI-III）评估一般精神病理学以及DSM-IV-TR人格特质/障碍。
仅就SCL-90-R参数进行比较时发现，脆性糖尿病患者在“恐惧焦虑”分量表中的得分更高。在两个糖尿病组之间，在所有其他SCL-90-R主要症状维度以及三个SCL-90-R总体痛苦指数方面均未观察到差异，在与DSM-IV-TR特定精神障碍相对应的所有MCMI-III临床综合征类别中也未观察到差异。然而，脆性患者在MCMI-III强迫性人格特质方面得分较低，而在偏执、分裂样、分裂型、反社会、边缘型、自恋型、回避型、依赖型、抑郁型和被动攻击型人格特质方面得分较高。
在本研究中，与非脆性受试者相比，脆性糖尿病患者在精神病理学痛苦的总体严重程度和轴Ⅰ特定的DSM-IV-TR诊断方面没有差异（恐惧焦虑除外）。不同的是，脆性糖尿病患者的特点是功能较差和适应不良的人格特征，并且更频繁、更强烈地遭受DSM-IV-TR所有类别中特定病理性人格特质的影响。
