Purpose: Starting from the psychopathological hypothesis of ‘Troilism’, just like ‘Cuckolding’, correctly framed (the latter) as a paraphilia, the present research aims to identify the clinical evidence capable of confirming the initial hypothesis, trying to identify the possible aetiological causes. For the purposes of this research, other possible causes that are not directly linked to a psychopathological nature are therefore excluded. 
Methods: The phases of the research were divided as follows: 1) Selection of the population sample divided into seven groups (A, B, C, D, E, F, G) as indicated in section 3 of this research work; 2) Clinical interview, to each population group; 3) Administration of the PICI-2 and PSM-Q (sections A, E), to each population group; 4) Data processing following administration; 5) Comparison of data obtained. 
Results: The entire sample of the selected population (550 people) presents a number of dysfunctional personality traits that are significant for diagnosing a specific disorder; in particular: in cluster A anxiety disorder, phobic disorder, obsessive disorder, dependent disorder and depressive disorder are recurrent; in cluster B bipolar disorder, borderline disorder, narcissistic disorder and sadistic-masochistic disorder are recurrent; in cluster C schizoid disorder, schizotypal disorder, schizoaffective disorder and dissociative disorder are recurrent. Behavioural dependency disorder and/or drug/alcohol dependency disorder is present in all the subjects investigated. In the male population sample (192 individuals), the percentage of cluster B disorders (with a greater prevalence for borderline and narcissistic disorder) tends to be markedly higher than in the female sample in the sexual troilistic forms, while it attenuates in the polyamorous form. In the female sample (358 persons), the percentage of cluster B disorders (with a higher prevalence for borderline and narcissistic disorder) tends to be markedly higher than in the male sample in the sentimental troilistic forms, while it attenuates in the polysexual form, although it is still higher than the average for the male sample. In both sexual genders, the net prevalence of cluster C disorders (in comorbidity with narcissistic traits) is in the anarchic sentimental troilistic form. The entire sample of the selected population (550 people) presents positivity on the test of dysfunctional behaviour in polygamous relationships, with extremely high data in the relational troilistic and polyamorous forms with a binary and/or anarchic style. The integrative questions put to the selected population sample revealed: for the male population sample, betrayal (76.4%) as the main cause that influenced the polygamous choice and narcissistic control in the relationship (47.4%) as the preferred cause of the polygamous choice. A clear minority (28.8%) is not sure or has doubts about the polygamous choice; for the female sample, failed family experiences (61.9%) are the main cause that influenced the polygamous choice and narcissistic control in the relationship (47.4%) is the preferred cause of the polygamous choice. A clear minority (23.3%) is not sure about the polygamous choice or has doubts, although the choice to embark on polygamous life is for a good percentage (40.4%) dependent on a choice originally proposed by the partner, unlike the male sample (18.6%).
Conclusions: The data reported and re-elaborated show the total psychopathological predisposition of subjects who consciously and intentionally undertake a polygamous style of couple relationship, confirming the prevalence of borderline and narcissistic disorders, up to the marked presence of psychotic dysfunctional traits in subjects who prefer the sentimental anarchic type of troilist relationship. The main causes that push the subject to undertake the troilist path are mainly traumatic relational experiences of a familial and affective-sentimental kind (betrayal); therefore the emotional tension and anxiety deriving from the fear of reliving negative experiences is attenuated by the troilist style of relationship that allows greater control of the couple’s relationship and internal dynamics, favouring a marked narcissistic control that generates, aggravates or self-feeds the dysfunctional traits found. In fact, the emotional experiences lived during the troilist (polygamous or polyamorous) conduct act as positive reinforcement, for the maintenance and strengthening of the subject’s beliefs. Confirmation of this hypothesis is the finding that, for both the male and female population samples, narcissistic control is the central motive for maintaining the troilist style. As already confirmed in another study, the troilist choice (polygamous or polyamorous) is also to be considered markedly psychopathological, and therefore deserving of in-depth clinical investigation in order to better frame the patient and support him or her adequately.

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Clinical evidence in Troilism (Polygamy and Polyamory): Definition, psychological profiles and clinical implications

Background and objectives: Heart failure is a pathological condition characterized by the inability of the heart to pump (cardiac output) an adequate amount of blood to meet the metabolic needs of the body or, at any rate, to be able to do so only at the expense of increased filling pressures in one or more cardiac chambers and the upstream venous circulation. The research group states here the primary objective of expanding the indications contained in the ESC 2021 with the results of the last year on the subject of treatment profiles, to facilitate a better understanding of the overall clinical picture and contribute to the next edition of the guidelines. Materials and methods: Systematic literature review in the English language from January 1, 2021, to September 30, 2022, on PubMed/MedLine, Web on Science, and Cochrane archive. Our search strategy retrieved 8,317 articles. We excluded books and papers, meta-analyses, reviews, and systematic reviews and selected only 46 studies most significant about the clinical trial and randomized controlled trial. Results: The recent ESC 2021 guidelines are accurate and timely, and have confirmed their usefulness from a functional perspective, including concerning certain aspects that were represented as a “grey area”. Early risk prediction plays a key role in the subsequent management of patients, and to optimize risk prediction and intensity of management, one should take into account that: a) biomarkers have improved the understanding of the pathophysiology of heart failure and may therefore help to adjust the intensity of management in AHF; b) among the wide variety of biomarkers currently available, NT-proBNP and cTn seem the most promising in this indication; c) among the risk scores described, those combining demographic and clinical parameters with biomarkers in a model with routinely available rapid variables seem the most promising tools; d) in addition to biomarkers, age, systolic blood pressure, respiratory rate, oxygen saturation, creatinine, electrolytes, and blood urea nitrogen are the most commonly used predictor variables in the risk scores described; e) among the models selected, the MEESSI-AHF risk score appears to be currently the most promising tool for predicting the risk of AHF; f) during the management of decompensated patients (and in later stages), the psychological aspect is completely ignored, thus promoting the worsening of psychological symptoms (the need is as evident during the acute episode as it is in the daily management of chronic heart failure). Conclusions: The scientific literature search enriched the structure of ESC 2021, suggesting its implementation, with other findings related to new drug therapies such as Sotagliflozin, Hydrochlorothiazide Apabetalone, Alprostadil, Empagliflozin, Sacubitril/Valsartan, Dapagliflozin, Sodium-glucose co-transporter-2 inhibitors, and biomarkers such as Urinary sodium (UNa+), IL-6 levels and rh-brain natriuretic peptide (rhBNP), as well as the use of mindful breathing session, osteopathic manipulative treatment, electrical muscle stimulation, low-level tragus stimulation, venoarterial extracorporeal membrane oxygenation, oral nutritional supplements, and the correlative hypothesis between heart failure and intestinal dysbiosis, also concerning the psychological profile. However, these clinical studies suffer from some limitations that will necessarily have to be taken into account, such as the limited size of the population sample selected or the conflict of interest determined by the fact that some research is funded by the same pharmaceutical company producing the drug used that do not necessarily represent a negative limitation on the results obtained from studies.

Heart Failure (HF): Recent innovations in clinical therapy and critical profiles of acute and chronic forms

Background and aims: Starting from the concept of “affective addiction”, then reworked and critiqued according to a clinical key, it was hypothesized that it is not a behavioral addiction, as erroneously determined by modern psychiatry, but is a symptom of a well-identified personality disorder. The purpose of this research is to test the correctness of this hypothesis. Materials and methods: Clinical interview, based on narrative-anamnestic and documentary evidence and the basis of the Perrotta Human Emotions Model (PHEM) concerning their emotional and perceptual-reactive experience, and administration of the battery of psychometric tests published in international scientific journals by the author of this work: 1) Perrotta Integrative Clinical Interviews (PICI-2), to investigate functional and dysfunctional personality traits; 2) Perrotta Individual Sexual Matrix Questionnaire (PSM-Q), to investigate the individual sexual matrix; 3) Perrotta Affective Dependence Questionnaire (PAD-Q), to investigate the profiles of affective and relational dependence; 4) Perrotta Human Defense Mechanisms Questionnaire (PDM-Q), to investigate the defense mechanisms of the Ego. Results: In a population sample of 206 subjects (103 m/f couples, in a stable relationship for at least 1 year and heterosexual), it was found that the totality exhibited at least 5 dysfunctional personality traits of the borderline, dependent, and masochistic types, with secondary traits of the neurotic, narcissistic covert, psychotic and histrionic types. Almost the totality of the sample also showed marked dysfunctionality of a sexual nature and activation of defense mechanisms typical of psychopathological processes. Conclusions: The data obtained confirmed the study hypothesis, and it is, therefore, plausible to think that affective addiction is not a behavioral addiction but a manifested symptom of a broader framework of personality disorder and that it is established in subjects with the same dysfunctional personality traits. Such subjects, in close relational contact, hyperactivate themselves, according to a logic of pathological determinism. The maintenance of hyperactivation then facilitates the decompensation of the subject’s psychopathological picture, reinforcing dysfunctionality and feeding the pathological circle that keeps one’s personality structure alive, in a continuous feeding determined by the similar or same-natured traits present in the partner. This also explains why, once affective dependence is established, it is so complicated to succeed in breaking the chain of events that keeps the dysfunctional relationship alive, since overactivation prevents a correct, conscious, and rational assessment of the factors at play in relationships between elements and people. To summarize: the more the hyperactivation persists, the more it reinforces the psychopathological decompensation that keeps alive both the toxic relationship and the bond between the two individuals who, while tending toward destruction or self-destruction, fail to break the affective, sentimental, and sexual bond, maintaining over time an increasingly toxic dysfunctional attachment.

The psychopathological roots of affective dependence: The origin and clinical evolution of the toxic bond

As a result of clinical findings it is necessary to make some changes to the previous model, the first version. The second version of the PICI model (Perrotta Integrative Clinical Interviews) improves the previous version by introducing some interpretative corrections,

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Clinical evidence in the phenomenon of Demonic Possession

As at the end of August 2020, the coronavirus disease outbreak has hit more than 50,000 across all the 36 states of Nigeria. Whilst the federal government declared contraception an essential service that can continue to be assessed from health facilities,

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Giulio Perrotta

Papers

“Perrotta Individual Sexual Matrix Questionnaire” (PSM-Q): Technical updates and clinical research