Psychiatria Danubina最新文献

This paper examines the intricate relationship between perception and illusion, emphasizing that human perception is a constructed, interpretative process shaped by sensory input, attention, and prior knowledge. It categorizes optical illusions into physical, physiological, and cognitive types, examining how perceptual hypotheses interact with sensory data and memory. Tracing the evolution of illusions from philosophical and artistic traditions to scientific investigation, the paper highlights how Renaissance innovations in perspective and chiaroscuro, alongside Gestalt psychology and neuroaesthetics, have expanded our understanding of visual perception. Art techniques such as linear perspective, trompe l'œil, and chiaroscuro demonstrate how illusions can create immersive visual experiences. Interdisciplinary insights from art, psychology, and neuroscience reveal the complexity of visual processing. Case studies such as the Rorschach test demonstrate how individuals impose meaning on ambiguous stimuli, revealing insights into both conscious and unconscious cognitive processes. Additionally, research on visual indeterminacy, the Default Mode Network, and non-invasive brain stimulation provides a comprehensive perspective on the neural dynamics underlying perception. Clinical applications of optical illusions are also explored, particularly for the identification and assessment of perceptual and cognitive disorders. In conclusion, the paper argues that illusions challenge and refine our understanding of reality, underscoring the cognitive and interpretative nature of human perception. It advocates for interdisciplinary collaboration as essential to deepening our appreciation of the complex mechanisms underlying visual experience.

Teen dating violence affects between 8.2% and 30% of adolescents, leading to significant mental and physical health consequences including depression, anxiety, substance use disorders, and increased risk of sexually transmitted infections. This narrative review synthesizes current evidence on prevention interventions for teen dating violence, examining their effectiveness and exploring applications for clinical practice. Based on findings from a comprehensive systematic review of 28 studies, this review identifies several types of effective prevention approaches. School-based universal programs such as Green Dot, Me & You, and Dating Matters have demonstrated effectiveness in reducing violence perpetration and changing attitudes toward violence. Targeted interventions for high-risk populations, particularly adolescents with previous violence exposure, often show stronger effects than universal approaches. Brief interventions using motivational interviewing and personality theory-based approaches show promise for healthcare settings, while digital prevention programs offer scalability and accessibility advantages. The evidence reveals that interventions are generally more effective at changing attitudes and norms than directly modifying violent behaviors, suggesting that cognitive shifts may precede behavioral change. Programs show differential effectiveness across gender, previous violence exposure, and socioeconomic characteristics, highlighting the importance of tailored approaches. Healthcare provider training demonstrates significant improvements in knowledge and screening practices, though implementation barriers remain. Economic evaluation suggests that prevention investments can yield substantial returns, with one program showing a benefit-cost ratio of 62.9. Sustained effects remain challenging to achieve, with some programs requiring multiple years of implementation. The predominantly U.S.-based research raises questions about generalizability across different cultural contexts. Future research priorities include long-term outcome studies, implementation research, culturally adapted interventions for diverse populations, and economic evaluations. Effective teen dating violence prevention requires comprehensive, multi-level approaches that address individual, family, school, and community factors, with sustained commitment and resources for implementation.

Silvan S. Tomkins (1911-1991) and scholars advanced the understanding of facial expressions and their connection to emotions in affect theory in confluence with the etho- and ethnological Darwinian traditions. While Tomkins at first attributed the origins of feelings to the mimical muscles, he soon realized that the overlying skin, as moved by the muscles, was the actual, not just facial, agent of feelings. Variants of the contested hypotheses on Emotional Facial Feedback (EFF) struggled since, while basic mostly clinical research on the sensory trigeminal (TGS) and the facial motor system (CN7S) couldn't offer a (patho-)physiology of affect concerning the lay experience of emotions to be felt around (activated) mimical muscles in a variant of soft touch - in a way similar to how "feelings" are elicited by emotional mental content alone. Here a broad psycho-physiological review concludes on three explanations: 1). the many "anastomotic" tracts with close adjacency of motor and sensing branches point to a simulating "shortcut" from the CN7S to the TGS thus just faking "feeling" without ensuing contraction - since branches of CN7S can just be alerted by readiness to move. This could be due to an orthogonal gaseotransmission by H2S and NO, also regulating its axonally transported enzymes (nNOS e.g.). 2). The very circumscribed sensorial areas in the face creating specific EFF gradients could function more precisely and adapting as a "somatotopic grid" by recruiting the second "onion-shaped" dermatomes of sensorial defluence providing "pain by rate", but also localization. 3). Merely intended movements of the jaw (via preparatory potentials) possibly provide psychological localizations of emotional and other semantic meanings within the Cartesian abstract mental space - limited to 4=3+1 (time) dimensions sustaining the role of movement in future AI. Self-constituting and empathic automatic mimicry and touch interactively point to their core clinical disturbances in "borderline personality" amenable to trigeminal inflammations e.g. at the cavernous sinus.

Background: This study explores the relationship between cognitive deficits, cognitive reserve (CR), and rehabilitation outcomes in psychiatric offenders and non-offenders. The objective is to analyze how neurocognitive functioning, impulsivity, and CR influence the duration and effectiveness of psychiatric rehabilitation.

Methods: Fifty-five patients from rehabilitation centers in Southern Italy were assessed using standardized psychiatric and neuropsychological scales. Participants were divided into offenders (n=19) and non-offenders (n=36). Assessments included BPRS, BIS-11, CRIq, T.I.B., and TMT A/B. Statistical analyses involved Pearson's correlation and t-tests using JASP.

Results: Significant correlations were observed between months of rehabilitation (MoR) and TIQ in non-offenders and CRIq in offenders. A significant correlation between MoR and TMT was observed only in offenders. Offenders with more than 24 months of rehabilitation showed lower impulsivity scores (BIS-11). These findings indicate distinct rehabilitative trajectories and neurocognitive responses in the two groups.

Conclusion: Cognitive reserve and neurocognitive assessment can inform individualized rehabilitation strategies in forensic psychiatric populations. Offenders may particularly benefit from longer and more targeted interventions to mitigate impulsivity and enhance cognitive functioning.

Assessing pain in people with intellectual disabilities (PWID), particularly those with multiple sensory and motor impairments, is a complex clinical challenge often overlooked, leading to the risk of underestimating pain. The Serafico Institute in Assisi investigated pain assessment in this population using the revised Face, Legs, Activity, Cry, Consolability (R-FLACC) scale and self-report tools. This follow-up study examined the reporting of unexplained behavioral changes and the use of pain scales in routine clinical practice one year after the initial research. A total of 110 participants (72% male; mean age 27 years, range 2-54) were enrolled, including 27 children (25%) and 83 adults (75%). Over seven months, 252 episodes of unexplained behavioral changes were recorded: 227 (90%) assessed with R-FLACC and 25 (10%) via self-report. Of these, 148 (59%) were classified as pain-related, 83 (33%) as distress episodes, and 21 (7%) remained unexplained. The number of episodes reported and consistent use of pain scales, indicate heightened awareness among healthcare and educational staff towards unexplained behaviors that might signal pain, prompting appropriate evaluation and treatment. Pain assessment has now become an integral component of Serafico Institute's clinical practice and operational guidelines for PWID.

Background: Hoarding disorder (HD) is increasingly recognized as a distinct, multifactorial condition. Recent findings in neuroimaging, psychopathology, compulsive acquisition, suicidality, stigma, and social context call for a redefinition of HD beyond its traditional association with obsessive-compulsive disorder.

Subjects and methods: This narrative review synthesizes recent clinical, neurobiological, and sociocultural literature, including latent class analysis and resting-state fMRI studies, exploring cognitive dysfunction, comorbidities, suicidality, stigma, and environmental context.

Results: HD is characterized by impaired executive functioning, frequently comorbid with ADHD and compulsive buying-shopping disorder. Subtype profiles identified through latent class analysis reveal complex multisymptomatic presentations. High rates of suicidality, social exclusion, and stigma - especially among individuals hoarding purchased items - suggest a need for a broader clinical and public health framework.

Conclusions: HD should be conceptualized within a neurodivergent and socially mediated model. Treatment and policy should address neurocognitive deficits, emotional regulation, social determinants, and stigma through interdisciplinary and person-centered interventions.

Delirium is a common and serious neuropsychiatric syndrome in older adults, characterized by acute and fluctuating disturbances in attention, awareness, and cognition. It is associated with multiple adverse outcomes, including increased mortality, functional decline, long-term cognitive impairment, and institutionalization. This review synthesizes current knowledge on the pathophysiology, risk factors, clinical presentation, diagnosis, prevention, treatment, and prognosis of delirium in elderly patients. Delirium arises from complex interactions between predisposing vulnerabilities (such as dementia, frailty, and sensory deficits) and acute precipitants (including infections, medications, surgery, and environmental stressors), resulting in a transient but often severe breakdown of cerebral function. Diagnostic tools such as the Confusion Assessment Method (CAM) and 4AT improve detection, though challenges remain in hypoactive presentations and in patients with underlying dementia. Multicomponent non-pharmacological interventions - focused on orientation, sleep hygiene, mobilization, hydration, medication review, and sensory support - are the most effective preventive and therapeutic strategies. Pharmacological treatment, primarily with antipsychotics, is reserved for severe behavioral disturbances and does not alter the course of the syndrome. Delirium is a clinical red flag indicating systemic decompensation and should prompt both acute management and structured follow-up to mitigate long-term consequences. Greater integration of delirium screening and prevention into hospital protocols is essential to improve care outcomes in this vulnerable population.

Background: It is known that youth aged 16 to 23 are more vulnerable to mental distress than other age groups. This vulnerability can be explained by several factors such as the high prevalence of mental illnesses, the changes in the environment, the social expectations and so on. Moreover, in this age group the transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) impacts the continuity of care, leading to a negative impact on the prognosis. This article aims to characterize this population based on risk factors, history of care and care plan.

Subjects and method: We conducted a retrospective study including patients who attended transition psychiatry consultations between October 2020 and December 2023. Data were collected at a secondary care outpatient service.

Results: The sample (n=122) was predominantly female (70.5%, n=86). Referrals were mostly made by psychologists (35.2%, n=43), although many individuals were self-referred (32%, n=39). In most cases, the consultation request came directly from the young person (60.7%, n=74). Regarding previous mental health support, 79.5% (n=97) had already received psychological care at the time of their transition consultation. In terms of risk factors, many participants had been exposed to adverse childhood experiences (ACE): 60% (n=69) reported a first-degree family history of psychiatric disorders, 28% (n=33) had experienced sexual abuse, and 37.3% (n=44) had been exposed to domestic violence. Among those who received follow-up care, 19.7% (n=24) were scheduled for planned inpatient care. Psychotherapeutic follow-up was offered to 79.6% of patients, and psychotropic medication was recommended for 68.9%.

Conclusion: This research highlights the major vulnerability of transition-aged youth (TAY) and reinforces the need for specialized care and continuity between CAMHS and AMHS.