Psychiatria Danubina最新文献

Background: People with Major Depressive Disorder (MDD) are far more likely to suffer from Early Life Stress (ELS) than the average population. This typically increases severity of symptoms, and often leads to treatment resistance. This study set out to examine which treatments work best to treat depression in patients who have suffered from ELS, as well as possible interactions between ELS and antidepressant effects in therapies.

Method: A literature review was conducted in July 2020 using the databases Embase, PsychInfo, and MEDLINE. The search looked for clinical trials treating MDD with psychotherapies and pharmacotherapies with patients who suffered from ELS. Data regarding demographics, comorbidities, measurement tools, and outcomes (generally response rates and remission) were extracted. The data was compared according to treatment types.

Results: Cognitive Behavioural Therapy (CBT) had the best evidence for treating MDD in people with ELS. There was some mixed evidence for Interpersonal Therapy, SSRIs, and SNRIs as suitable treatments for MDD. There was also very promising but limited evidence for Cognitive Behavioural Analysis of System Therapy and combination treatments (pharmacotherapy and psychotherapy together). Nefazodone (a SARI) had the weakest evidence.

Conclusions: CBT was the most effective treatment for MDD with ELS. However, more research needs to be conducted to ascertain a proper hierarchy of treatments, particularly with combination treatments.

Obsessive-compulsive disorder (OCD) is a common and debilitating psychiatric disorder with an approximate incidence of 2.5% in the general population. Serotonin reuptake inhibitors (SRIs) are considered the first line of pharmacological treatment but up to 50% of patients fail to achieve clinical remission or response. Atypical antipsychotics are one of the most common augmentation strategies in OCD treatment resistant patients. Brexpiprazole, a novel atypical antipsychotic with dopamine partial agonism action, has never been studied in addition to SRIs treatment in OCD resistant patients. This study retrospectively investigated the safety and efficacy of a 12 week brexpiprazole augmentation trial in 34 OCD resistant patients. SRI treatment resistance was defined as failing to improve the YBOCS total score by more than 25% from the beginning of the SRI trial. Brexpiprazole augmentation response was defined as at least a 25% improvement in the YBOCS total score. At the end of the study, 17 patients (50.0%) met the response criteria of ≥25% improvement in YBOCS total score vs. baseline. No safety issues were raised throughout the observation period. A total of 19 patients (55.9%) reported adverse experiences, generally mild and not requiring medical intervention. This is the first study to examine the safety and efficacy of brexpiprazole augmentation in resistant OCD patients. Our findings show that brexpiprazole may be a promising and well-tolerated augmentation strategy for SRI-resistant OCD patients. However, further research in larger populations is needed to confirm these results and investigate the long-term safety and tolerability of brexpiprazole in OCD patients.

Air pollution has been demonstrated to represent a major threat to mental health, leading to higher risk of development or exacerbation of serious psychiatric disorders. The current study was aimed at investigating the associations between air pollutant concentrations (particulate matter 2.5 and 10, ozone, carbon monoxide, nitrogen dioxide) and symptom severity in a sample of inpatients suffering from schizophrenia spectrum disorders. We collected sociodemographic, clinical, and psychopathological characteristics of subjects (n=118) with schizophrenia spectrum disorders who were hospitalized in the Psychiatric Inpatient Unit of the University Hospital of Perugia in the period 1^stJanuary 2015-31^stDecember 2016. Psychopathological characteristics were assessed using the Positive And Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global impressions (CGI) scale. Hierarchical multiple regressions were run to assess the association between air pollutants concentrations and the PANSS, BPRS, and CGI total subscale scores, controlling the analyses for sex/age and meteorological data. We found a significant positive association between the average concentration of ozone before admission and the anxiety-depression factor score domain at the PANSS. No significant associations between the other pollutants and the different scores at the scales used for the psychopathological assessment were found. Short-term exposure to ozone may influence the clinical presentation of schizophrenia spectrum disorders and should be thus considered among the potentially modifiable risk factors in the urban environment. Air pollution should be considered among the main threats to human mental health and policymakers should address the built of sustainable urban environments.

The concept of mixity is the essential cognitive cornerstone for quantifying and understanding unstable mood and restlessness, which are components of all mood disorders, diseases that always present fluctuations in mood, from the depressive component to the restless one and to the hypomanic and manic one. The GT-MSRS Mixed States Rating Scale becomes an essential means for early diagnosis.

More than a century is passed since Freud conceived the concept of defense mechanisms. In this article, we retrace the historical evolution of the construct and offer a narrative review of current clinical and empirical literature on its relevance in clinical psychology. Conceptual contributions and empirical findings on the relationship between defenses and personality, as well as between defensive styles and psychopathology (e.g., eating, depressive, and personality disorders) were described. Findings showed that defense mechanisms can help clinicians in understanding the function of patients' symptoms and in tailoring therapeutic interventions. Lastly, we reviewed studies on the potential role of defense mechanisms in unpredictable and changing environmental conditions, such as the outbreak of Covid-19 pandemic. All these studies support the view that defensive functioning is a key topic in the mental health field, and that the further application of reliable and clinically relevant assessment tools is a pivotal future direction in both research and clinical practice.

Introduction: Health literacy is defined as the "ability to obtain, process and understand basic health information and to access health services in order to make informed choices". The concept of Mental Health Literacy (MHL) has been introduced in recent years in order to promote mental health. MHL refers to knowledge and beliefs about mental disorders that facilitate their recognition, management, and prevention. A low level of MHL represents a fundamental barrier to seeking mental health care.

Methods: For this review we followed a narrative approach. Papers published between 2013 and 2024 were screened for inclusion. Only 24 articles met the inclusion criteria, all of them were included in the review.

Results: Among the 24 articles included, schools represented a particularly important context for interventions, as adolescents spend much of their time in school and school staff are often the point of reference for young people seeking help and advice. School-based interventions aimed at improving MHL and reducing stigma have the potential to prevent mental disorders and promote mental well-being, ultimately reducing their health, social, and economic burden.

Conclusions: Schools are a key setting for mental health interventions, given the significant time adolescents spend there and their reliance on school staff for support. Enhancing MHL and reducing stigma through school-based programs can prevent mental disorders and promote well-being. Both live and digital interventions have shown effectiveness, though long-term impacts need more study.

Background: Suicide pacts are always tragic though they remain under-identified and under-reported. History and fiction are full of them, though they would only represent less than one percent of all suicides in Occident. A suicide pact is an agreement made between two or more people to commit suicide together and requires a reciprocal consent but also intent, volition and capability. Victims, motivations and operating methods are multiple, and continue to diversify even more with Internet and social media. How can we identify people at risk?

Subjects and methods: Between November 2023 and May 2024, a literature search based on electronic bibliographic databases as well as other sources of information (grey literature) was conducted in order to investigate the most recent data on suicide pacts and especially how they evolved with Internet and social media.

Results: Different categories of suicide pacts can be made, but the typical template for a prospective suicide pact describes as two withdrawn individuals, in a tight and close relationship, who feel ensnared in a desperate and unmitigable situation.

Conclusions: Prevention can done at various levels, but screening individuals who fit the profile for risk would certainly be a start. To identify a suicide pact, forensics, criminology and sociology need to be considered.

Background: This article proposes a reflection on the use of the genogram in the management of (psycho)geriatric patients. Understanding family dynamics seems essential in the management of elderly patients, confronted with multiple changes in psychological, physical, social, financial aspects etc, and who present chronic complaints, despite multiple treatments and cares.

Subjects and methods: We realized a literature review based on articles dating from 2005 to 2023 and selected from following danabases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "genogram", "family", "(psycho)geriatrics", "symptom".

Results: Thanks to the analysis of the patient's symptomatology through the prism of relational and contextual dynamics, the genogram offers a reading grid on the family system. It allows us to understand the places and functions occupied by each person, their life story, relational issues, the open and hidden conflicts, their family and social representations… This is done by taking into account the context in which we meet a patient and his/her entourage. This reading grid also allows caregivers to avoid reproducing the same interactional modes in the care of the patient and his or her family, which makes it possible to fight against the chronicization of the symptom.

Conclusion: The creation and analyse of the genogram aim to offer another point of view, in relation to the management of complicated families and/or patients with chronic symptoms, without associated organic origins. The goal is to move away from a linear vision and causality (cause-consequence) to offer a systemic reading grid. This is in order to understand the various relational issues associated with these complex family and interactional dynamics.

The increasing integration of eclectic knowledge from fields not directly related to clinical psychology is coherent with a current tendency to employ alternative ideas to investigate psychopathology in the light of a more phenomenological perspective. The concept of epistemic trust may provide the gateway to alternative causal models for personality psychopathology that links poor mentalizing environment to a more general lack of social support. People who have been denied the ability to trust the information circulating in their more proximate environment may showcase a remarkable disadvantage in terms of social adjustment that relate to early insecure attachment experiences. Research assumes that patients who have been suffering an epistemic deficient environment in infancy could be trapped into a vicious cycle of suffering, loneliness and inability to seek or accept help. Although most contributes cited in this brief article deal with epistemic trust as potential tool for social learning from a theoretical point of view, the recent introduction of systematic measures of epistemic trust as a dimensional personality variable outlines a likely future increase in the use of new questionnaires and protocols for clinical assessment and treatment monitoring expressively focused on epistemic trust. The benefits of adopting such a holistic etiological paradigm in personality pathology are outlined, as proposed by the many works that advocate a more equitable clinical practice that assume individual development in the context of an unequal social world, that is believed to determine the child's evolutionary trajectory from the very first stages of life. In the same vein, the importance of fostering an authentic relationship of trust between patient and therapist as a fundamental element of the therapeutic alliance, as well as a driving force for salutogenesis at the community level, is vividly highlighted.