Rivista di psichiatria最新文献

Introduction: Many women with perinatal depression (PND) do not respond adequately to treatment, and perinatal insomnia remains particularly challenging to manage. The aim of this study was to evaluate the efficacy of light therapy (LT) as an adjunctive treatment to standard care in reducing symptoms of PND and sleep disturbances.

Materials and methods: Outcomes were compared with a control group of women with PND who received standard care alone. A final sample of 15 women (7 in the LT group and 8 in the non-LT group) was recruited at the "SOS MAMMA" clinic at the University of Rome "Tor Vergata." Participants in the LT group received 30 minutes of light therapy daily for five consecutive weeks. We performed a baseline clinical assessment, and the following psychometric instruments were administered from the T0, weekly for five weeks (T1-T5), after one months (T6): Edinburgh Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDI-II), Hamilton Depression Rating Scale (HAM-D). LT group underwent a follow-up six months later (T7).

Results: The repeated measures ANOVA showed statistically significant Time × Group interaction effects of all psychopathological outcomes. LT-group showed greater improvements of depressive symptoms (BDI-II: Wilks' λ= .281, F= 3.42, η2= .719, p= .056; HAM-D: Wilks' λ= .290, F= 3.27, η2= .710, p= .062; EPDS: Wilks' λ= .134, F= 8.61, η2= .866, p= .004) and sleep quality (PSQI: Wilks' λ= .302, F= 3.07, η2= .698, p= .072) compared to the non-LT group. In the LT-group, the paired-sample t-tests comparing T6 with T7 showed improvements of BDI-II (t, 6= 3.81; Cohen's d= 1.44; p= .009) and PSQI (t, 6= 3.10; Cohen's d= 1.17; p= .021), indicating that the effectiveness was maintained over time.

Conclusions: Light therapy proved effective as an augmentation treatment in women with perinatal depression, demonstrating sustained efficacy over time and strategic tolerability. We propose that LT is a valuable intervention that targets difficult-to-treat symptoms such as insomnia, and may allow for the use of lower doses of antidepressants - reducing concerns about potential adverse effects on the offspring.

The intellectual capital of medicine is the creativity linking clinical practice and research. Intellectual freedom, that allows the emergence of new paradigms, is the basic component of scientific progress in medicine. There have been major threats to intellectual freedom in the past decades: financial conflicts of interest that allowed the drug industry to gain control of scientific societies, clinical practice guidelines and reporting investigations in meetings and journals; special interest groups suppressing the pluralism of viewpoints; financial thresholds for investigators reporting their data and views (open access journals); the totalitarian derive of Evidence-Based Medicine. Further, there have been growing attacks of publishers to the independence of editors and editorial boards, with the ensuing resignations of editors and members of the editorial boards. Such events recently occurred in a journal, Psychotherapy and Psychosomatics, that was a symbol of independent thinking, pluralism and innovations.

The liquidity of postmodernity would appear to have been displaced, within the mainstream, by a process of re-solidification under the aegis of strong values seeking cultural hegemony. The Author designates this shift as a form of "neo-Victorian puritanism", antithetical to the past in terms of ideological content yet equally prescriptive and homogenizing. At the level of clinical practice, its most salient effect manifests itself in the eclipse of sexuality as a theme, insofar as the clinician often refrains from engaging with it, not least out of concern for being perceived as deviating from the prevailing "neo-Victorian" cultural norm.

Background: Inflammation plays a role in the etiology and pathophysiology of schizophrenia symptoms, through the effects of proinflammatory cytokines such as IL-1β. Ajwa dates are one of the non-pharmacological modalities that have anti-inflammatory and antioxidant properties. However, clinical trials are still limited in exploring the role of Ajwa dates as an adjuvant in the management of schizophrenia.

Objective: To determine the effect of Ajwa dates adjuvant therapy on the improvement of clinical symptoms and serum IL-1β levels in schizophrenia patients. As well as determining the correlation between clinical symptoms and serum IL-1β levels.

Methods: Quasi-experimental study with random group selection using a single blind method. The number of subjects was 60, divided into a treatment group that received risperidone 4-6 mg/day plus 7 Ajwa dates/day for 8 weeks and a control group that only received risperidone. Improvement of clinical symptoms was assessed using the PANSS score, and serum IL-1β levels were measured in the first week (baseline) and week 8, with enzyme-linked immunoassay.

Results: The better improvement in clinical symptoms was observed in the treatment group. A significant decrease in serum IL-1β levels was observed in both groups after 8 weeks of therapy, but the treatment group showed a greater decrease compared to the control group. A significant correlation was found between the improvement of positive symptoms and general psychopathology symptoms with a decrease in serum IL-1β levels in the treatment group.

Conclusions: Ajwa dates have an adjuvant effect on improving clinical symptoms and reducing serum IL-1β levels through their anti-inflammatory properties in schizophrenia patients receiving risperidone therapy.

This paper explores the concept of causality in Massimo Fagioli's works, in the context of his 'Human Birth Theory', especially with respect to propositions in Western philosophical thought and to the psychiatric debate. In the history of philosophy, the nature of cause-and-effect relationship has taken on three basic meanings: regular succession, rational deductibility and productive power. We propose how these are rethought in Fagioli's theorisation as follows: as psychic activity (reaction), as dynamic phenomenon in the context of an unconscious relationship, and as human creativity. In particular, Fagioli analyzed how, within sadomasochistic relationships, the subject unconsciously conceives a concept of cause as constant repetition, and how this dynamic is resolved pathologically with the annulment pulsion, through the psychic elimination of the external object. This makes it possible to regard interhuman relationships as irrational, unconscious dynamics. Finally, the concept of cause is reconsidered based on the internal emergence of new psychic contents for the disappearance fantasy - psychic human creativity - originating at birth. Implications for psychopathology, psychodynamics and psychotherapy are then discussed.

Background and objectives: Catatonia, a complex neuropsychiatric condition, is frequently linked to psychiatric illnesses, especially schizophrenia. While its motor and behavioral signs are well-recognized, cognitive deficits in catatonia are insufficiently studied. This systematic review investigates whether catatonia involves impairments in attention, executive functioning, and other cognitive areas, particularly in psychiatric conditions like schizophrenia.

Methods: We performed a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. We searched PubMed, Scopus, and BioMed Central using terms related to catatonia and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) cognitive domains, including only studies that specifically assessed cognitive deficits in individuals with catatonia.

Results: Thirty studies were included, consistently revealing cognitive deficits in catatonia, especially in schizophrenia patients, affecting memory, executive functioning, attention, and perceptual skills. These deficits may reflect mechanisms shared with broader schizophrenia-related cognitive challenges.

Conclusions: Cognitive deficits in catatonia, often neglected, are significant in schizophrenia, emphasizing the necessity for regular cognitive evaluations and further neurobiological research to enhance diagnosis and therapeutic strategies.

The consequences of war extend beyond the directly exposed generation, affecting the mental and physical health of descendants. Recent studies show that trauma can be transmitted intergenerationally through epigenetic mechanisms, altering gene expression without changes to the DNA sequence. This editorial explores the psychological impact of war, highlighting epigenetic effects in the offspring of survivors.

Background: Artificial intelligence (AI) is the simulation of human intelligence by machines, especially computer systems. It includes learning, reasoning, and problem-solving. Chatbots are AI-powered programs that simulates human conversation. This paper explores the growing role of AI, particularly chatbots, in the field of mental health.

Methods: This review article is based on professional and scientific literature as the research method. The literature search was conducted using databases such as Google Scholar, PubMed, Scopus, and Web of Science that met the inclusion criteria.

Results: The findings of this review suggest that chatbots, as AI-powered tools, provide continuous emotional support and can improve access to mental health support. They are particularly useful between therapy sessions and in crisis situations. Still, AI cannot replace human therapists. There are some ethical concerns, including misinformation and privacy risks.

Conclusions: It is highly likely that AI has a bright future in mental health care. A balanced and well-regulated approach is essential for understanding how chatbots work: we can use them in an informed and rational way.

Depression is a highly prevalent and debilitating condition that frequently coexists with various physical illnesses, including cardiovascular, metabolic, neurological, oncological, pulmonary, and gastrointestinal diseases. This bidirectional relationship complicates diagnosis, exacerbates disease burden, and negatively impacts clinical outcomes, quality of life, and treatment adherence. The underlying mechanisms involve neuroinflammation, autonomic dysfunction, metabolic dysregulation, and behavioral factors. The pharmacological management of depression in patients with comorbid physical conditions requires careful selection of antidepressants to minimize adverse effects and drug interactions. Special considerations are necessary for patients with hepatic and renal impairment, as altered drug metabolism and clearance may increase the risk of toxicity or therapeutic inefficacy. Similarly, in pregnant and breastfeeding women, antidepressant selection must balance maternal benefits with fetal and neonatal safety. While SSRIs such as sertraline are generally preferred due to their relatively favorable safety profiles, medications like paroxetine and fluoxetine require caution due to potential teratogenic risks and higher infant exposure through breast milk. A comprehensive, multidisciplinary approach integrating psychiatric and medical care is essential to improve outcomes and ensure the safe and effective treatment of depression in individuals with chronic physical diseases and special populations.

Aim: The aim of the study was to define compliance and clinical efficacy on sleep disorders of a niaprazine-based galenic product; the active molecule marketed by an Italian pharmaceutical company since long time is no longer available as medical prescriptions are mostly oriented towards benzodiazepines and derivatives whose side effects in the medium-long term suggest however moderating and modulating their use. Niaprazine might therefore be prescribed in the interval drop out of benzodiazepines, or even as a primary therapeutic indication without significant side effects as widely confirmed by its previous historical use very frequent in children. Our research evaluated some aspects of prescribing pertinence and the clinical outcome results obtained with the use of galenic niaprazine in a cohort of patients with an indication for hypnoinducing treatment.

Methods: In our observational and retrospective anecdotal study, we recruited, through the Second Opinion Network, 42 otherwise healthy volunteer subjects aged between 30 and 83 years, most of whom were engaged in a nighttime evening use of mobile phones, tablets and computers who complained of difficulty falling asleep and early morning awakenings partly due to physiological reasons (micturition stimuli, thirst, sweating or other). Each patient was instructed to take niaprazine 50 mg/ml produced in galenic formula by the Farmacia del Pavaglione in Bologna and supplied by the ACEF Spa company in Fiorenzuola d'Arda (Piacenza, Italy). Specifically, each patient took 8 drops before bedtime for a treatment period of 30 days. Each patient was then subjected to the following questionnaires at the beginning of the study and at the end of the treatment: 1) Sleep Disturbance Questionnaire (QDS). 2) Pittsburgh Sleep Quality Index (PSQI). 3) Insomnia Severity Index (ISI).

Results: The data collected from the evaluation of the questionnaires (QDS, PSQI, and ISI) performed before and after the treatment showed that the quality of sleep and in general the quality of life of each patient was significantly increased (p<0.0001****).

Conclusions: The results of our study confirm what is already known about the safety and handling of niaprazine formulated galenically in sleep disorders; in all cases its efficacy (only one drop out) was appreciated with a request to prolong its treatment, especially in subjects dedicated, in the evening hours, to cortical hyperarousal from prolonged (sometimes exhausting) use of technological means, low physical activity (and consequent poor cerebral oxygenation), and in those who had already benefited from the use of an industrial syrup based on niaprazine (Nopron) currently suppressed.