Rivista di psichiatria最新文献

Background: Although bipolar disorder (BD) and cognitive impairment are straightly connected, limited tools exist to capture the patient's perspective on cognitive decline and its impact on this disorder. The aims of the study are: 1) to assess the reliability and validity of the Italian version of a brief self-report scale (COgnitive Complaints in Bipolar disorder Rating Assessment - COBRA) among euthymic bipolar patients; 2) to investigate the relationship between the self-report scale, COBRA, the objective neurocognitive measure Screen for Cognitive Impairment in Psychiatry (SCIP), and the course of illness in BD.

Methods: Western all-white sample (n=216) included 108 BD patients and 108 healthy matched controls. The psychometric properties of the COBRA (e.g., internal consistency, retest reliability, discriminative validity, factorial analysis, ROC curve and feasibility) were analyzed. A screening neuropsychological battery was used for objective cognitive assessment.

Results: The Italian version of the COBRA (COBRA-I) had a high internal consistency (Cronbach's alpha= 0.852) and retest reliability (ICC=0.848). Factor analysis validated the one-factor model, and the cut-off value was obtained with a score of 10.5. BD patients experienced greater cognitive complaints compared to control group suggesting a discriminative validity of the instrument. No significant correlation was found between COBRA and SCIP in the patients group. Higher COBRA scores were associated with BD type II, life-time hypomanic episodes and number of total episodes.

Conclusions: The study proved the validity of the COBRA-I as a simple and reliable self-report instrument for screening or monitoring cognitive complaints in adult patients with BD.

Background: According to UNHCR, at the end of June 2024 there were 8 million asylum seekers and 43.7 million refugees worldwide, a 16% increase versus year end 2023 for both categories; these rapidly growing numbers are posing significant political, humanitarian, and healthcare challenges. These are persons who have been displaced due to wars, persecution, political and economic instability, climate change, and other disasters. Trauma, an inevitable consequence of forced displacement, is a crucial factor in the development of psychiatric diseases, causing short and long-term synaptic alterations. Post-traumatic stress disorder (PTSD), anxiety, depression, and impulse control disorders are prevalent in this sub-population; providing efficient mental health services is a global challenge that requires developing early mental health screening and treatment programs.

Purpose: The main purpose of this study is to examine the available scientific literature regarding the scales used for evaluating psychiatric impairment in asylum seekers and refugees. We are particularly interested in analysing these psychometric scales from a culturally unbiased perspective, in which the psychiatric evaluation is devoid of cultural features that could influence the outcome of the interview.

Method: We carried out a search on PubMed for articles published between inception and September 30, 2024 containing references to clinical and screening tools that evaluate mental illness among asylum seekers and refugees. Various scales are used to screen for PTSD (11), anxiety (12) and depression (11) with a significant heterogeneity in the number of items and how the scales are administered, but only one for identifying psychosis. Two tools were used to screen specifically for substance use disorders. In various studies, general scales were used for screening for mental illness. We found that in general there was little information regarding when and how the tools are administered, and if they are used for follow-up interviews.

Conclusions: This review highlights the need to create a specific, easy-to-use tool that avoids cultural biases to screen for mental illness, including PTSD, anxiety, psychosis, substance abuse and suicidal tendences, among asylum seekers and refugees.

In contemporary bio-juridical debate, the expression 'Ulysses contract' is used to define a set of self-binding instruments through which a person who suffers from a mental disorder with a remitting-relapsing or cyclical pattern can make explicit their advance directives regarding psychiatric treatment (PAD), in anticipation of a crisis in which the subject's preferences may conflict with those previously expressed. Unlike other countries, Italy does not have a specific regulation regarding PAD; however, we believe that important hints may come from law 219/2017 regulating informed consent, advance directives and shared care planning. The aim of this paper is to provide an interpretation of shared care planning (SCP) in psychiatry and thus contribute to the discussion on the implementation of law 219/2017 for people with mental disorders. The article presents a description of PAD in the international context, highlights their value for the subject's self-determination, and considers obstacles and facilitators to advance directives in psychiatry resulting from the literature. Building on these elements and considering the SCP specificity, SCP is suggested as a tool for making advance decisions on treatment in the context of mental disorders, specifically of those with a remitting-relapsing or cyclical pattern. The study also points to the need for an interdisciplinary dialogue between the bioethical, legal and clinical field in order to confirm the validity of SCP in psychiatry, including with regards to Ulysses contracts, and to provide practical guidance to ensure its applicability.

Background: Nowadays, it is well-known that burnout is a syndrome that mainly affects the helping professions. The nursing profession is obviously among those categories of workers that can develop burnout and, precisely because of its proximity to people who suffer associated with high workloads characterized by high emotional impacts.

Aim: The aim of this systematic review is, therefore, to highlight whether the high nursing workload during the pandemic has contributed to the onset of burnout syndrome in nurses who served in intensive care units (ICUs) dedicated to the care of Covid-19 patients.

Methods: A systematic review was carried out. The main scientific databases were consulted, such as PubMed, Scopus, Web of Sciences and CINAHL analyzing all the papers present in literature. Using PRISMA guidelines, fifteen articles were included in the review. The protocol for this review has been registered on PROSPERO, the international prospective register of systematic reviews (PROSPERO ID: CRD42024502094). The quality assessment of the articles included in this review was conducted using the Newcastle-Ottawa Scale (NOS) for observational studies.

Results: In accordance with the literature, all the 15 included studies documented high levels of burnout among ICU professionals, nevertheless those levels were greater than the ones registered in the pre-pandemic period. In Covid-19 era, nurses experienced higher levels of burnout compared to other professions and working as a nurse was identified as an independent risk factor for increased risk of burnout. As reported by all included studies, the overwhelming severity of Covid-19 patients entailed a significant increase in workload for health care providers, particularly nurses. Ultimately, this increase showed a significant correlation with increased burnout risk.

Conclusions: The review highlights the correlation between workload and burnout of nurses in Covid-19 intensive care units. It is expected that this and other studies will contribute to a better understanding of the importance of assigning the adequate workload to nurses.

A study was conducted on the acceptability of a music therapy intervention in a group context, in a psychiatric ward where people with acute psychopathological conditions are hospitalized. The objectives of the intervention are both therapeutic (stress reduction) and informative-descriptive, on topics ranging from stress management, to the first signs of crisis and drugs. For this purpose, musical stimuli provided by the presentation, listening and analysis of author's pieces were used, through the diffusion of pleasant sounds at moderate rhythm and volume among patients and operators. Acceptability was assessed through a satisfaction questionnaire. The responses to the questionnaire were very positive, confirming the narrative observations of the operators who found favorable ways of interacting with the patients with whom they shared the activity in all its contents. Participation in the music therapy intervention in a group context led users to an improvement in their stress management skills and to a more positive adaptation to the condition of hospitalization.

Aim: To assess the utilization rate of a university psychological counselling center in Southern Italy, a retrospective analysis of data collected from September 2018 to December 2023 was conducted.

Method: Data were gathered through an online questionnaire, which was distributed to students seeking psychological help (SH) from University Counselling Service (UCS) at their first contact with the service.

Results: The frequency of contacts with UCS (n=639) and the number of SH students who received psychological counselling (n=503) significantly differed over a 6-year period, with the highest number of interviews delivered after the Covid-19 pandemic (contacts: χ2=84.814, p<.0001; interventions: χ2=25.161, p<.0001). More than 40% of the SH students were medical students, followed by approximately 32% of students attending psychological courses. Differences were found across years in the type of course attended by SH students (χ2=54.323, p<.0001) and in dropout rates (χ2=24.427, p<.0001).

Discussion and conclusions: The significantly higher demand for psychological help confirms the increased psychological distress in university students. The shift to online modalities and the broader dissemination of mental health literacy, particularly in the aftermath of the Covid-19 outbreak, may explain the significant increase in service utilization rates. These findings highlight the need for timely interventions to address the needs of SH students.

The Psychiatric Fast Track pathway at the Bolzano Hospital was established in 2023 to improve the management of psychiatric emergencies in the Emergency Department context. This brief document analyzes the current structuring of the pathway and its implementation in the practical reality of Bolzano and its surrounding area. The benefits of the pathway, the challenges encountered, and potential areas for improvement are discussed.

Tardive dyskinesia (TD) is a chronic, often disabling hyperkinetic movement disorder associated with prolonged use of dopamine receptor blocking agents (DRBAs), particularly antipsychotics (APs) for psychiatric disorders such as schizophrenia and bipolar disorder. It manifests as abnormal, involuntary movements, often involving the orofacial region, extremities, or trunk, and is associated with significant physical and psychosocial impairment. TD is primarily linked to dopamine receptor hypersensitivity, oxidative stress, and genetic susceptibility, with a higher prevalence in patients treated with first-generation APs. However, second-generation APs (SGAs) have not eliminated the risk entirely, particularly in older adults and those with prolonged exposure. Diagnosis relies on clinical assessments such as the Abnormal Involuntary Movement Scale (AIMS) and comprehensive neurological evaluations. Treatment guidelines emphasize early detection, prevention through minimal effective doses of APs, and the use of VMAT2 inhibitors (vesicular monoamine transporter 2 inhibitors) as a first-line therapy in moderate-to-severe cases. VMAT2 inhibitors reduce dopamine signaling dysregulation without directly blocking D2 receptors, effectively managing symptoms in many patients. For treatment-resistant cases, deep brain stimulation and other non-pharmacological interventions offer promising alternatives. Current research underscores the complexity of TD's pathophysiology and the need for personalized approaches. Future directions include developing biomarkers for risk stratification, refining therapeutic strategies, and optimizing long-term outcomes through multidisciplinary care.

The debate on assisted suicide for patients suffering from severe depression raises complex issues spanning clinical, ethical, scientific, medico-legal, and cultural domains. This position paper asserts that such an option is unacceptable in the context of depressive illness, even in its most severe and treatment-resistant forms. Depression is not an irreversible or terminal condition: there are multiple therapeutic options available, including spontaneous and late remissions, and suicidal ideation must be seen as a core symptom of the disorder, not as a rational choice. Scientifically, there are no reliable biomarkers to define the "incurability" of depression, and prognosis is often uncertain. Ethically, the principle of non-maleficence prohibits physicians from contributing to a patient's death, while the vulnerability of individuals with severe depression impairs their decision-making capacity. From a medico-legal standpoint, it is extremely difficult to assess competence in such contexts with any degree of certainty. Culturally and symbolically, psychiatry must reaffirm its healing mandate and resist dangerous shifts that could legitimize stigma or suicidal contagion. In conclusion, psychiatrists cannot and must not adopt the role of facilitators of death. Instead, they are called to provide care, instil hope, and protect patients, even in the most challenging clinical scenarios.

The increasing prevalence of Novel Psychoactive Substances (NPS) presents a significant challenge for both diagnosis and treatment, particularly due to the complex psychotic states they can induce. This paper explores the concept of lysergic psychoma, rooted in Bonhoeffer's exogenous psychosis model, and its relevance to modern substance-induced psychoses. Lysergic psychoma, characterized by vivid hallucinations, delusional thinking, and somatoesthetic disturbances, represents a critical stage where temporary psychotic episodes risk evolving into chronic psychosis. This condition is closely linked with mental automatism, a phenomenon initially described by De Clérambault, where patients experience uncontrollable, parasitic thoughts and sensations that disrupt normal cognitive functions. The study underscores the importance of recognizing mental automatism in the progression of substance-induced psychosis, particularly as NPS use continues to rise. It challenges traditional distinctions between endogenous and exogenous psychosis, suggesting a more nuanced understanding of the interaction between genetic predisposition, environmental stressors, and the neurobiological impacts of psychoactive substances. This work calls for refined diagnostic criteria and targeted interventions to address the growing mental health crisis associated with NPS use. Emphasizing early intervention and prevention, particularly among adolescents, is critical in mitigating the risks of these emerging psychotic disorders. Integrating historical perspectives with contemporary research, this study offers new insights into the psychopathological processes underlying substance-induced psychoses, providing valuable frameworks for clinical practice and future research.