Rivista di psichiatria最新文献

Fetal Alcohol Spectrum Disorders (FASD) encompass a range of conditions caused by prenatal alcohol consumption, leading to physical, behavioral, and learning challenges. It is a significant cause of preventable mental disability, with a prevalence rate of 7.7 cases per 1,000 individuals in the Western world. FASD includes various categories such as alcohol-related neurodevelopmental disorders (ARND), alcohol-related birth defects (ARBD), partial fetal alcohol syndrome (pFAS), and FAS. Mortality is primarily linked to external causes and individuals with FAS may have a projected lifespan of around 34 years. This review highlights the key features of FASD, including neurological impact, behavioral abnormalities, placental and congenital malformations, organic abnormalities, and hormonal and immune disruption. Additionally, potential therapeutic approaches for FASD are briefly discussed based on the different manifestations. Prevention remains the most effective strategy to reduce its incidence, although the general population’s understanding of this topic is currently insufficient. Timely diagnosis and intervention are crucial as they can significantly enhance outcomes through appropriate support and management strategies. Increasing awareness among citizens about the detrimental effects of alcohol use disorders on newborn health is of utmost importance.

Fetal Alcohol Spectrum Disorders (FASD) encompass a spectrum of clinical manifestations resulting from maternal alcohol consumption during pregnancy. This condition presents with diverse anomalies including intrauterine and extrauterine growth retardation, phenotypic abnormalities, cerebral structural anomalies, cognitive delays, and behavioral abnormalities. Regrettably, FASD remains an irreversible and epigenetic condition, with total abstention from alcohol during pregnancy being the sole effective preventive measure due to the absence of a viable therapy. Diagnosis typically occurs postnatally, based on a combination of alcohol exposure history and the presence of aforementioned physical or behavioral abnormalities. The diagnosis is not always easy to make even in the post-natal period due to the different subtypes of existing FASD. Indeed, only some of these subtypes cause behavioral or neurodevelopmental abnormalities in the absence of pathognomic physical anomalies. Although the diagnostic criteria are useful, unfortunately, there is a heterogeneity resulting from the different guidelines that are used in different countries. The aim of our review, based on a literature search of online databases including Medline, Medline Complete, PubMed, and Google Scholar, is therefore to provide an overview of the diagnostic criteria used in Italy.

Aim: Depression in young people is common and can lead to poor long-term outcomes. Digital therapies are a promising means of promoting access to care. Currently, among the digital treatments for depression in adolescents recognized by the NICE guidelines, there is SPARX (Smart, Positive, Active, Realistic, X-factor), based on Cognitive Behavioral Therapy, CBT. This narrative review aimed to evaluate: 1) Who were the depressed young people who used SPARX and what was their experience with the treatment? 2) Were users satisfied with the SPARX treatment? Did the youth's perceived level of satisfaction with using SPARX impact completion rates? 3) What was the role of professionals (researchers, consultants, teachers) in the SPARX studies? Has their support in running SPARX affected completion rates?

Methods: A narrative review of the English literature was performed. The articles were searched in Pubmed, SCOPUS, and Web of Science databases (from 2012 to 2023) with keywords such as 'SPARX,' depression' and 'young adult'.

Results: Of 557 papers, 18 were included in our review. The young people who used SPARX were students or adolescents from special help-seeker populations at risk or with mild to moderate depression. The highest satisfaction levels were present in users of primary health services, such as general practice and counseling services. The support of the school counselor and experts in mental health clinicians was instrumental in impacting user satisfaction and completion rates. The personalization of the game in terms of user culture - symbols, language, norms, values, and artifacts; the customization of the avatar, the gender identity; the narrative structure; the presence of a guide character (virtual therapist); the CBT homework seemed to represent crucial SPARX characteristics related to satisfaction and completion rates.

Discussion and conclusions: Our narrative review provides an overview of the main results of using SPARX with interesting considerations that may suggest improvements for broader use and diffusion of this digital treatment.

Objective: This study aims to explore the prevalence, characteristics, and psychopathology related to Problematic Use of Internet (PUI), including Internet Addiction (IA), within a sample of psychiatric outpatients.

Methods: 143 psychiatric stable outpatients (18-65, mean age: 49; F=84) were included in this study, regardless of their categorical diagnosis. Socio-demographic, clinical, psychopathological, and Internet use-related data (PIU-Scale, Internet Addiction Test, devices, use, activities) were collected across the sample.

Results: The prevalence of PUI ranged between 1% (IAT) and 25% (PIU-S), with a homogeneous distribution of PUI symptoms' severity among the four main psychopathological areas (depressive, bipolar, anxiety, and psychotic disorders). PUI was correlated with age and was higher in students as in the general population. Significant associations were found between PUI symptoms and both personality and eating disorders; PUI was also positively correlated with the presence of other addictions (e.g., alcohol and/or substances). A greater proportion of patients with PUI presented other forms of behavioural addiction compared to non-symptomatic patients. Social media and online shopping, as well as video-streaming, resulted to be the main forms of PUI among patients with problematic use of the Internet.

Discussion: More studies are required among students diagnosed with eating and personality disorders. The association between PUI and other addictive disorders would support the hypothesis of their common shared pathophysiology.

Conclusion: Healthcare providers and educators should be made aware of such risks. More studies are needed to confirm such preliminary findings.

To fully respond to the provisions of the Judicial Authority relating to the care of minors and/or young adults subjected to judicial measures and affected by mental suffering and/or substance abuse, also with a view to a possible provision of placement in a therapeutic community, the UOSD "Protection of the Health of Adults and Minors in the Penal Area" - ASL Salerno has ensured operations through the establishment of a dedicated multidisciplinary team, made up of a psychiatrist, psychologist and social worker, as required by DGRC 567/2018, or as the only interface with the Judicial Authority in reference to healthcare. This article aims to describe the birth of the EMM (Equipe Multidisciplinare Minori), and of the methods used to take care of minors and/or young adult offenders affected by mental suffering and/or substance abuse. The article examines a sample of 207 minors, relating to the years 2018-2022, to highlight the most critical areas.

Background: Suicide constitutes a significant global health concern. Joiner's interpersonal-psychological theory of suicide focuses on three variables: Thwarted Belongingness (TB), Perceived Burdensomeness (PB) and Acquired Capability for Suicide.

Methods: A sample of 90 psychiatric patients, comprising outpatients, inpatients and individuals residing in therapeutic communities, was recruited between 2021 and 2022. Scales measuring anxiety, depression, mental pain, reasons for living, TB, PB and fearlessness about death were administered. Patients with and without suicidal ideation (SI), as well as those with and without history of suicide attempt (SA) were compared and two stepwise logistic regression models were performed.

Results: Both patients with SI and with SA had higher anxiety, depression, mental pain, PB, fearlessness about death and lower self-esteem. Notably, depression, PB and beliefs about coping strategies were strongly associated with SI, while higher fearlessness about death and PB were strongly linked to history of SA. Additionally, inpatients and therapeutic community patients were at higher risk of suicide and had higher levels of depression compared to outpatients.

Limitations: The small sample size and the inclusion of patients with mixed psychiatric diagnoses limit the generalizability of the findings. The cross-sectional design hinders causal hypotheses about the relationship between current SI or past SA and potential risk factors. The use of self-report measures entails biases. The analyses did not include details about pharmacological treatments.

Conclusions: SA history could be explained by fearlessness about death. Improving the ability to cope with suicidal thoughts constitutes a pivotal component of therapeutic interventions with suicidal patients.

Objective: The purpose of this study was to investigate the cultural adaptation and validation of the Children's Knowledge of Abuse Questionnaire (CKAQ-RIII). This tool, which is used in Iranian primary schools, examines children's understanding of the concepts of sexual abuse.

Materials and methods: A sample of 80 primary school children between 8 and 12 years of age was selected from schools in Iran. The questionnaire was administered three times: before and immediately after the Child Abuse Prevention Program and at the three-month follow-up assessment.

Results: The included children (n=80) completed the Persian version of the CKAQ-RIII during the three-month follow-up. The internal consistency of the CKAQ-RIII was high for the Inappropriate Touch Scale (ITS) and moderate for the Appropriate Touch Scale (ATS). Analysis of the Pearson correlation coefficients indicated a strong relationship between the ITS and ATS and the overall scores. The mixed-design analysis of variance (ANOVA) on the ITS showed that the children's knowledge increased after the intervention. In general, higher scores were observed for children in the fifth and sixth grades (11 to 12 years old) after the intervention, indicating greater concept knowledge. Repeated measures ANOVA was also performed on the ATS, which showed a significant increase in children's knowledge.

Conclusions: The Persian version of the CKAQ-RIII is an effective and reliable tool for assessing the level of knowledge of the concepts of sexual abuse in Iran.

Introduction: Group psychoeducation is effective in preventing relapse in bipolar disorder. It's indicated as an adjunctive intervention to pharmacotherapy for all outpatients. This retrospective, single center experience of group psychoeducation for bipolar disorder over a 6 years period, aims to assess severity of symptoms and comparative relapse episodes and intensity prior to and following psychoeducation as well as evaluating the decrease in hospitalizations and days of hospitalization.

Methods: Between 2014 and 2019 patients with a bipolar disorder were invited to attend a Colom model group psychoeducation (weekly 90 minutes sessions for 22 weeks). Depression and mania were assessed at baseline, following psychoeducation, 6 months and 12 months with the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Patient specific hospitalization admissions data for 3 years prior to and 3 years following psychoeducation course were accessed. Subgroup analyses were performed according to patient sex and age with ANOVA methodology.

Results: Of the 95 eligible patients, 77 completed psychoeducation: 18 (19%) patients dropped out. Mean patient age was 45 years and 33 (43%) were male. Overall and subgroup specific YMRS and HDRS improved significantly throughout follow-up (p<0.01). Hospitalization analyses (45 patients; 58.4%) revealed a significant decrease in relapse and hospital stay days after psychoeducation, p<0.01.

Discussion: We provide evidence of applicability and efficacy of adjunctive psychoeducation in a real-world setting. Advantages observed were independent of patient sex and age. Analysis of the optimal number of sessions provided to patients according to efficacy and retention rates is required.

Conclusions: Despite inherent study design limitations, retrospective evaluation of a single-center psychoeducation program supports evidence of psychoeducation effectiveness in significantly reducing the severity of bipolar disorder and hospitalizations, despite a drop-out rate of 1 in 5.

Objective: To investigate the effects of electroacupuncture combined with paliperidone palmitate long-acting injection (PP-LAI) on withdrawal symptoms and neurotransmitters in methamphetamine (MA) addicts.

Materials and methods: A total of 109 methamphetamine addicts, who were treated in the hospital from October 2021 to October 2022, were selected. According to the random number table, the patients were divided into the study group (n=54) and the control group (n=55), in which the control group was treated with PP-LAI and the study group was treated with electroacupuncture on the basis of the control group; the methamphetamine withdrawal symptom score scale was used to assess the therapeutic effect before treatment and within 12 months after treatment; the changes of brain neurotransmitters dopamine, γ-aminobutyric acid, serotonin, acetylcholine values were compared between the two groups.

Results: 1) There was no statistical difference in MA withdrawal symptom scores between the two groups before treatment (p>0.05); 2) MA withdrawal symptom scores have a statistically significant difference between the study group and the control group after 3 and 6 months of treatment; 3) dopamine levels in the study group were significantly higher than those in the control group after 6 months of completion of treatment, and γ-aminobutyric acid values and 5- serotonin values in the study group were significantly lower than those in the control group (p<0.05).

Conclusions: Electroacupuncture combined with PP-LAI can partially improve the withdrawal symptoms and anxiety of methamphetamine addicts. This is a potential treatment for preventing relapse of withdrawal symptoms.

Aim: The Standards of Care (SOC-8) by the World Professional Association for Trans Health provide guidelines for the care of transgender and gender diverse individuals through safe and effective multi-professional interventions for physical and mental well-being. The aim of this work is to summarize the SOC-8 recommendations for childhood and adolescence, highlighting the importance of psychosocial assessment and available medical and surgical therapeutic options, and emphasizing the need for healthcare provider training.

Methods: The SOC-8 recommendations are based on scientific evidence and professional consensus from experts in transgender health, developing classification criteria and access to therapies, based on systematic literature reviews (PubMed and Embase).

Results: The SOC-8 underscores the importance of assessing and preserving gender identity, supporting prepubescent individuals from a psychosocial perspective, and ensuring adolescents access to medically and surgically conforming treatments according to local legislation. It is the responsibility of healthcare providers to understand and adapt international guidelines for an inclusive clinical practice of gender diversity.

Discussion and conclusions: Gender affirmation therapies in minors require comprehensive evaluation, parental involvement, and consideration of their cognitive and emotional maturity. Treatments should also focus on preserving fertility and accessing medicalized treatments which are beneficial to the well-being of transgender and gender diverse individuals.