Rivista di psichiatria最新文献

Objective: In Eastern European countries, suicide rate are among the highest in the world and suicide attempts are among the most important risk factors. The aim of this study is to identify factors associated with suicide attempt (SA) in non-psychotic patients with suicidal ideation (SI).

Methods: Among 6204 consecutive adult patients (residents of Moscow) with non-psychotic mental disorders (NPMD), 361 individuals aged 18-77 years (median 24 years) were enrolled in the study after screening for lifetime SI with the Self-Injurious Thoughts and Behaviors Interview (SITBI). All participants were assessed for sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of abuse, sexual behavior, psychiatric treatments, suicide plan, SA, and nonsuicidal self-injury (NSSI). Results of multivariable analyses (MV) are presented as odds ratios (OR) with 95% confidence intervals (CI).

Results: 166 patients (46%) reported lifetime SA. In MV, variables associated with SA included smoking (OR 2.1; 95% CI 1.2-3.7), having made a suicide plan (OR 3.4; 95% CI 2.0-5.7), and scars covered by tattoos (OR 5.2; 95% CI 1.5-17.9). History of law violation (OR 2.0; 95% 1.0-4.2) was of borderline significance.

Conclusions: Transition from SI to SA in patients with NPMD was associated with smoking, suicide planning, history of law violation and presence of tattoos covering scars.

Objective: Hospitalization for Covid-19 has been recognized as a potentially traumatic experience. This longitudinal cohort study assessed the impact of psychological intervention for Covid-19 patients on anxiety, depression, and post-traumatic stress disorder (PTSD).

Materials and methods: Of 386 Covid-19 patients enrolled, 127 completed HADS and PCL-5 questionnaires at 2 months (T1), 6 months (T2) and 12 months (T3) after hospital discharge. Between T1 and T2, patients were offered the opportunity to receive psychological intervention: 92 did not request any psychological support (No support group), 15 received only one psychological consultation (Consultation group) and 20 received longer psychological support (Support group). Mixed ANOVAs were used to assess the psychological symptoms of the 3 Groups over Time.

Results: The No support group reported lower anxiety, depression, and PTSD than the other two groups. Anxiety and PTSD increased over time across groups. A Time x Group interaction was found for depression (F(2.124)=3.72, p<.05, pη2=.06). The Support group reported a decrease in depression from T1 (M=7.85) to T2 (M=7.05) and an increase from T2 to T3 (M=8.05), although not significant. The No support (T1 M=2.84; T3 M=4.36; p<.001) and the Consultation groups (T1 M=4.73; T3 M=6.33; p<.05) reported an increase in depression from T1 to T3.

Conclusions: Psychological interventions were appropriately allocated to patients with more severe symptoms. Most of the patients did not request psychological intervention. Long-term psychological support may have helped Covid-19 patients to contain depressive symptoms over time.

Introduction: Mental health disorders and chronic health diseases are highly prevalent and impactful consequences of distressful experiences among refugees, yet a comprehensive conceptual model encompassing biopsychosocial factors is lacking. This study aims to assess the relevance of widowhood to PTSD and major depression maintenance as well as to adverse health outcomes in a cohort of Bosnian refugees.

Methods: This longitudinal study included 526 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varaždin, Croatia, in the Bosnian language. Data were collected using the Harvard Trauma Questionnaire and Hopkins Checklist-25, respectively. Physical health disorders were self-reported.

Results: Both at baseline and endpoint female gender and marital loss are associated with a statistically significant higher burden of psychological and physical health outcomes. This group showed higher rates of PTSD and major depression disorders, as high comorbidity with hypertension, cardiovascular diseases, asthma and arthritis.

Discussion: The results of the present study align with a wealth of literature studies linking marital loss to shifts in mental health and impaired physical health. A conceptual framework is provided for understanding how both mental health and physical health outcomes are highly dependent on social phenomena.

Conclusions: This investigation reinforces the hypothesis of the role of social bonds and marital support in recovery from trauma experiences. Further studies are, however, needed for a better understanding of the consequences of adverse events on trauma-exposed subjects from a holistic bio-psycho-social point of view.

Parental Alienation Syndrome (PAS) is a term addressed to describe negative, psychopathological feelings, thinking and behaviours, including hostility and fear, exhibited by children who have been alienated from one parent by the other parent. Despite its relevance in the clinical psychology field, theoretical and empirical contributions to understanding and deepening the many facets of this concept are still few. In particular, literature aimed at disentangling the alienating parent's psychological characteristics is scarce and fragmented. Our contribution encompasses a narrative review of scientific literature since the term PAS was coined in 1987 by Gardner, to delineate narcissistic proneness in alienating parents. Namely, considering the narcissistic drift the western society is going toward, we hypothesised that narcissism has a pivotal role in parents' alienating behaviours against the alienated ones. Firstly, the elements that emerged from our literature search confirmed our theoretical hypothesis, in terms of the likely role of narcissism/narcissistic marked traits in alienating parents. In the second section, we contextualised the phenomenon in a psychodynamic/psychoanalytic theoretical framework. Finally, based on previous findings/considerations, the developmental trajectories of children with PAS have been traced. An improved theoretical knowledge of this phenomenon, also in terms of the psychopathology associated with its genesis, means to refine the diagnostic and treatment tools to prevent it.

Introduction: Incestuous behaviors are often placed in family constellations that are highly dysfunctional from the perspective of communication between members and also with regard to the roles and expectations held in the family. The expert case being presented reflects these characteristics.

Methods: Beginning with an expert case of particular interest with respect to incestuousness and destructibility, the authors report considerations from a clinical criminological and forensic psychological-psychiatric point of view on the link between the two item.

Conclusions: A careful historical, anthropological, documentary reconstruction, the examination of the relational set-up of the various subjects involved, and not only the clinical and psychodiagnostic aspects, are the indispensable premises, in order to make overall sense of crimes in families of particular complexity, difficult to decipher, such as those exposed in the present scientific work.

Background: The Mini-Z is a questionnaire created to evaluate the levels of burnout in healthcare workers. It consists of 10 items rated using a 5-point Likert scale and one open question. It explores three outcomes (burnout, stress and satisfaction) and seven drivers of burnout (work control, work chaos, teamwork, values alignment with leadership, documentation time pressure, EMR use at home, and EMR proficiency). The aim of this study is to validate the Italian version of the Mini-Z, comparing it with the other most used scales.

Materials and methods: We recruited a sample of 120 healthcare professionals and administered all three questionnaires to each of them, after which we compared the answers and the scores of the results. A cross-sectional study among healthcare workers was conducted from May to July 2022. An online questionnaire was sent, by e-mail, to 120 healthcare workers (60.8% male, 39.2% female), aged between 18 and 60 years old (26.8% between 25 and 38 years old). They were invited to answer to an anonymous survey, consisting of three assessment instruments: Copenhagen Burnout Inventory (CBI), Maslach Burnout Inventory (MBI) and Mini-Z Inventory 2.0. The Mini-Z 2.0 is a new and easier tool to assess burnout syndrome, actually validated only in English. It was translated into Italian by reverse translation. Cronbach's Alpha coefficient, a statistical index, was used to assess its reliability. The last phase of the study compared the Mini-Z, the CBI and the MBI, by means of Pearson's coefficient, to highlight the Mini-Z's ability to be used for Burnout assessment.

Results: The analysis of the results showed that 18.3% of the interviewed healthcare professionals scored equal (2.5%) or higher (15.8%) than 40. The average percentage value was 33.35%, with a standard deviation of 6.3%. This emphasises, therefore, that this portion of employees is more or less satisfied with their working environment. The remaining portion of employees, on the other hand, 81.7%, scored below 40, emphasising an unpleasant and unjoyful working environment.

Discussion and conclusions: Burnout is very common among employees and especially among healthcare workers and a routine assessment seems to be necessary to be able to prevent the syndrome. The Italian version of the Mini-Z includes ten items, is more user-friendly and aims to assess not only Burnout subscales, as in the previous tests, but also well-being factors and has applied a rigorous approach, including forward translation, back translation and cognitive debriefing.

Treatment with long-acting injection (LAI) antipsychotics, such as paliperidone palmitate, has improved the quality of life in terms of symptoms and prevention of relapses in patients with schizophrenia. Although there are plenty of evidences about the efficacy and safety of paliperidone palmitate 3-monthly injection (PP3M) in adults with schizophrenia, literature appears lacking about the use of LAIs during pregnancy. We hereby describe the clinical case of a pregnant woman affected by schizophrenia (DSM-5-TR), taking pharmacological treatment of PP3M. Considering the inadequate evidence regarding the use of PP3M in pregnancy in agreement with the patient, we switched PP3M to an oral therapy with aripiprazole. The switch to oral aripiprazole allowed the patient to improve her sense of autonomy and strengthen the therapeutic relationship. To our knowledge, this is the first case report monitoring an entire pregnancy of a women affected by schizophrenia in treatment with PP3M injection and oral aripiprazole. No obstetrical or fetal complications were reported. As the research in this field is very demanding, it would be precipitous to derive final conclusions from the current case report, but we hope to build a growing number of data that would allow us to make more appropriate and safe therapeutic choices in such a vulnerable phase as the peripartum.

Background: Perinatal mental health is a topic of growing interest, that could affect mothers in a period of high vulnerability, and the impact of coronavirus disease 2019 (Covid-19) pandemic is an important factor to consider in this field. The aim of our study is to study the correlations between five dimensions of personality and subjective Covid-19-related distress in a sample of women in the perinatal period.

Methods: The study included 114 Italian women in the perinatal period. Subjects were asked to complete the Big Five Inventory (BIG-5) and a version of the Impact of Event Scale - Revised (IES-R) anchored to Covid-19-related distress.

Results: When the BIG-5 personality traits and several confounding variables were included in a regression model with IES-R total score as criterion, neuroticism subscale of BIG-5 inventory was the only variable independently associated with higher IES-R total score (p<0.001).

Conclusion: Our study highlights the importance of considering the personality vulnerability factors that can worsen psychopathological symptoms of women in the perinatal period, especially in periods of high psychological stress.

Introduction: Prenatal alcohol exposure causes a variety of impairments to the fetus called Fetal Alcohol Spectrum Disorders (FASD). Since it is very difficult to identify women that consume alcohol during pregnancy, different methods have been studied to evaluate alcohol exposure. Ethyl Glucuronide (EtG) and Fatty Acid Ethyl Esters (FAEEs) are commonly used to measure alcohol consumption in individuals at-risk for alcohol abuse, including pregnant women.

Materials and methods: We conducted a study of two cohorts of 1.5 year-old infants (of mothers without a history of alcohol abuse) with or without meconium samples positive to both EtG and FAEEs and we evaluated their cognitive-behavioral development by the Griffiths Mental Developmental Scale (GMDS) method. Our protocol included 8 infants with meconium positive to alcohol metabolites (EtG and FAEEs) and 7 with meconium negative to alcohol metabolites.

Results: None of the 8 alcohol metabolites positive meconium infants exhibited distinctive facial features and growth retardation of severe FASD, showing that other factors may contribute to the FASD onset but elevations in EtG and FAEEs in the meconium were significantly associated with disrupted neurodevelopment and adaptive functions within the first year and a half of life. Indeed, we found out that infants with meconium positive for both EtG and FAEEs, although without displaying any FASD morphological features, had a delay in the fine regulation of their own locomotory capabilities.

Conclusions: Further analyses and larger studies are needed to estimate the right link between prenatal alcohol exposure and the different range of disorders connected but this study provides an additional step in the field of FASD in order to suggest early treatments for at-risk newborns and infants.

Aim: Eating disorders are major illnesses that primarily affect adolescents and young adults and seriously threaten public health. Early identification of at-risk individuals and timely initiation of treatment is crucial to improve outcomes. The Inside Out Institute Screener (IOI-S) is a rapid self-administration screening tool for high-risk and early-stage eating disorders. This study aimed to investigate the risk of having an eating disorder in a sample of Italian students by testing the Italian version of the IOI-S.

Methods: A multicentre cross-sectional study was conducted in a population of students aged 12-19 years; validity and reliability of the IOI-Sita were investigated.

Results: Four-hundred and ninety-one (81.97%) students were enrolled, 24.85% of whom were found to be at "very high risk" of an eating disorder, according to IOI-Sita. Younger (p<0.001) and female (p<0.001) students had higher risk scores. The EFA confirmed the original monodimensional structure of the tool, S-CVI=0.95%. The Content Validity Index of the scale (S-CVI) was 0.95, ω coefficient was 0.927.

Discussion and conclusions: This research confirms the need to screen for eating disorders in Italian youth adequately; the psychometric properties of the IOI-Sita confirm it as a valid and reliable tool for screening high-risk and early-stage eating disorders.