Rivista di psichiatria最新文献

Introduction and aims: Bipolar disorder (BD) is a severe and recurring mental illness associated with a significant personal and social burden. It has been recently hypothesized that increased levels of pro-inflammatory cytokines and cortisol, which is also associated with a reduced expression of the brain-derived neurotrophic factor (BDNF), may influence affective recurrences in BD. Our study aims to: 1) assess changes in the levels of peripheral cytokines, BDNF and salivary cortisol during acute and euthymic phases of bipolar disorder, compared to that of a sample oh healthy controls; 2) evaluate whether these changes represent a biosignature for the different phases of the illness.

Materials and methods: Patients aged 18-65 years old, with a diagnosis of BD I or II types, will be enrolled during an acute episode, according to DSM-5 criteria, together with age- and gender-matched healthy controls. Blood and salivary samples will be collected at baseline and after 3 and 6 months. Validated assessment instruments will be administered to all participants for the evaluation of symptom severity, global functioning, suicidal risk, stress levels and physical comorbidities.

Expected results: We expect changes in inflammatory and neuroendocrine indices to be predictive of the onset of an acute phase of bipolar disorder and that overall levels of cytokines, cortisol and BDNF are overall significantly different between BD patients and healthy controls.

Conclusions: The longitudinal design of the study will allow to assess whether the presence of acute affective symptoms in BD patients correlates with significantly higher levels of cytokines and salivary cortisol and with reduced BDNF levels compared to euthymic phases. Moreover, the comparison with healthy control subjects will allow to understand if inflammatory mediators as well as the hypothalamic-pituitary-adrenal (HPA) axis are chronically elevated in BD patients and are independent from mood swings.

Insomnia disorder is the most common sleep disorder. The new models frame insomnia as a stress-related disorder and a "24-hour" syndrome with night and day symptoms. The hyperarousal has been identified as the neurobiological mechanism underlying chronic insomnia. Since chronic insomnia is considered a risk factor for psychopathology it is possible that hyperarousal may act as a link with psychopathological conditions. Assessing and treating insomnia could therefore also have a preventive value in psychopathology.

Introduction: The ongoing pandemic has not only placed significant strain on healthcare systems and global economies but has also exacerbated psychiatric issues, undermining the mental well-being of countless individuals. It is widely recognized that epidemic events, particularly periods of lockdown, heighten the risk of developing anxiety disorders, depression, and aggressive behaviors.

Materials and methods: In an Italian cohort, a retrospective study was conducted to examine the consumption and costs of antipsychotic medications during and after the Covid-19 pandemic, specifically in the years 2020-2022. Utilizing a database known as the "Sistema Tessere Sanitaria", data on medication dispensations from publicly accessible community pharmacies were extracted, covering a population of approximately one million individuals.

Results: The findings for the years 2020-2021 showed relatively stable patterns, with overall consumption and expenditure slightly decreasing from 2020 to 2021. However, it is worth noting that the antipsychotic drug aripiprazole exhibited an opposite trend, with an increase in consumption. Despite expectations of heightened antipsychotic medication use, real-world evidence indicates a different phenomenon, suggesting that the pandemic might not have significantly influenced the consumption of these medications.

Conclusions: The limited accessibility to healthcare and medical appointments likely played a role in this observation, potentially masking the therapeutic needs of the population. It will be crucial to monitor the situation in the upcoming years, as normal clinical activities resume, to determine whether there will be an upsurge in the consumption of antipsychotic drugs, which represent a significant portion of the National Healthcare System's expenditure.

Falls in the elderly represent one of the major clinical problems as they are serious events that often result in high residual disability and mortality rates. Knowledge on the subject derives mainly from geriatric and gerontopsychiatric research. However, gerontopsychiatric patients differ from geriatric patients not only for the psychiatric and neurological comorbidities, which are often not sufficiently taken into account in the scientific context, but also for the intake of psychotropic drugs, notoriously described as one of the main risk factors for falls. Such drugs are widely prescribed in this group of patients, often even off-label. Clinicians therefore should pay particular attention to falls, since various comorbidities and polypharmacy as a prescribing issue can have important consequences for clinical management. Falls have not been sufficiently investigated yet in a purely psychiatric context.

We hereby report a case of a young Ukrainian woman refugee who immigrated in Italy after the war outbreak in February 2022. The researcher arrived in Italy in March 2022, thanks to a scholarship of the University of L'Aquila. Shortly after settling in L'Aquila, she started to manifest depressive symptoms, which eventually led her to seek psychological and pharmacological help in the local psychiatric unit. In April 2022, she accessed twice in a week to the emergency department of the "San Salvatore" Hospital of L'Aquila. The second time she presented an acute anxiety attack accompanied by psychomotor disturbances (negativism, mutism) that eventually required admission to the local psychiatric ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC) with the aim of managing the clinical presentation from a pharmacological and psychotherapeutic perspective. The patient submitted a series of validated scales in her own language. After 13 days of hospitalization, the patient was discharged with a diagnosis of "Acute Depressive Disorder, mild severity", according to PHQ-9, and referred to psychiatric services with a dedicated program. The present report aims to underline the need to take into consideration the possibility of developing depressive symptoms and reactions among Ukrainian war refugees and, in light of this evidence, the importance of a cross-country shared program when addressing the mental health of all refugees.

Introduction: In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes.

Materials and methods: The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records.

Results: The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations.

Conclusions: Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.

Aim: The aim of the present research is to assess the satisfaction levels of participants in a multifamily psychoanalysis group conducted within a territorial mental health service, following the model developed by Argentine psychoanalyst Jorge García Badaracco.

Methods: To evaluate participant satisfaction in the therapeutic group, an anonymous satisfaction questionnaire was adopted and administered during each multifamily therapy session between 2016 and 2019. The sample consisted of designated patients and their family members participating in the groups.

Results: The results obtained from measuring participant satisfaction during the specified time period indicate a consistent and increasing level of satisfaction with the group activities conducted by all participants.

Discussion and conclusions: The obtained results indicate that the experience of multifamily psychoanalysis seems to be well-received and positively perceived by both users and family members, thereby contributing to an overall increase in satisfaction with the mental health service. The measurement of subjective satisfaction ratings in scientific literature is explored in relation to satisfaction, adherence, compliance, and treatment persistence, and can also be included as part of a broader set of variables aimed at identifying objective indicators of intervention outcomes in multifamily psychotherapies.

Aim: Advance healthcare directives in the psychiatric field raise more concerns and controversies compared to their use in other medical branches. We discuss the role of advance directives in this field and suggest a criteria proposal for the settlement of a comprehensive regulation on the matter.

Methods: We analyse the existing law and discuss the ethical points in the Italian context and, in comparison, with the United Kingdom context.

Results: Numerous studies have highlighted that psychiatric patients experience advance directives as an instrument to participate in therapeutic decision-making. Regarding the usefulness of advance directives, Italy and the United Kingdom did not approve deontological rules or laws. The United Nations Commission states that, based on the principles of the Convention on the Rights of Persons with Disabilities, it is necessary to respect the spatient's will, even if it is biased by psychic disorders.

Conclusions: The Convention does not consider advance directives; instead, they just suggest using some support to have the patient regain their competence. In case this is unsuccessful, it is necessary to appoint a substitute decision-maker to express, even in the light of the advance directives, the will that the patient would have expressed if he had been competent.

Objectives: The Shared Decision Making Questionnaire-Physician Version (SDM-Q-Doc) is the main tool assessing SDM relationship between patient and physician using the clinician viewpoint. It is reliable in all medical fields, and the validation of its Italian version was still missing. Our aim was to validate the Italian version of the SDM-Q-Doc in a clinical sample of patients suffering from severe mental illness.

Methods: We approached 369 patients affected by major psychiatric disorders (including schizophrenia spectrum disorders, affective disorders and eating disorders) in a real-world outpatient clinical setting. We run the Confirmatory Factor Analysis (CFA) to test the SDM-Q-Doc structure. We calculated the correlations between the SDM-Q-Doc and the Observing Patient Involvement (OPTION) scale, used as comparing test, and McDonald ω coefficient to measure convergent validity and internal consistency respectively.

Results: We reached a response rate of 93.2% (344 final participants). The CFA showed a very good fit compared of the Italian version of SDM-Q-Doc (χ2/df=3.2, CFI=.99, TLI=.99, RMSEA=.08, SRMR=.04). We found several correlations between the SDM-Q-Doc and OPTION scale supporting a robust SDM-Q-Doc construct validity, while internal consistency of the scale was McDonald ω coefficient .92. Further, inter-item correlations ranged from .390 to .703, with a mean of .556.

Conclusions: This study confirms the suitability of the Italian version of SDM-Q-Doc, with good reliability and soundness even when compared to other languages validated versions and to OPTION scale. SDM-Q-Doc represents an easy-to-use physician-centered measure to assess patients' involvement in medical decision-making, well performing in the Italian-speaking population.

Purpose: This review aims to investigate the role of midwifery care in perinatal death. Specifically, it aims to investigate the type and implications in the clinical practice of psychological and psychiatric support interventions for women/couples.

Methods: A scoping review was conducted following the PRISMA methodology. For this purpose, the following databases were queried: PubMed, APA PsycInfo, CINAHL Plus with Full Text, and ERIC, considering only studies published in the 2002-2022 time frame.

Results: 14 studies were found to be eligible by the literature review. These researches were divided into 3 macro-topics representing the most crucial factors in influencing the quality of care: the healthcare setting, the experience and training of caregivers, and the experience of parents.

Discussion: The healthcare figure who experiences such a tragic event most closely is the midwife. The health and geographic context in which care is provided - understood to be low-medium-high resources - have a fundamental impact on the quality of midwifery care and caregiver satisfaction. The training was found to be incomplete, and midwives' experiences revealed how they felt unprepared. Parents' experiences indicate the need for multidisciplinary care, better communicability, and follow-up including psychological/psychiatric support for mothers who are increasingly alone in coping with bereavement. To date, there are no guidelines for psychological support for this specific event in the literature.

Conclusions: Birth-death management should be a structured part of professional courses so that new generations of midwives can improve the quality of care for affected families. Future research should focus on how to improve communication processes, and hospital centers should adopt protocols adapted to the needs of parents, including a midwifery-led model policy based on psychological support for the mothers/couples involved, as well as increase follow-ups.