Rivista di psichiatria最新文献

Aim: The covid-19 pandemic/lockdown had a great impact on Severe Mental Illnesses (SMI) on the following variables: adherence to protective measures, infection, Covid-related psychopathology, stress related symptoms exacerbation, social relationship loss and higher mortality risk. InteGRO, a new effective salutogenic-psychoeducational approach, has been designed to help people with SMI manage their life-stress and achieve personal recovery goals through improved social functioning. Positive outcomes after pandemic/lockdown in patients trained with InteGRO and also their opinion about its usefulness are discussed.

Methods: All above mentioned variables were collected in a 1-year observational study (March 2020-2021) for all patients trained with InteGRO. In April 2021 patients were asked to respond to: an ad hoc semi-structured in-depth telephone interview, the Stress-Scale, the Brief Psychiatric Rating-Scale, the Personal and Social Performance Scale.

Results: 37 people out of 41 underwent the observational study. The overall outcome was good: one patient with asymptomatic infection, 40/41 vaccinated, a very low (2/37) trend of hospital admissions similar to previous years, very high personal and social functioning as well as low level of stress. In the interview, patients answered they found the InteGRO Training very useful, above all the meetings concerning Defining Goal and Problem-Solving. They often felt their desire to socialize was prompted by InteGRO training.

Conclusions: These results suggest InteGRO had a good impact on SMI patients to face pandemic/lockdown, with high level of personal and social functioning. They also suggest using structured salutogenic psychoeducational programs in public health services can be useful to promote life-skills to face traumatic events. Further studies are needed to understand the duration of these improvements and outcomes.

Background: In England, psychosis incidence is 31.7×100,000 persons per year. Mindfulness-based interventions for psychosis (MBIp) might reduce its symptoms; however, the research outcomes on its effect size (ES) vary considerably. This project aims to ascertain the existing evidence.

Methods: Eight publications from a pool of over 260 studies were extracted and analysed at meta-analysis for ES as satisfying the inclusion criteria.

Results: MBIp has a moderate ES (r=0.34; p<.001) on psychosis with a 95% confidence interval (CI) of 0.26-0.42 (small to high).

Discussion: MBIp improves psychosis symptoms. However, the studies analysed show heterogeneity in ES. Hence only conditional recommendations can be made for MBIp.

Introduction: Priapism is defined as a prolonged penile erection in absence of sexual arousal, leading also to serious sexual and urological problems such as erectile dysfunction and penile fibrosis. Amongst many different etiologies, priapism may be caused by a wide range of antipsychotic medications, mainly due to the α1-adrenergic receptor antagonism. On the other hand, only a couple of cases of opioid compounds have been linked to the onset of priapism, with evidence coming only from methadone and buprenorphine. Here we describe the case of a patient treated with antipsychotics who developed priapism four times following rapid discontinuation of buprenorphine/naloxone (Suboxone®).

Case presentation: S.C. is a 30-year-old Caucasian man suffering from chronic buprenorphine/naloxone (Suboxone®) abuse, borderline personality disorder, antisocial traits, and multiple suicide attempts. During the acute and the first part of post-acute Suboxone® withdrawal, four episodes of priapism developed while he was treated with clotiapine, clozapine, and chlorpromazine. However, after the last episode of priapism, despite he was either on haloperidol or zuclopenthixol and chlorpromazine, no other urological event occurred during the following 6 months of observation.

Conclusions: As opioids may have dampened the patient's sexual function due to chronic consumption, a rapid drug suspension coupled with an antipsychotic therapy might have created the conditions to facilitate the occurrence of close clustered priapism events.

The attention deficit hyperactivity disorder (ADHD) in women has recently received considerable attention, as research has shown an underestimation of the disorder in females, due to a difference in presentation compared to males: females have a higher risk of having ADHD, without those "disruptive" symptoms that determine the request for help. The purpose of the present narrative review is to identify the neglected clinical problems in the diagnostic and therapeutic intervention of women with ADHD and to analyze the associated comorbid problems. The conducted PubMed search and the relevant literature review on the topic show that the impairment of ADHD in women is underestimated due to the different ways the phenomenon manifests compared to traditional male's symptoms. This underestimation consequently leads to an inadequate treatment and has negative repercussions on the social context in which women are involved in.

Aim: In urban contexts, Mental Health Services are increasingly involved in the assessment of users with a heterogeneous ethnic and cultural background. These characteristics of migrants can exert an influence on access to healthcare, diagnostic evaluation, and use of therapeutic resources. The present work aimed to compare these differences among individuals who received their first clinical evaluation at the Mental Health Outpatient Service of Prato in 2019-2021, exploring variations across time, among the entire non-native population, and based on their continent of origin.

Methods: In the abovementioned clinical population, socio-demographic data, the type of evaluation received, and the primary diagnostic classification were retrieved. Their absolute and relative frequencies were registered, and differences based on the origin of migrants were explored.

Results: Of 3,992 assessments, 485 (12.1%) involved non-natives from 60 different countries, with a lower mean age as compared to the Italian counterpart, and a heterogeneous gender prevalence based on the continent of origin. The percentage of migrants increased from 11.8% to 14.2% across time, with a higher proportion of psychiatric evaluations and a lower implementation of multi-professional interventions. As compared to native individuals, a higher proportion of adjustment, psychotic, substance-related, somatic, conversive, dissociative, and post-traumatic disorders was observed.

Discussion and conclusions: The access of migrants to the Public Mental Health outpatient facility proved to be remarkably lower than expected, based on the composition of the general population. Given the proportional increase in the requested evaluations, it is necessary to promote a reflexion on the specificity of the emergent psychopathology, and on difficulties in access to psychotherapy: a trans-cultural approach to mental health may require adequate resources for the management of these distinctive needs.

The early identification of anorexia (AN) and bulimia nervosa (BN) in the general population represents a crucial strategy to avoid their chronicization and clinical worsening. This pilot-study aims to test the validity of a new screening tool (DiCA33) dedicated AN/BN risk in online settings, based on the Italian version of EAT-26, a self-report questionnaire for measuring AN/BN symptoms. First analyses excluded the effect of demographic factors on results and suggested a limited explanation power of the mere total scores of DiCA33 for risk detection. Alternatively, a selection of risked items from the DiCA33 checklists (as evidenced on EAT-26 scores), then combined in a subscale, showed a necessary sensitivity for screening purposes. The DiCA33-subscale constitutes a reliable and useful index for the early and quick detection of AN/BN risk in young Italian female population, composed mainly by students. Considering the non-diagnostic nature of this tool, subsequent rigorous and psychiatric evaluations are necessary for positive cases to confirm the risk. Further studies may validate the tool even recruiting patients with eating disorders to improve tool specificity.

Purpose: Current guidelines, due to potential toxicity and lack of clinical evidence, do not recommend the use of lithium in the treatment of Anorexia Nervosa (AN). Scarce evidence is available on the use, side effects, and tolerability of this drug in children and adolescents with AN, a population characterized by specific clinical, metabolic, and hydro-electrolytic balance features. Here we report a case series of children and adolescents hospitalized for AN and treated with lithium.

Methods: Case series reporting the use of lithium in 7 female young patients with AN. Reasons for introduction, dosages, formulation, plas-ma levels, adverse drug reactions (ADR) and modifi-cations of electrocardiogram (EKG) and plasma levels of glucose, cholesterol, creatinine, urea, sodium, and thyroid-stimulating hormone (TSH) were assessed. Re-sults. Reasons for the introduction of lithium included unstable mood, insufficient compliance with nutri-tional programs, and psychomotor agitation. In all of the patients an improvement on target symptoms was observed. Lithium was started at 171.4 (+/-56.7) mg/day, up to 600.0 (+/-173.2) mg/day. The most frequent scheme was three times daily. The mean plasmatic concentration was 0.6 (+/-0.3) mmol/L at one month. One pa-tient experienced polyuria, polydipsia and dry mouth, and another showed increased creatinine kinase. No major modifications of EKG, glucose, cholesterol, cre-atinine, urea, sodium emerged.

Conclusions: In this sample of children and adolescents hospitalized for AN, lithium was administered to improve psychiatric symptoms impairing compliance. All the patients experienced an improvement on these symptoms after being admin-istered lithium. ADR were reported in 2 cases. These data should be investigated in wider populations and controlled studies.

Background: Psychiatry has been affected by the 'Brain Drain' phenomenon for decades, with professionals usually migrating from lower- to higher-income countries. Whilst Italy faces a decreasing Psychiatric workforce in the near future, little is known about the factors that influence migration of Psychiatry trainees in Italy.

Aim: To explore the migration tendencies of Psychiatry trainees training in Italy.

Methods: A cross-sectional survey was disseminated to Psychiatry trainees in Italy.

Results: The vast majority (84.2%) of the trainees had 'ever' considered leaving Italy, and more than half (60.4%) considered leaving the country 'now'. Only a quarter (25.3%) had taken 'practical steps' towards migration. Male trainees were more likely to have 'ever' considered leaving Italy. Trainees without children were more likely to have 'ever' considered leaving and more likely to consider leaving 'now'. More southern Italian trainees were considering leaving the country 'now' compared to those from the centre-north. 'Academic' and 'work' reasons were the two most cited factors given both as a reason for wanting to leave Italy and as conditions that should be improved in the country. The main reason cited to remain in the country was personal.

Conclusions: Several Psychiatry trainees in Italy consider migration as a possibility, mainly driven by work and academic reasons. The main factor keeping trainees in Italy was personal reasons. Highlighting the reasons why trainees leave is crucial to facing these issues and either finding ways to encourage trainees to remain or finding other solutions for the medical shortage.

Reviewing the history of theories associated with psychotherapy establishes that motivational psychotherapy (MPT) has been centered on environmental mind, lies, selfishness, and rich mind, which are often rooted in previous theories but portrayed in an effectively different manner. By creating new concepts in the field of psychotherapy, MPT provides a useful and practical way to treat psychological problems. The analytical method has been also exploited to reflect on the theory of MPT. The results of this study revealed that MPT, recruiting the concept of rich mind, opens a new path for clients to effortlessly remove many problems in order to reach perfection and nurture their soul.

Objectives: The dimensional approach to psychopathology has been proposed to reliably evaluate suicidality. Potential gender modulation of psychopathological dimensions associated to suicide attempts was investigated.

Methods: 91 subjects who committed a near-lethal suicide (SA group) and 374 who did not (nSA group) were recruited in a Psychiatric Intensive Care Unit regardless of their categorical diagnosis. The Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale - Expanded version (BPRS-E) and the Scale for Rapid Dimensional Evaluation (SVARAD) were administered at the admission. A Factorial Multivariate ANOVA was conducted according to General Linear Model: Sex and Suicidality were input as fixed factors, HAM-D, BPRS-E and SVARAD scores as dependent variables.

Results: Men with SA (MSA) displayed significant lower scores in SVARAD Activation dimension compared to women with SA (FSA) (p=0.049), men without SA (MnSA) (p<0.001) and women without SA (FnSA) (p<0.001). Both SA groups displayed significant higher scores compared to nSA groups in regard of Depression item (BPRS-E) (p<0,001). The MSA group displayed significant lower scores in Psychomotor agitation (HAM-D) compared to FSA (p=0,044), MnSA (p<0,001) and FnSA (p<0,001).

Conclusions: By means of multifactorial statistics sex resulted a moderator of the relation between activation/agitation and suicidality, despite categorical diagnosis.