Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths.

BACKGROUND: Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms. METHODS: The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS. RESULTS: The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups. CONCLUSION: People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.

Integrated Programs for Early Recognition of Severe Mental Disorders: Recommendations From an Italian Multicenter Project.

The onset of mental disorders often occurs in adolescence or young adulthood, but the process of early diagnosis and access to timely effective and appropriate services can still be a challenge. The goal of this paper is to describe a pilot case of implementation of the ultra-high-risk (UHR) paradigm in six Italian departments of mental health employing an integrated approach to address clinical practice and service organization for youth in a broader preventive perspective. This approach entailed the integration of the UHR paradigm with a service provision model which prioritizes prevention and the promotion of local community coalitions to improve youth service accessibility. The multicenter Italian project "Integrated programs for recognition and early treatment of severe mental disorders in youths" funded by the National Centre for Disease Prevention and Control (CCM2013 Project) implemented in three Italian regions will be described. As a result of synergic actions targeting accessibility of young individuals to innovative youth mental health teams, a total of 376 subjects aged 15-24 years were recruited by integrated youth services within 12 months. Subjects have been screened by integrated multidisciplinary mental health youth teams employing standardized procedure and evidence-based clinical assessment instruments for at-risk mental states in young subjects [e.g., Comprehensive Assessment of At-Risk Mental States (CAARMS)]. Considering the three UHR categories included in CAARMS, the percentage of UHR subjects was 35% (n = 127) of the sample. In conclusion, future strategies to improve the organization of youth mental health services from a wider preventive perspective will be proposed.

Age and Gender Differences in Emotion Recognition.

BACKGROUND: Existing literature suggests that age affects recognition of affective facial expressions. Eye-tracking studies highlighted that age-related differences in recognition of emotions could be explained by different face exploration patterns due to attentional impairment. Gender also seems to play a role in recognition of emotions. Unfortunately, little is known about the differences in emotion perception abilities across lifespans for men and women, even if females show more ability from infancy. OBJECTIVE: The present study aimed to examine the role of age and gender on facial emotion recognition in relation to neuropsychological functions and face exploration strategies. We also aimed to explore the associations between emotion recognition and quality of life. METHODS: 60 healthy people were consecutively enrolled in the study and divided into two groups: Younger Adults and Older Adults. Participants were assessed for: emotion recognition, attention abilities, frontal functioning, memory functioning and quality of life satisfaction. During the execution of the emotion recognition test using the Pictures of Facial Affects (PoFA) and a modified version of PoFA (M-PoFA), subject's eye movements were recorded with an Eye Tracker. RESULTS: Significant differences between younger and older adults were detected for fear recognition when adjusted for cognitive functioning and eye-gaze fixations characteristics. Adjusted means of fear recognition were significantly higher in the younger group than in the older group. With regard to gender's effects, old females recognized identical pairs of emotions better than old males. Considering the Satisfaction Profile (SAT-P) we detected negative correlations between some dimensions (Physical functioning, Sleep/feeding/free time) and emotion recognition (i.e., sadness, and disgust). CONCLUSION: The current study provided novel insights into the specific mechanisms that may explain differences in emotion recognition, examining how age and gender differences can be outlined by cognitive functioning and face exploration strategies.

Emotion recognition impairment in traumatic brain injury compared with schizophrenia spectrum: similar deficits with different origins.

The aim of our study was to identify the common and separate mechanisms that might underpin emotion recognition impairment in patients with traumatic brain injury (TBI) and schizophrenia (Sz) compared with healthy controls (HCs). We recruited 21 Sz outpatients, 24 severe TBI outpatients, and 38 HCs, and we used eye-tracking to compare facial emotion processing performance. Both Sz and TBI patients were significantly poorer at recognizing facial emotions compared with HC. Sz patients showed a different way of exploring the Pictures of Facial Affects stimuli and were significantly worse in recognition of neutral expressions. Selective or sustained attention deficits in TBI may reduce efficient emotion recognition, whereas in Sz, there is a more strategic deficit underlying the observed problem. There would seem to be scope for adjustment of effective rehabilitative training focused on emotion recognition.

[The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The Project SIEP-DIRECT'S]. / Il trattamento dell'episodio psicotico acuto: discrepanze fra pratiche di routine ed evidenze. Il Progetto SIEP-DIRECT'S.

AIMS: To evaluate the quality of psychiatric care during the acute psychotic episode and the early post-acute period. METHODS: Data concerning 24 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT'S Project to evaluate the implementation of NICE recommendations in Italian Mental Health Services. RESULTS: The treatment of the acute episode in the Italian Mental Health Services is not based only on admissions in Psychiatric Ward in General Hospitals, but also on intensive home based care. The utilization of day hospital facilities for treating acute episodes is less frequent, as the presence of home based follow up after discharge. About 3/4 of Departments of Mental Health did not have clinical guidelines concerning the pharmacological treatment in this area. However usually the standard practices followed NICE recommendations in terms of prescribed dosages, monitoring side effects and rationale for shifting to atypical antipsychotic drugs. Antipsychotic drugs, atypical or conventional, were frequently prescribed concurrently, while utilization of atypical antipsychotic drugs was increasing. CONCLUSIONS: The results show critical points concerning on one hand the scarce diffusion of clinical guidelines, on other hand the connection between standard practices, clinical guidelines and marketing of atypical antipsychotic drugs. It should be reinforced the role of the community and particularly at service level the capacity of community mental health teams to treat the acute patients.