Body dysmorphic disorder and psychotherapeutic interventions: a systematic literature review.

Introduction: Body dysmorphism disorder (BDD) is a disabling mental disorder characterized by an anxious preoccupation with a perceived defect in physical appearance. Objective: This systematic review arose with the main objective of identifying the most effective psychotherapeutic intervention in the treatment of BDD. Methods: From February to October 2022, we conducted a systematic review aimed at identifying the psychotherapeutic intervention for BDD, the search for these concepts was on PubMed. There were no language limitations, only time limitations, we delved into studies published in the databases between 2015 and 2022. Results: We identified a total of 393 unique records. Of these, 43 full-text articles were evaluated for eligibility, and seven of these met the inclusion criteria and were included in the final systematic review. Conclusions: Cognitive-behavioral therapy has been shown to be effective compared with other therapies, especially when combined with drug therapy. The results confirm that BDD-NET (INTERNET-based CBT) led to significant improvement of symptoms in patients with body dysmorphism. In conclusion, we can say that cognitive-behavioral therapy, whether in direct or online form, appears to be the most effective treatment for this disorder.

Prevalence of Post-Traumatic Stress Disorder Among Asylum Seekers in Italy: A Population-Based Survey in Sicily.

Italian coasts are docking berths for the majority of boats carrying asylum seekers coming from Middle East and Sub-Saharan countries. These people escaped from their home countries in an effort to survive war, hunger and torture. These experiences might have affected their mental health, which became more endangered during their journey. The main aim of our work was to assess the prevalence of post-traumatic stress disorder (PTSD) in asylum seekers in a first aid facility, where immigrants were aided after their arrival. Thus, we designed a cross-sectional survey with paper-and-pen questionnaires. The setting was the C.A.R.A. (Centro Accoglienza Richiedenti Asilo) in Mineo (Sicily). Participants were asked for general information. They also completed the PTSD Checklist of the DSM-IV (PCL-C) and the Harvard Trauma Questionnaire (HTQ). We collected 140 questionnaires and the PCL-C was completed by 98 residents; 44% of responders were considered affected by PTSD. Although we used a conservative cut-off, PTSD prevalence was found to be much higher than that in the general population.

Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study.

Borderline personality disorder (BPD) often co-occurres with bipolar disorder (BD). Impulsivity and aggressiveness represent core shared features and their pharmacological management is mainly based on mood stabilizers and antipsychotics, although scarce evidence is available for this context of comorbidity. The aim of the present study was to evaluate the role of Asenapine as an adjunctive drug for reducing aggressiveness and impulsivity in a sample of Italian BD type I outpatients with or without a comorbid BPD. This was an observational 12-week open-label uncontrolled clinical study carried out from April to October 2014 in two psychiatric clinics in Sicily. Each patient was treated with asenapine at two dose options, 5 mg (twice daily) or 10 mg (twice daily), and concomitant ongoing medications were not discontinued. We measured impulsivity using the Barratt Impulsiveness Scale (BIS) and aggressiveness using the Aggressive Questionnaire (AQ). For the analysis of our outcomes, patients were divided into two groups: with or without comorbid BPD. Adjunctive therapy was associated with a significant decrease of BIS and AQ overall scores in the entire bipolar sample. Yet, there was no significant difference in BIS and AQ reductions between subgroups. Using a regression model, we observed that concomitant BPD played a negative role on the Hostility subscale and overall AQ score variations; otherwise, borderline co-diagnosis was related positively to the reduction of physical aggression. According to our post-hoc analysis, global aggressiveness scores are less prone to decrease in patients with a dual diagnosis, whereas physical aggressiveness appears to be more responsive to the add-on therapy in patients with comorbidity.

Sleep Quality, Perceived Stress, and Caffeinated Drinks Intake in Psychiatry Residents: A Cross-Sectional Study.

Background: Medical residencies are highly demanding and stressful and have been associated with mental and emotional problems. Studies that evaluated this relationship in Italian psychiatry residents are scarce. In this study, we examined sleep quality and its association with perceived stress and caffeinated beverages consumption in Italian psychiatry residents. Methods: Seventy-two PGY1-5 psychiatry residents at two University Hospitals in Italy were asked to complete an anonymous questionnaire. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to determine the sleep quality and the level of daytime sleepiness (EDS). In addition, we investigated perceived stress and caffeinated drinks consumption (coffee, tea, soda, energy drinks). Results: Seventy psychiatry residents responded to the survey (97.2% response rate) (M = 34.3%, F = 65.7%; mean age = 30.5 ± 4.2 SD years). 44.3% had poor sleep quality and 15.7% had abnormal EDS. 64.3% reported significant perceived stress. Perceived stress score and coffee consumption were associated with greater likelihood of poor sleep quality. Conclusions: Psychiatry residents have high prevalence of poor sleep quality. Future longitudinal studies are needed to investigate causality and identify appropriate coping strategies and lifestyle changes aimed to improve mental health in psychiatry trainees.

Can topiramate induce pruritus? A case report and review of literature.

A 41-year-old woman with Major Depressive Disorder-Recurrent was treated with topiramate at 150 mg/day. After this administration, she developed intense pruritus and skin lesions due to scratching. Consequently, she was weaned off topiramate and the lesions regressed. Pruritus and cutaneous lesions are extremely rare side effects of topiramate, so we report an interesting case of skin reaction to this drug.

Video game addiction in gambling disorder: clinical, psychopathological, and personality correlates.

OBJECTIVE: We studied the prevalences of video game use (VGU) and addiction (VGA) in gambling disorder (GD) patients and compared them with subjects with non-video game use (non-VGU) in relation to their gambling behavior, psychopathology, and personality characteristics. METHOD: A sample of 193 GD patients (121 non-VGU, 43 VGU, and 29 VGA) consecutively admitted to our pathological gambling unit participated in the study. Assessment. Measures included the video game dependency test (VDT), symptom checklist-90-revised, and the temperament and character inventory-revised, as well as a number of other GD indices. RESULTS: In GD, the observed prevalence of VG (use or addiction) was 37.3% (95% CI :30.7% ÷ 44.3),VGU 22.3% (95% CI :17.0% ÷ 28.7), and VGA 15% (95% CI :10.7% ÷ 20.7). Orthogonal polynomial contrast into logistic regression showed positive linear trends for VG level and GD severity and other measures of general psychopathology. After structural equation modeling, higher VG total scores were associated with younger age, general psychopathology, and specific personality traits, but not with GD severity. Patients' sex and age were involved in the mediational pathways between personality traits and VG impairment. CONCLUSIONS: GD patients with VG are younger and present more dysfunctional personality traits, and more general psychopathology. The presence of VG did not affect the severity of GD.

Venlafaxine augmentation with agomelatine in a patient with obsessive-compulsive disorder and suicidal behaviors.

Obsessive-compulsive disorder is a chronic and disabling condition that often proves to be treatment resistant. Of the patients suffering from obsessive-compulsive disorder, 10%-27% may attempt suicide at least once in their life. We report the case of a patient who presented severe obsessive-compulsive disorder symptoms and attempted suicide ingesting 25 tablets of fluoxetine (20 mg). The patient was treated with venlafaxine and agomelatine and showed improvement of obsessive symptoms and suicidal ideation. Future studies are needed to investigate this treatment regime in large cohorts of obsessive-compulsive disorder patients with suicidal ideation.

Pramipexole induced psychosis in a patient with restless legs syndrome.

In the last few years, dopamine agonists (DA) have been used as first-line treatment for restless legs syndrome (RLS), a disabling sensorimotor disorder. Only recently have they reported some possible iatrogenic side effects, as shown below. The following case presents a RLS patient who developed hallucinatory and delusional symptoms with paranoid ideation after pramipexole assumption; these symptoms gradually decreased after pramipexole suspension and treatment by an oral antipsychotic therapy (quetiapine XR). Correlation between DAs assumption and psychotic symptoms is still not clear. The development of these side effects might be related to many risk factors such as genetic susceptibility, premorbid personality and psychosocial stressor; in order to minimise the risk of iatrogenic psychosis it could be useful to assess patients' vulnerability factors selecting an alternative medication regime.