Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG).

BACKGROUND: Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD). METHODS: An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ2 tests for qualitative variables. RESULTS: Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium (p < 0.001) and complete satisfaction with education on lithium (p < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium (p < 0.001). CONCLUSIONS: Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.

'Too many BeEPs in our teens!' Behavioral and emotional problems in a large group of Italian adolescents.

BACKGROUND: One in six adolescents suffers from mental health problems. Despite the presence of general information on Italian adolescents' mental health, researches conducted with standardized assessment tools are scarce in the literature. We evaluated the prevalence of self-reported behavioral and emotional problems in a group of Italian adolescents and examined their relation to socio-demographical variables. METHODS: This population-based sampling survey was conducted on high school students aged 14-18 from urban areas of Rome and Latina. Participants completed Youth Self-Report (YSR) and a socio-demographic schedule to collect information on age, gender, type of school attended, socio-economic status, urbanicity. RESULTS: Final sample consisted of 1400 adolescents (38.61% male, mean age 16 years, s.d. 1.42). Prevalence of Internalizing Problems, Externalizing Problems and Total Problems was 29.55%, 18.34% and 24.13%. In our multivariable model, Internalizing Symptoms were not explained by sociodemographic variables while Externalizing Symptoms were explained by Male Gender [OR = 1.53 (1.14-2.06)], older age [OR = 2.06 (1.52-2.79)] and attending a Technical and Professional Institute [OR = 2.15 (1.53-3.02)], with an adjusted R2 = 4.32%. Total Problems were explained by School Type [Technical and Professional Institutes and Art and Humanities v. Grammar and Science School; OR respectively 1.93 (1.40-2.67) and 1.64 (1.08-2.47)], adjusted R2 = 1.94. CONCLUSIONS: The study provides, for the first time, evidence of a great prevalence of self-reported behavioral and emotional problems in a large sample of Italian adolescents, highlighting the role of different socio-demographic variables as risk factors for externalizing behaviors. Our results emphasize the urgent need for implementing prevention programs on mental health in adolescence.

Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: A multicenter-observational study.

OBJECTIVE: Comorbidities between psychiatric diseases and use of traditional substances of abuse are common. Nevertheless, there are few data regarding the use of novel psychoactive substances (NPS) among psychiatric patients. Aim of this multicentre survey is to investigate the consumption of a number of psychoactive substances in a young psychiatric sample. METHODS: Between December 2013 and September 2015, a questionnaire was administered in 10 Italian psychiatric care facilities to a sample of 671 patients, aged 18-26 (mean age 22.24; SD 2.87). RESULTS: About 8.2% of the sample declared to have used NPS at least once, and 2.2% had consumed NPS in the previous 3 months. The three psychiatric diagnoses most frequently associated with NPS use were bipolar disorder (23.1%), personality disorders (11.8%), and schizophrenia and related disorders (11.6%). In univariate regression analysis, bipolar disorder was positively associated with NPS consumption, an association that did not reach statistical significance in the multivariate analysis. CONCLUSIONS: The use of NPS in a young psychiatric population appears to be frequent, and probably still underestimated. Bipolar disorder shows an association with NPS use. Careful and constant monitoring and an accurate evaluation of possible clinical effects related to NPS use are necessary.

[The 5th revised edition of the DSM: a revolution half-accomplished]. / La pubblicazione del DSM-5: una rivoluzione a metà

To date, the diagnosis of mental disorders has been based on clinical observation and the 5th revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013, has confirmed this approach placing disorders in discrete statistical categories like the preceding editions. This has disappointed the expectations of those who hypothesized the revolution of a "neuroscience based DSM", where the psychiatric diagnoses are based on the identification of sensitive biological markers. Another controversial point is that, according to several authors, the DSM-5 does not provide a clear definition of the boundaries between mental disorders and the range of normality. However, in the new edition of the DSM, there are several interesting changes, such as the introduction of the "dimensions" that are aimed to bridge the gap between the historical categorical approach and the new research data and the reclassification and the redefinition of most categories. Purpose of this editorial is to provide a brief overview of these changes and critical aspects.

Counseling in the face of crisis: supporting mental health in Tor Vergata University students during the Covid-19 era.

AIMS: This study aims to present an overview of the clinical experience of the counseling service "Sportello Studenti". The service offers free diagnostic and therapeutic psychological assistance to all Tor Vergata University of Rome students. METHODS: Preliminary findings on the prevalence of anxious, depressive, and prodromal symptoms in a subset of participants recruited during the initial three-year period of the service's operation (2019-2022) are presented. Beck's Depression Inventory II (BDI-II), Symptom Checklist-90-Revised (SCL-90-R), Prodromal Questionnaire 16 (PQ-16) and Aberrant Salience Inventory (ASI) have been used to investigate principle psychopathological dimensions. RESULTS: 261 students aged 18 to 35 completed the assessment (180 female - 69%). Mild widespread depressive symptoms (35.5%) and mild to severe suicide ideation (5.1%) were highlighted. Ninety students (37.2%) result at a higher risk condition for psychosis. A significant statistical correlation between negative psychopathological indicators, such as suicidal thoughts and age, suggests that younger students exhibit higher susceptibility and vulnerability to mental health issues. DISCUSSION AND CONCLUSIONS: The increasing prevalence of distress among young individuals represents an urgent public health concern that necessitates immediate intervention. It is crucial for countries to adopt a comprehensive approach to promoting psychological and mental health. University counseling services serve as an effective initial intervention to address the negative impact of mental illness on academic performance, social interactions, and emotional well-being in young individuals. They also play a pivotal role in the early identification of individuals at risk of developing severe psychiatric disorders. Sportello Studenti has proven to be a valuable initiative addressing the mental health needs of University of Tor Vergata students, underscoring the significance of promoting psychological well-being.

Psychopathological characteristics in ultra-high risk for psychosis with and without comorbid ADHD.

AIM: This study investigates the psychopathological characteristics of a sample of individuals at ultra-high risk for psychosis with and without comorbid attention-deficit hyperactivity disorder (ADHD). METHODS: Twenty-eight subjects (aged 13-21 years; 13 females) with attenuated psychosis syndrome (APS) were recruited in a cross-sectional study and divided into two groups, each with 14 patients, according to the presence or absence of ADHD. RESULTS: The APS group showed a significantly higher prevalence of negative symptoms than the APS + ADHD group. Other characteristics investigated (positive symptoms, aberrant salience, psychotic-like experiences and prodromal symptoms) did not differ between groups. CONCLUSIONS: The different profiles of negative symptoms in the APS with or without ADHD might suggest the presence of a specific subtype among individuals at ultra-high risk for psychosis. Longitudinal studies with larger samples will provide information about the role of negative symptoms in determining conversion to full psychosis in those people with 'pure' APS and those with APS + ADHD.

TRPV1 channels regulate cortical excitability in humans.

Studies in rodents show that transient receptor potential vanilloid 1 (TRPV1) channels regulate glutamate release at central and peripheral synapses. In humans, a number of nonsynonymous single-nucleotide polymorphisms (SNPs) have been described in the TRPV1 gene, and some of them significantly alter the functionality of the channel. To address the possible role of TRPV1 channels in the regulation of synaptic transmission in humans, we studied how TRPV1 genetic polymorphisms affect cortical excitability measured with transcranial magnetic stimulation (TMS). Two SNPs of the TRPV1 gene were selected and genotyped (rs222747 and rs222749) in a sample of 77 healthy subjects. In previous cell expression studies, the "G" allele of rs222747 was found to enhance the activity of the channel, whereas rs222749 had no functional effect. Allelic variants in the rs222749 region were not associated with altered cortical response to single, paired, and repetitive TMS. In contrast, subjects homozygous for the G allele in rs222747 exhibited larger short-interval intracortical facilitation (a measure of glutamate transmission) explored through paired-pulse TMS of the primary motor cortex. Recruitment curves, short-interval intracortical inhibition, intracortical facilitation, and long-interval intracortical inhibition were unchanged. LTP- and LTD-like plasticity explored through intermittent or continuous theta-burst stimulation was also similar in the "G" and "non-G" subjects. To our knowledge, our results provide the first evidence that TRPV1 channels regulate cortical excitability to paired-pulse stimulation in humans.

Common variants at VRK2 and TCF4 conferring risk of schizophrenia.

Common sequence variants have recently joined rare structural polymorphisms as genetic factors with strong evidence for association with schizophrenia. Here we extend our previous genome-wide association study and meta-analysis (totalling 7 946 cases and 19 036 controls) by examining an expanded set of variants using an enlarged follow-up sample (up to 10 260 cases and 23 500 controls). In addition to previously reported alleles in the major histocompatibility complex region, near neurogranin (NRGN) and in an intron of transcription factor 4 (TCF4), we find two novel variants showing genome-wide significant association: rs2312147[C], upstream of vaccinia-related kinase 2 (VRK2) [odds ratio (OR) = 1.09, P = 1.9 × 10(-9)] and rs4309482[A], between coiled-coiled domain containing 68 (CCDC68) and TCF4, about 400 kb from the previously described risk allele, but not accounted for by its association (OR = 1.09, P = 7.8 × 10(-9)).

Defense style and psychopathology in oncological patients: a preliminary report.

INTRODUCTION: Previous studies shows that 30-40% of oncological and hematological patients report symptoms of distress compatible with a psychiatric disorder. The use of various and mostly unconscious defense mechanisms is implemented to cope with increased suffering after a cancer diagnosis. In this preliminary report, we explored the presence of defense mechanisms and their associations with psychopathological dimensions in a sample of late-stage cancer patients without history of psychiatric disorders. METHODS: We recruited 50 patients (28 females, 18-64 years old) with cancer diagnosis without prior history of any substance use disorder or psychiatric disorders. All participants were given the following self-report questionnaires: the Symptom Checklist 90 (SCL-90) and the 40-item version of the Defense Style Questionnaire (DSQ-40). RESULTS: In our study we demonstrated significant psychiatric distress in a third of our patients (defined as SCL-90 ≥2 points). A Pearson correlation analysis on all patients shows that psychotic defense styles were correlated with hostility, obsessive-compulsive, anxiety, somatization, interpersonal sensitivity, and psychoticism, while neurotic defense styles correlated with somatization. DISCUSSION AND CONCLUSION: Our results are in line with previous findings showing that one third of cancer patients suffers from a psychiatric disorder. Moreover, we found that somatization correlates with both psychotic and neurotic defense mechanism styles. This demonstrates the importance of assessing oncological patients coping mechanisms to achieve best possible treatment.

Feasibility and efficacy of an at-home, smart-device aided mindfulness program in people with Multiple Sclerosis.

BACKGROUND: Multiple Sclerosis (MS) is a chronic disease with a high prevalence of neuropsychiatric symptoms. Mindfulness is a practice that encourages individuals to cultivate a present-focused, acceptance-based approach for managing psychological distress. Its positive effect on MS has been demonstrated, but learning such technique is expensive and time-consuming. In this study, we investigated the feasibility and efficacy of an 8-week, at-home, smart-device aided mindfulness program in a cohort of MS patients. Specifically, we explored the role of a brain-sensing headband providing real-time auditory feedback as supportive tool for meditation exercises. METHODS: The study included two visits, one at baseline and another after the mindfulness program. We measured adherence to the proposed mindfulness treatment and its effect on questionnaires investigating different psychological domains, cognition, fatigue, quality of life and quantitative EEG parameters. All participants received a smart biofeedback device to be used during the therapeutic program consisting of daily meditative exercises. RESULTS: Twenty-nine patients were recruited for the present study. Among them, 27 (93%) completed the entire program and 17 (63%) completed more than 80% of the scheduled sessions. We observed a statistically significant reduction of the Ruminative Response Scale score and a significant increase of the Digit Span Backward. Regarding neurophysiological data, we found a significant reduction of the whole-scalp beta and parieto-occipital theta power post intervention. CONCLUSION: Our results show that an at-home, smart-device aided mindfulness program is feasible for people with MS. The efficacy in terms of reappraisals of stress, cognitive and emotional coping responses is also supported by our neurophysiological data. Further studies are warranted to better explore the role of such approaches in managing the psychological impact of MS diagnosis.

Locus of Control behavior in ultra-high risk patients.

The term "Locus of Control" has been defined by Rotter (1954) as a general attitude regarding the nature of the causal relationship between one's behavior and its consequences. External Locus of Control Behavior represents an important factor of psychopathological vulnerability and can increase people's vulnerability to psychosis. Using the Craig Scale (1984), we investigated the Locus of Control Behavior in a sample of patients at high risk of psychosis compared to schizophrenia patients and mood disorder patients. Furthermore, we investigated the possible correlation between an external Locus of Control and psychopathological dimensions such as aberrant salience, and attenuated positive and negative symptoms.

Autistic symptomatology in UHR patients: A preliminary report.

Several studies have evaluated the level of autistic symptomatology in schizophrenia patients (SCZ) and ultra-high risk for psychosis (UHR) patients, but the data are not conclusive. Using the PANSS Autism Severity Score (PAUSS) scale, we found that the degree of autistic symptomatology in UHR patients is significantly lower compared to SCZ patients but higher than in patients with a mood disorder. Moreover, we found a significant correlation between autistic symptomatology and the severity of formal thought disorders, confirming Bleuler's hypothesis about autism and association disorders as core features of psychosis.

Recognizing Psychosis in Autism Spectrum Disorder.

There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of comorbid psychosis in patients with Autism Spectrum Disorder represents a complex challenge from a psychopathological point of view, in particular in patients with greater deficits in verbal communication. Intercepting the onset of a psychotic breakdown in autism may be very difficult, both disorders in fact occur along a phenotypic continuum of clinical severity and in many cases, psychotic symptoms are present in an attenuated form. In this paper, we reviewed the available scientific literature about comorbidity between psychosis and autism, focusing our attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course. The aim of this paper is to provide clinical tools to identify these psychotic phenomena in autistic patients, even when they occur in their attenuated form.

Clinical profile and conversion rate to full psychosis in a prospective cohort study of youth affected by autism spectrum disorder and attenuated psychosis syndrome: A preliminary report.

Psychosis can occur at high rates in individuals with autism spectrum disorder (ASD). However, the detection of prodromal psychotic symptoms, including attenuated psychosis syndrome (APS), conditions at high risk of converting to full psychosis, has not been extensively investigated in ASD. We longitudinally evaluate a sample of young ASD individuals (age, mean ± SD: 13 ± 2.9) with (n = 13) or without (n = 18) concomitant APS through a standardized assessment of autistic (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2) and psychotic (Structured Interview for Psychosis-Risk Syndromes, SIPS) symptoms and cognitive and adaptive skills. Individuals with other neuropsychiatric disorders were excluded. We estimated the conversion rate to full psychosis (according to SIPS criteria) over time (39.6 ± 11.5 months) and explored the role of clinical variables at baseline in the transition to full psychosis. A conversion rate to full psychosis of 30.7% was found in ASD/APS. Conversion to full psychosis was not affected by the severity of the autistic and psychotic symptoms. At baseline, young individuals with ASD/APS who later converted to full psychosis showed lower cognitive performance (d = 2.05) and greater impairment of adaptive social functioning profile (d = 1.2) than those with ASD. The results of this preliminary report revealed that nearly a third of young individuals with ASD/APS convert to full psychosis over time. Conversion to full psychosis is affected by decreased cognitive and adaptive skills. Further investigations are needed to confirm the utility of APS detection and to better characterize the psychotic developmental trajectory in ASD, with consequent important implications on prognosis and therapeutic strategies.

Suicide-Related Knowledge among Italian Early Career Psychiatrists and Trainees: Results from a Cross-Sectional Survey.

The training of mental health professionals is an important component of suicide-prevention programs. A cross-sectional survey was conducted in different Italian regions to evaluate knowledge of, and attitudes toward, suicide as well as the experience of a patient's suicide or a suicide attempt in early career psychiatrists (ECPs) and trainees (N = 338). The Suicide Knowledge and Skills Questionnaire and the Impact of a Patient's Suicide on Professional and Personal Lives scale were administered. Furthermore, symptoms of intrusion, avoidance, and arousal were examined through the Impact of Event Scale in ECPs and trainees who had experienced the suicide of a patient or a suicide attempt. Participants with training were more confident in the clinical management of suicide-risk patients. The group with experience of a patient's suicide reported more suicide skills except for support and supervision. Finally, the participants who reported a patient's suicide presented a more conservative patient selection, difficulties in relationships, loss of self-esteem, dreams linked to suicide, intrusive thoughts of suicide, guilt, and anger. Our results show that knowledge of, and attitudes toward, suicide are essential in the management of suicide-risk patients.

Genetic variants of the NMDA receptor influence cortical excitability and plasticity in humans.

N-methyl-d-aspartate (NMDA) receptors play crucial roles in glutamate-mediated synaptic transmission and plasticity and are involved in a variety of brain functions. Specific single nucleotide polymorphisms (SNPs) in the genes encoding NMDA receptor subunits have been associated with some neuropsychiatric disorders involving altered glutamate transmission, but how these polymorphisms impact on synaptic function in humans is unknown. Here, the role of NMDA receptors in the control of cortical excitability and plasticity was explored by comparing the response to single, paired, and repetitive transcranial magnetic stimulations of the motor cortex in 77 healthy subjects carrying specific allelic variants of the NR1 subunit gene (GRIN1 rs4880213 and rs6293) or of the NR2B subunit gene (GRIN2B rs7301328, rs3764028, and rs1805247). Our results showed that individuals homozygous for the T allele in the rs4880213 GRIN1 SNP had reduced intracortical inhibition, as expected for enhanced glutamatergic excitation in these subjects. Furthermore, individuals carrying the G allele in the rs1805247 GRIN2B SNP show greater intracortical facilitation and greater long-term potentiation-like cortical plasticity after intermittent -burst stimulation. Our results provide novel insights into the function of NMDA receptors in the human brain and might contribute to the clarification of the synaptic bases of severe neuropsychiatric disorders associated with defective glutamate transmission.

Aberrant salience in adolescents is related to indicators of psychopathology that are relevant in the prodromal phases of psychosis.

AIM: Aberrant salience has been considered as a predisposing factor during prodromal phases of psychosis and in ultra high-risk subjects. Most studies investigated the presence of aberrant salience in general population as a measure of vulnerability to psychosis. This study aimed atinvestigating the level of aberrant salience in a sample of Italian high-school students. METHODS: Aberrant salience was measured with the Aberrant Salience Inventory (ASI) and its association with measures of general psychopathology (Youth Self Report [YSR]) was tested. A sample of 312 high school students (115 boys, 197 girls; age range: 14 to 19) was recruited. RESULTS: Within the ASI and the YSR, the subscales did associate with each other at medium to large effect size, while the associations of the ASI subscales to the YRS scales had small effect sizes, indicating that the two tools measure different constructs. Latent Class Analysis revealed a distribution of aberrant salience across three classes with the intermediate class corresponding to more than half of the sample (58.3%). The class with the highest endorsement of the ASI items included 101 subjects (32.4%). Greater differences by classes were found in the "increased significance" and the "impending understanding" subscales. Higher aberrant salience was found on the anxious/depressed, the somatic complaints, and the thought problems scales of the YSR. CONCLUSIONS: Aberrant salience represents a common experience in the adolescent population and is associated with various psychopathological disorders, in particular, thought disorder. Aberrant salience might be involved in proneness to psychosis.

Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature.

A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.

Maternal Vitamin D and its Role in Determining Fetal Origins of Mental Health.

There is evidence that mental health disorders may have roots in fetal life and are associated with deficiencies in various micronutrients, including vitamin D. During pregnancy, vitamin D balance is influenced by an increase in maternal calcitriol and a substantial increase in maternal Vitamin D Binding Protein concentrations. In the early stages of life, vitamin D is necessary to mediate numerous brain processes such as proliferation, apoptosis, and neurotransmission. Furthermore, Vitamin D has a recognized anti-inflammatory activity that normally suppresses inflammation. Increased activation of hypothalamo-pituitary-adrenal axis (HPA) and inflammation during gestation may influence maternal health and fetal neurodevelopment during and beyond pregnancy. A deficit of Vitamin D and maternal stressful events during gestation, such as perinatal depression, could influence the efficacy of the immune system altering its activity. Vitamin D deficiency during gestation associated with a reduction in fetal brain development has been widely described and correlated with alteration in the production of the brain-derived neurotrophic factor. To this regard, many studies highlights that low maternal vitamin D dosage during gestation has been related to a significantly greater risk to develop schizophrenia and other severe mental illnesses in later life. The objective of this paper is a comprehensive overview of maternal vitamin D balance in determining the fetal origins of mental health with some references to the link between vitamin D levels, inflammatory responses to stress and mental disorders in adult life.

Auditory Mismatch Negativity in Youth Affected by Autism Spectrum Disorder With and Without Attenuated Psychosis Syndrome.

The present study investigates the differences in auditory mismatch negativity (MMN) parameters given in a sample of young subjects with autism spectrum disorder (ASD, n = 37) with or without co-occurrent attenuated psychosis syndrome (APS). Our results show that ASD individuals present an MMN decreased amplitude and prolonged latency, without being influenced by concurrent APS. Additionally, when correlating the MMN indexes to clinical features, in the ASD + APS group, we found a negative correlation between the severity of autistic symptoms and the MMN latency in both frequency (f-MMN r = -0.810; p < 0.0001) and duration (d-MMN r = -0.650; p = 0.006) deviants. Thus, our results may provide a more informative characterization of the ASD sub-phenotype when associated with APS, highlighting the need for further longitudinal investigations.