Psychological Assessment in Anorexia Nervosa: A Single Case Study on Predictive Factors of Dropout.

Anorexia nervosa (AN) has the highest mortality rate among psychiatric disorders. Adult AN patients have a chronic history of treatment dropout due to denial of their psychological and physical disease states, which may be connected to defense mechanisms. We developed an assessment protocol to evaluate the psychological functioning of patients undergoing a psychodynamic approach for eating disorders (PAED), aimed at identifying the psychological factors associated with intervention success or dropout. We analyzed the case of an adult patient who quit treatment at the start and discussed her psychological functioning profile. We present the case of a 45-year-old woman with enduring AN, who entered the PAED program at an Italian hospital. In adult AN patients, denial and acting out may have significant impacts on clinic compliance. This hampers establishing a relationship with the clinic and the success of the psychological work aimed at promoting mental awareness and insights into the disorder. This highlights the need to consider which aspects of the initial psychological assessment are predictive of dropout in AN patients.

Exploring Sex Differences in Adult Obesity Candidates for Bariatric Surgery.

INTRODUCTION: Obesity represents a global health crisis and results from complex interactions between psychological, environmental, and genetic factors. Any therapeutic approach should consider the social, personal, and psychological characteristics of the obese subject, as well as possible medical complications. This study investigates sex differences in candidates for bariatric surgery. SUBJECTS AND METHODS: This is a cross-sectional study including subjects who underwent psychiatric pre-surgical evaluation. The evaluation comprised a clinical interview and the administration of self-report questionnaires that assessed socio-demographic and clinical aspects. Descriptive and bivariate analyses and a multivariate logistic regression model were performed to evaluate variables significantly associated with sex in bariatric surgery candidates. RESULTS: The sample consisted of 173 subjects, of which 71.1% were women. Significant differences between men and women were detected in employment status, birth nationality, psychopathological history, organic comorbidities, and BMI value. There were no significant differences in clinical aspects. CONCLUSION: Obesity has a significant impact on global health. Women and men who are considering bariatric surgery represent two different populations in demographic, personal, and social characteristics. Therefore, a sex-tailored approach is essential to guarantee adequate support in the management of the various aspects of obesity.

Air Pollution and Symptom Severity in Hospitalized Subjects with Schizophrenia Spectrum Disorders.

Air pollution has been demonstrated to represent a major threat to mental health, leading to higher risk of development or exacerbation of serious psychiatric disorders. The current study was aimed at investigating the associations between air pollutant concentrations (particulate matter 2.5 and 10, ozone, carbon monoxide, nitrogen dioxide) and symptom severity in a sample of inpatients suffering from schizophrenia spectrum disorders. We collected sociodemographic, clinical, and psychopathological characteristics of subjects (n=118) with schizophrenia spectrum disorders who were hospitalized in the Psychiatric Inpatient Unit of the University Hospital of Perugia in the period 1stJanuary 2015-31stDecember 2016. Psychopathological characteristics were assessed using the Positive And Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global impressions (CGI) scale. Hierarchical multiple regressions were run to assess the association between air pollutants concentrations and the PANSS, BPRS, and CGI total subscale scores, controlling the analyses for sex/age and meteorological data. We found a significant positive association between the average concentration of ozone before admission and the anxiety-depression factor score domain at the PANSS. No significant associations between the other pollutants and the different scores at the scales used for the psychopathological assessment were found. Short-term exposure to ozone may influence the clinical presentation of schizophrenia spectrum disorders and should be thus considered among the potentially modifiable risk factors in the urban environment. Air pollution should be considered among the main threats to human mental health and policymakers should address the built of sustainable urban environments.

Impulsivity and Anger in Obese Patients Undergoing Bariatric Surgery.

INTRODUCTION: Several studies show an association between obesity, impulsivity, and anger. The condition of obesity has moreover an important correlation with Eating Disorders (EDs), the most frequent of which is Binge Eating Disorder (BED). Obese patients seem to express peculiarities regarding the expression of some emotional processes, including impulsivity, aggression and anger, compared with regular-weight patients and those without an ED. SUBJECT AND METHODS: This is a cross-sectional study carried out on a population of 47 obese patients undergoing bariatric surgery. Patients underwent a psychiatric evaluation at the outpatient clinics of the Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation of the University Hospital of Perugia. Levels of anger and impulsivity were characterized using the STAXI-2 and BIS-11 scores. Scores were compared based on sex, the presence/absence of EDs and on the presence/absence of psychiatric disorders attested during the evaluation. RESULTS: No statistically significative difference were detected on STAXI-2 and BIS-11 scores comparing men and women. People diagnosed with EDs had higher scores in the subscores of attention, cognitive complexity, motor impulsivity, non-planning impulsivity, and in the BIS-11 total score. No differences were detected in the STAXI-2 scores. When comparing patients on the presence/absence of psychiatric comorbidities, obese patients with a psychiatric diagnosis had higher scores on the impulsivity measures, but also a higher value on the ER index of the STAXI-2. CONCLUSIONS: Obese subjects undergoing bariatric surgery represent a fragile population that must be carefully evaluated from a psychiatric point of view. Indeed, the co-existence of psychiatric comorbidities may underpin the present of trait-like characteristics, such as impulsivity and anger, that should be carefully considered when proposing treatment strategies.

A Psychological Service Dedicated to Work-Related Stress: the Experience at Perugia General Hospital.

INTRODUCTION: The characteristics of the working environment significantly influence the mental well-being of workers, and the presence of unfavorable conditions in the workplace can have a negative impact on mental health. Healthcare professionals are particularly exposed to the risk of burnout and the development of psychiatric, and particularly affective, symptoms. This paper aims to describe the activity of a psychological support service dedicated to work-related stress at the General Hospital of Perugia, Italy. SUBJECTS AND METHODS: In June 2022, a free and anonymous psychological service dedicated to healthcare professionals was established at the Perugia General Hospital. The main objectives of the service were to promote overall well-being of workers, to provide psychological support, and to address professionals towards specific pathways to care. RESULTS: The activity of the service consisted of clinical consultations with psychiatrists and psychologists who also administered psychometric tools to better characterize the overall clinical picture. After the clinical evaluation process, healthcare professionals who accessed the service were addressed to specific pathways of care, when needed. The data collection carried out from June 2022 to April 2024 showed a total number of 139 accesses to the Service, with a majority of requests from women (80%) and mainly belonging to nursing staff (53%). CONCLUSIONS: Preliminary data from the psychological service dedicated to healthcare professionals confirms the high prevalence of work-related stress, especially in specific settings. In the near future, psychological support services are expected to identify work-related stress situations as soon possible, possibly contributing to the reduction of stigma and to the built of healthier working environments.

Feeding and Eating Disorders in Bariatric Surgery: A Retrospective Study.

INTRODUCTION: Obese subjects undergoing bariatric surgery often display medical and psychiatric comorbidities, influencing post-operative course and long-term prognosis. Candidates for bariatric surgery are evaluated through a multidisciplinary assessment in the pre-operative phase, including a psychiatric visit. The psychiatric examination aims to screen psychiatric comorbidities, including feeding and eating disorders (FEDs). Indeed, there is evidence of the association between obesity and several psychiatric disorders, such as FEDs, but also anxiety disorders, mood disorders, psychotic disorders, neurodevelopment disorders and personality disorders, particularly B and C cluster personalities. This study aims to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery, and to underline the clinical correlates of FEDs diagnosis at the pre-operative assessment. SUBJECTS AND METHODS: Patients were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia. Psychiatric comorbidities were investigated by a psychiatric interview and hetero-administered scales for the evaluation of DSM-5 psychiatric syndromes (Structured Interview for DSM-5 Disorders - clinical version - SCID-5-CV), psychopathological and personality characteristics (Minnesota Multiphasic Personality Inventory - MMPI-2 and Structured Clinical Interview for DSM-5-Personality Disorders - SCID-5-PD) and specific scales for the evaluation of FEDs (Binge Eating Scale - BES, Obesity Questionnaire - OQ, Bulimia Test-Revised - BULIT-R and Body Shape Questionnaire - BSQ). After performing descriptive statistics, we performed bivariate analyses to assess significant differences between subjects with and without FEDs diagnosis (p˂0.05). RESULTS: The sample was composed of 160 subjects (70.6% F versus 29.4% M). The average BMI was 42.90 ±6.258 and 86.8% of subjects had a Class 3 Obesity (BMI ≥40). 41.3% of patients received a psychiatric diagnosis and, specifically, a diagnosis of FEDs was highlighted in 28.7% cases. Individuals with FEDs more frequently had a family history of obesity and FEDs. As for psychopathological characteristics, altered scores on the BES and on the BULIT-R were more frequent in the group with psychiatric disorders excluding FEDs. CONCLUSIONS: Patients evaluated in bariatric surgery pre-operative assessment often display FEDs. Patients with FEDs more frequently suffer from other psychiatric disorders, showing the need for specific support pathways in this group of patients.

Coercion and Compulsory Treatment in Anorexia Nervosa: a Systematic Review on Legal and Ethical Issues.

BACKGROUND: The aim of this systematic review is to critically summarize current literature concerning ethical and legal issues related compulsory treatment (CT) in patients with anorexia nervosa (AN). SUBJECTS AND METHODS: Relevant articles were identified following the PRISMA guidelines after performing title/abstract screening and full text screening. We built the search string using the following terms: "coercion", "compulsory/involuntary treatment", "eating disorders", "anorexia nervosa", "mental capacity", "ethical/legal issues". Research was conducted on original articles published from any time until June 2023. RESULTS: Out of 302 articles retrieved, seven were included for the analysis, including five studies on mental health practitioners, and two on hospital records. The results show that mental health practitioners a) favor the use of CT, but the support is weaker in AN vs other psychiatric conditions (i.e., schizophrenia or depression); b) support of mental capacity is controversial and some variability was found between different categories of psychiatrists; in particular, both ED-treating and CT experienced mental health practitioners support higher use of CT and lack of capacity of AN patients vs. general psychiatrists; c) use of CT is more supported in the early vs. chronic AN, when chances of success are lower. The analysis of hospital records identified 1) comorbidities, previous admissions and current health risk as CT predictors in 96 Australian patients; 2) family conflicts association with longer hospitalizations in 70 UK patients. CONCLUSION: CT is usually intended for patients with AN at the onset of disease, mainly to prevent risk of death and self-injury. However, there is some variability in the attitude to perform CT among psychiatrists working in different setting, also related to the concept of mental capacity. There are also cross-national variabilities regarding CT. We can conclude that forcing patients to treatment is a conceivable option, but the balance between protection respect for patient's autonomy should be evaluated on individual bases.

Duration of Involuntary Treatment in a Psychiatric Inpatient Unit: the experience of Umbria, Central Italy.

OBJECTIVES: The present retrospective study was aimed at analyzing the socio-demographic and clinical correlates of the duration of involuntary treatment (IT) in a Psychiatric Inpatient Unit in central Italy. SUBJECTS AND METHODS: We reviewed clinical charts of subjects admitted following IT, extracting sociodemographic and clinical information. We used the duration of the IT as a "proxy" for the early cessation of the conditions that determined the need for involuntary commitment. Hospitalizations were thus labeled as "short-IT" and "ultra-short-IT" depending on their duration (< 7 days or < 3 days). Bivariate analyses (p<0.05). were performed to compare "short-ITs" with hospitalizations that were longer that 7 days. The same procedure was repeated for comparing "ultra-short-ITs" with hospitalizations lasting >3 days. RESULTS: In the present sample (362 subjects, 459 hospitalizations), 112 (24.4%) hospitalizations belonged to the "short-IT" and 56 (12.2%) to the "ultra-short-IT" subgroups. Both subgroups were characterized by a lower prevalence of single marital status and by a higher prevalence of admissions due to psychomotor agitation. The diagnoses of schizophrenia spectrum and mood disorders were less frequent in the two subgroups, with lower antipsychotic prescription rates, while higher prevalence of substance-related and impulse control disorders were detected. Both hospitalization types were more frequently followed by a "revolving door". As for "short-IT", subjects were referred to the ward by community mental health services in fewer cases. CONCLUSIONS: The early cessation of IT is more frequent in case of subjects who do not suffer from a serious psychiatric disorder and are referred to the inpatient ward due behavioral disturbances. The engagement with community mental health services should be improved in order to propose possible alternative solutions to IT and avoid revolving doors.

Consultation-Liaison Psychiatry-From Theory to Clinical Practice: an Observational Study in a Psychiatric Unit in the General Hospital of Perugia.

BACKGROUND: Subjects suffering from psychiatric disorders are frequently hospitalized due to medical comorbidities. In the present study, we analyzed consultation-liaison psychiatry (CLP) activity in a General Hospital, describing the sociodemographic, diagnostic, and therapeutic characteristics of the evaluated subjects, as well as reasons for consultation requests. SUBJECTS AND METHODS: Data concerning psychiatric consultation performed at the Perugia General Hospital during a 1-year period (01/06/2022-20/06/2023) were collected and analyzed by means of descriptive statistics. RESULTS: A total of 707 psychiatric consultations were performed. The primary reason that led to psychiatric consultations was psychomotor agitation. 85 (18.5%) patients attempted suicide; the most frequent modality was the assumption of drugs at non-therapeutic doses. The 72% of the sample (n=509) presented a clear-cut medical comorbidity. In most cases, subjects were referred to Community Mental Health and Addiction services (n=22, 32.4%). CONCLUSIONS: CLP plays a crucial role in the perspective of the overall well-being of hospitalized subjects, but also for the overall management of complex cases. Despite this, a homogeneous approach with standardized guidelines is needed in this field.

New determinants of mental health: the role of noise pollution. A narrative review.

Urbanisation processes and anthropogenic actions led to a significant increase in pollution levels, with relevant consequences on global health. In particular, noise pollution demonstrated an association with cardiovascular, metabolic, and respiratory diseases. Furthermore, increasing evidence underlined the possible role of air and noise pollution in the development of psychiatric disorders. In this narrative review, evidence concerning the relationship between noise pollution and the emergence of psychiatric symptoms or psychiatric disorders is summarised. After the literature search process was completed, 40 papers were included in the present review. The exposure to road-, rail-, and air- traffic represented a risk factor for the emergence of affective disorders. This could also be mediated by the occurrence of circadian rhythms disturbances or by noise annoyance and noise sensitivity, both influencing psychological well-being and health-related quality of life. Fewer studies concentrated on special populations, particularly pregnant women and children, for whom noise pollution was confirmed as a risk factor for psychopathology. The better clarification of the complex interaction between noise pollution and mental health may help to identify subjects at risk and targeting specific prevention and intervention strategies in the urban environment.

Dysphoria Spectrum in the Evaluation of Suicide Risk: An Overview and Exploratory Study.

BACKGROUND: The aim of the present paper was to summarize the role of dysphoria in the development of suicidality. We performed an exploratory study to evaluate dysphoria dimensions in inpatients suffering from borderline personality disorder (BPD), mood disorders, and schizophrenia spectrum disorders who were evaluated due to suicidal ideation or suicide attempt. SUBJECTS AND METHODS: Subjects aged 18-70, diagnosed with BPD, mood disorders, or schizophrenia spectrum disorders according to the DSM-5 criteria who were hospitalized following suicidal ideation or suicidal attempt were recruited in the present study. Dysphoria was assessed by the Nepean Dysphoria Scale, Italian version (NDS-I), a 24-item auto-administered tool evaluating the different dimensions of dysphoria. Between-group comparisons were performed by means of the Chi-square and Mann-Whitney U test. RESULTS: In the present sample (n=30), 15 (50%) subjects were admitted following a suicide attempt and 15 (50%) presented suicidal ideation. There were no significant differences in the NDS-I scores between subjects who performed a suicide attempt and those who presented suicidal ideation, neither for the total score nor for the subscales. Subjects suffering from BPD scored significantly higher at the NDS-I than those who were diagnosed with a mood disorder or a schizophrenia spectrum disorder. The result was replicated for the NDS-I subscales, except for the one analyzing discontent. When comparing subjects suffering from mood disorders to those with a diagnosis schizophrenia spectrum disorders, the two subgroups did not differ except for the irritability subscale, where subjects with mood disorders scored significantly higher. CONCLUSIONS: The dimension of dysphoria should be evaluated when assessing subjects who display high suicide risk. Dysphoria could be reconsidered a third affective pole representing psychopathological correlate of suicidality in subjects suffering from BPD.

Comorbidities, Depression Severity, and Circadian Rhythms Disturbances as Clinical Correlates of Duration of Untreated Illness in Affective Disorders.

Background and Objectives: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. Materials and Methods: Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI (p < 0.05). Results: In our sample (n = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration (p = 0.022) and a higher rate of psychiatric (p = 0.048) and physical comorbidities (p = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression (p = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale (p = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total (p = 0.044) and social domain (p = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: p = 0.029, 18b: p = 0.047). Conclusions: A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.

Psychiatric Comorbidity in Bariatric Surgery: A Retrospective Study in a General Hospital.

BACKGROUND: Candidates for bariatric surgery undergo a multidisciplinary evaluation in the pre-operative phase, including a psychiatric visit aimed at the screening for psychiatric comorbidities, including feeding and eating disorders (FEDs), which are shortcomings to the intervention or predictors of worse prognosis. The presence of FEDs, such as Binge Eating Disorder (BED) and Bulimia Nervosa (BN), is associated with higher rates of other psychiatric disorders. Furthermore, there is evidence of the association between obesity and Depressive Disorders, as well as B and C Cluster Personality Disorders. The aim of this study was to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery. SUBJECTS AND METHODS: Subjects were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia after being referred by surgeons. Psychiatric comorbidities were investigated by means of the Structured Clinical Interview for DSM-5 Disorders. Subjects underwent specific assessment with scales for the evaluation of FEDs, namely Binge Eating Scale, Obesity Questionnaire, Bulimia Test-Revised and Body Shape Questionnaire. RESULTS: The sample consisted of 101 subjects: 43 (42.6%) were diagnosed with at least one psychiatric disorder, including FEDs. In particular, 30 subjects (29.7%) presented at least one FED, among which the most frequent were FED not otherwise specified (24.1%) and BED (6.8%). Moreover, 26 subjects (25.7%) were diagnosed with at least one psychiatric disorder other than FEDs, such as Personality Disorders (17.1%), with a higher prevalence of B and C Cluster Disorders. Depressive Disorders were detected in 5% of the sample. CONCLUSIONS: Subjects undergoing bariatric surgery often display psychiatric comorbidities, more frequently one or more FEDs. The systematic screening of these conditions should be implemented in the clinical practice in order to provide early intervention strategies and adequate monitoring.

Suicidality and COVID-19: Data from an Emergency Setting in Italy.

BACKGROUND: Suicidality is a widespread phenomenon with a dramatic burden worldwide. The Coronavirus disease 2019 (Covid-19) pandemic determined a relevant impact on mental health, due to the infection itself and its socio-economic consequences. The present study is aimed at analyzing the prevalence of suicidality during the Covid-19 pandemic among subjects requiring a psychiatric consultation in an emergency setting. SUBJECTS AND METHODS: Socio-demographic and clinical information was collected at the emergency department of the General Hospital of Perugia from June 1st, 2020 to January 31st, 2021. Data was entered into an electronic datasheet and retrospectively analysed. Pearson's bivariate correlation was performed in order to assess significant associations between suicide-related variables and specific socio-demographic and clinical features (p<0.05). RESULTS: Among 447 subjects included in the analysis, 109 (24.4%) showed suicidality-related phenomena, particularly suicide attempts (SA) (n=44, 9.8%), suicidal ideation (SI) (n=41, 9.2%), non suicidal self-injury (NSSI) (n=31, 6.9%), that in some cases co-occurred. A statistically significant association was detected between NSSI and living with marital family (p=0.024) and between suicidality-related phenomena and adjustment disorders (p=0.018). None of the examined subjects reported a previous positivity for Covid-19 and neither did their relatives. CONCLUSIONS: The present study confirms the impact of the Covid-19 pandemic on suicide-related phenomena. Consultation psychiatry fulfills a key role in the early detection and clinical management of these conditions, that require targeted intervention strategies.

Neurotropism and Neuropsychiatric Symptomsi in Patients with COVID-19.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2). Beyond the most common clinical features of COVID-19, mainly represented by respiratory symptoms, other systems may be interested by the infection. Among these, through a neurotropic pathway, the central nervous system (CNS) may be affected by the virus, leading to developing neuropsychiatric symptoms. Particularly, this study focuses on neurological symptoms determined by the Sars-CoV-2 infection, as well as on the underlying pathogenetic processes. METHODS: For the present review, we followed a narrative approach. A literature search was carried out concerning the neurological consequences of COVID-19. Papers were screened, focusing on the clinical manifestations interesting the CNS and on their possible role in the early diagnosis of the disease. RESULTS: We display the most significant neurological clinical manifestations of COVID-19. Common neurological manifestations (ageusia, anosmia, and encephalitis) are first described. Subsequently, we provide a focus on delirium and its possible pathogenetic and clinical correlates. Delirium is not only a possible resultant of the COVID-19 neurotropism, but it may also be precipitated by a number of environmental factors that assume further relevance during the pandemic. CONCLUSIONS: Neuropsychiatric symptoms, and particularly delirium, can help identifying the infection at an early stage. Tailored treatments should be identified in order to prevent complications.

Does Post-Traumatic Spectrum Comorbidity Influence Symptom Severity in Bipolar Disorders? A Cross-Sectional Study in a Real-World Setting.

BACKGROUND: The present cross-sectional study investigates the relationship between post-traumatic spectrum comorbidity and the severity of symptoms in subjects diagnosed with Bipolar Disorders (BD). SUBJECTS AND METHODS: In- and outpatients diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were consecutively recruited. Sociodemographic and clinical data were collected. Psychopathology was evaluated by means of the Hamilton Rating Scale for Depression (HAM-D), the Young Mania Rating Scale (YMRS), and the Positive and Negative Syndrome Scale (PANSS). Sociodemographic, clinical and psychopathological characteristics of BD subjects with and without sub-threshold PTSD were compared by means of bivariate analyses (p<0.05). RESULTS: BD subjects with post-traumatic spectrum comorbidity (n=24.49%) presented a significantly higher number of hospitalizations when compared to those who did not present the co-occurrence of the two conditions (2.67±2.3 versus 1.65±2.32, p=0.039). As for treatment features, subjects with subthreshold PTSD were more frequently prescribed benzodiazepines at the moment of evaluation or in the past (n=18, 100% versus n=22.55%, p=0.032). When assessing differences in terms of psychopathological characteristics, subjects with subthreshold PTSD showed higher HAM-D total score (16.22±9.06 versus 10.22±7.23, p=0.032) and higher PANSS negative symptom scale score (16.06±6.92 versus 11.41±4.68, p=0.017). CONCLUSIONS: Findings from the present study suggest that subthreshold PTSD may underpin higher symptom severity and worse outcomes when occurring as a comorbid condition in BD.

Antepartum Distress during COVID-19 Pandemic: an Observational Study.

BACKGROUND: The present study investigates the impact of the Coronavirus diseases 2019 (Covid-19) pandemic on the subjective experience of pregnant women, as well as the impact of the pandemic on this population in terms of psychopathological correlates. SUBJECTS AND METHODS: Pregnant women referring to the Section of Obstetrics and Gynecology of the General Hospital of Perugia, Italy, were recruited from 1st May, 2021 to 15th June, 2021. Socio-demographic and clinical data was collected, as well as information regarding the Covid-19 pandemic impact on the subjective experience of pregnancy. Psychopathology was evaluated by means of the State-Trait Anxiety Inventory Form Y (STAI-Y), the Symptom Checklist-90 (SCL-90) and the Prenatal Distress Measure (Pre-DM). Descriptive analyses were performed. Significant associations between distress symptoms and the collected sociodemographic and clinical variables were assessed by using the Pearson correlation (p<0.05). RESULTS: 25 women were included in the study. Among these, 18 (72%) reported that the Covid-19 pandemic negatively impacted their experience of pregnancy. Were detected an average Pre-DM total score of 7.28±4.33 and an average state anxiety scale value of 35.56±9.21 and an average trait anxiety scale value of 34.04±7.44 at the STAI-Y. A global severity index > 1 at SCL-90 was detected in 8.3% of the sample. CONCLUSIONS: The identification of antepartum distress and the early treatment of perinatal psychopathology represent a priority during the Covid-19 pandemic era.

Single-sided NMR: a non-invasive diagnostic tool for monitoring swelling effects in paint films subjected to solvent cleaning.

During solvent cleaning of a painted surface, the control of solvent diffusion into the painting matrix is a primary concern for conservators. In this work, a comparative systematic study of solvent ingress and of the ensuing swelling phenomenon in paint films due to cleaning treatments was tackled using single-sided NMR. Specifically, the effects of a TAC aqueous solution (triammonium citrate in deionized water) applied in both free and gelled forms (by Klucel® G) on acrylic emulsion and vinyl-based model paints were evaluated. Notably, the NMR measurements (proton spin density depth profiles and transverse relaxation decays) collected before, during, and after these wet-cleaning tests proved that the use of the aqueous gel did not significantly minimize the penetration and the swelling action of water compared with the free solution. Furthermore, swelling effects associated with the use of an organic solvent (ligroin) were evaluated by NMR profilometry on varnished oil and egg-tempera paints. In this case, by comparing the depth profiles collected before and after the solvent treatments, a moderate paint swelling was observed followed by a width reduction of the paint films ascribable to the removed varnish layer.Overall, the reported NMR results reveal the analytical potentialities of the technique for a non-invasive assessment of the swelling effect of paint films subjected to cleaning (by water or an organic solvent), thereby providing an analytical method in support to the conservators' practice.

'Come share my world' of 'madness': a systematic review of clinical, diagnostic and therapeutic aspects of folie à deux.

Folie à deux, also known as shared psychotic disorder, shows intrinsic differences when compared to other psychiatric disorders. Literature about this condition is scanty and findings about its clinical correlates are not univocal. The present systematic review aimed at critically summarizing the existing evidence about folie à deux, also focussing on psychopathological, diagnostic and treatment features. The electronic databases PUBMED, Web of Science and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles reporting original data about socio-demographic, aetiological, clinical, diagnostic and treatment features of folie à deux, providing information about both primaries and secondaries, were included. Risk of bias was evaluated using the Critical Appraisal Skills Programme (CASP) instruments. The initial search yielded 834 records. After the screening process only 9 papers were deemed eligible for inclusion in the review. Folie à deux emerged to be a heterogeneous condition with a complex etiopathogenesis. The clinical presentation of the disorder included a multi-facet aspect, going beyond the classical description mainly focussed on delusions and possibly explaining conflicting outcomes of different treatments. Diagnostic categories appear to be often reductive and the need for a dimensional approach capable of global reliability emerged.

Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review.

Background and objectives: A deeper comprehension of the role that environmental risk factors play in the development of adolescent Bipolar Disorder (BD), as well as in the evolution of high-risk states for BD, may entangle further prevention and treatment advances. The present systematic review is aimed at critically summarizing evidence about the role that environmental risk factors play in the development of BD in adolescence and their interaction with BD high-risk states. Materials and Methods: MEDLINE/Pubmed, Scopus and Web of Science datasets were systematically searched until 4 September 2020. Original studies that reported information about the role of environmental risk factors in the development of BD during adolescence, or assessing their influence on the development of psychopathology in high-risk states for BD, were considered for inclusion. Two blind researchers performed title/abstract, full-text screening, and hand-screening of relevant references. The risk of bias was assessed by means of the Newcastle-Ottawa Scale. Results: Fourteen studies were included in the review. Negative stressful life events, particularly sexual and physical abuse, but also emotional mistreatment, were associated with more severe psychopathology in adolescents with BD, as well as with higher risk for developing mood disorders in BD offspring. Similar findings were detected for familial environment-related features, such as parental rejection and low perceived care, while no univocal results were found when analyzing familial functioning. Conclusions: The present systematic review confirmed the relevant role that environmental risk factors, particularly negative stressful live events and family-related features, play in the development of BD psychopathology during adolescence. Future studies are expected to clarify possible further environmental factors that may be implicated in the development of BD during youth that may serve as target of prevention and early treatment strategies.