First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services.

BACKGROUND: It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. METHODS/DESIGN: The "Italian study on first-episode psychosis and migration (PEP-Ita)" is a prospective observational study over a two-year period (1 January 2012-31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose ("core") of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. DISCUSSION: The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy.

Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.

Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.

[Cognitive deficits in depressive illness: how many and which instruments to identify them?]. / Deficit cognitivi nella malattia depressiva: quanti e quali strumenti per identificarli?

INTRODUCTION: Major depressive disorder is a disabling illness that involves affect and cognition of a person, negatively influencing social and work functioning. Cognitive deficits are often present in depression, although they are often believed to be secondary to typical depressive symptoms. AIM: A detailed literature review has been carried out to assess the cognitive deficits identified in people with major depressive disorder and identify specific assessment tools used for their evaluation. METHODS: Using key-words, we selected papers published on Embase and PubMed/Medline, with a particular reference to those published in the last five years. RESULTS: The literature review confirmed that cognitive deficits are one of the most important causes of social disfunctioning in patients with major depressive disorder. Cognitive deficits can be observed already in the first depressive episode. Assessment tools for cognitive deficits are scarcely used in clinical practice. CONCLUSION: There is a need to identify cognitive deficits in people with major depressive disorder and their relation with social and work functioning, quality of life and risk of relapse as well as to assess the effects of therapeutic intervention on cognitive performance. To achieve this purpose, it is important to use appropriate and sensitive tools for the assessment of cognitive deficits.