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.

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.

The complex relationship between gut microbiota dysregulation and mood disorders: A narrative review.

Gut microbiota regulates neurotransmission, neurogenesis, neuroinflammation, and neuroendocrine signaling. The aim of the present review is to analyze the literature concerning gut microbiota dysregulation and mood symptoms, with the specific hypothesis that such alterations play a role in the onset of mood disorders. Here, in fact, we review recent research focusing on how gut microbiota dysregulation influences the onset of mood disorders and on possible pathophysiological mechanisms involved in this interaction. We pay specific attention to the relationship between gut microbiota dysregulation and inflammatory state, Th17 differentiation, neuroactive factors, and TRP metabolism. The association between gut microbiota dysregulation and mood disorders is critically analyzed under a clinical point of view, also focusing on the emergence of mood symptoms in the context of medical conditions. These latter correlations may enable an interdisciplinary perspective in the clinical approach to such symptoms, as well as new treatment strategies, such as nutritional interventions, psychobiotics, antibiotics, as well as fecal microbiota transplantation.

COVID-19 and Youth Psychopathological Distress in Umbria, Central Italy: A 2-Year Observational Study in a Real-World Setting.

Introduction: Adolescents and young adults represent a vulnerable population in the context of the Coronavirus disease 2019 (COVID-19) pandemic. The present retrospective study aims to investigate the pandemic's psychological impact on adolescents and young adults by analyzing data from an outpatient mental health service dedicated to youths in Umbria, central Italy. Materials and Methods: The clinical charts of subjects aged 14-24 who first accessed the service in the timeframe between March 1st, 2019, and February 28th, 2021, were reviewed. Subjects were divided into two subgroups according to the period of time when they accessed the service (pre-COVID-19 vs. during- COVID-19 outbreak). Bivariate analyses were performed using the Chi-square test and the Welch's t-test. A secondary analysis was performed considering only subjects suffering from psychiatric disorders. Furthermore, data concerning individuals who were already followed by the service before the pandemic were analyzed by the McNemar's test and the t-paired test to assess changes in treatment features. Results: The number of new accesses during the pandemic period remained stable. After the emergency onset, youths accessing the service showed a higher prevalence of anxiety disorders (p = 0.022). During the COVID-19 period, services were more frequently delivered by using a digital mental health approach (p = 0.001). Psychopharmacological treatment was more frequently prescribed among subjects that were referred to the service after the pandemic onset (p = 0.033). As for substance use, a highly significant reduction in opioid use was observed (p = 0.003). Family therapy was delivered less frequently in the during-COVID-19 subgroup, especially in the subpopulation of subjects suffering from psychiatric disorders (p = 0.013). When considering subjects referred to the service in the pre-COVID-19 period, the number of interventions provided to this population increased after the pandemic outbreak (p = 0.038). Conclusion: In the context of the COVID-19-related public health crisis, youths represent an at-risk population for which pathways to care should be reinforced, and targeted interventions, including psychosocial treatments, should be implemented.