Emotional Dysregulation, Temperament and Lifetime Suicidal Ideation among Youths with Mood Disorders.

Background: Psychopathological dimensions contributing to suicidal ideation in young age are poorly understood. We aimed to investigate the involvement of emotional dysregulation and temperament in suicide risk in a sample of accurately selected young patients with mood disorders and a matched sample of healthy controls (HC). Methods: We assessed 50 young patients (aged 14-25 years) with DSM-5 bipolar or depressive disorders for clinical and psychopathological characteristics and 82 age and sex, educational level, and smoking habits-matched HC. Emotional dysregulation and temperament were assessed using the Difficulties in Emotion Regulation Scale (DERS) and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A-39), respectively. We tested their associations with suicidal ideation, using standard univariate/bivariate methods, preceded by overall multivariate analysis. Results: In the group of patients, 24 (48%) reported lifetime suicide ideation (LSI). Patients with LSI scored higher on emotional dysregulation (p < 0.001) and cyclothymic (p < 0.001), irritable (p = 0.01), and hyperthymic temperaments (p = 0.003) than HC. Patients with LSI specifically presented with more emotional dysregulation (p < 0.001) and cyclothymic temperament (p = 0.001), than patients without LSI (N = 26). Conclusions: Temperamental features, in particular cyclothymic temperament, and emotion dysregulation may represent independent factors for increased vulnerability to lifetime suicidal ideation in young adults with mood disorders.

[Timing and effectiveness of Brenner's IPT cognitive training in early psychosis. A pilot study]. / Valutazione di efficacia del training cognitivo IPT di Brenner nell'esordio psicotico. Uno studio pilota.

AIM: The present study evaluates the outcome of cognitive training as part of Brenner's Integrated Psychological Therapy (IPT) in two groups of individuals with a schizophrenic spectrum disorder (F20-F24 ICD-10). 28 participants were divided into either an experimental group or a control group. The experimental group was composed of 13 individuals (46%) with a mean age of 21.2 years and a mean duration of illness (since their first episode of psychosis FEP) of 15.6 months. The control group included 15 individuals (54%) with a mean age of 25.6 years and a mean duration of illness of 74.4 months (beyond the critical period). METHOD: Participants underwent an assessment of cognitive functioning which focused on attention, memory, executive functioning and cognitive flexibility as measured by the WCST (Wisconsin Card Sorting Test). Each individual was tested pre- and 6-month post-intervention. The original IPT method was altered by reducing the frequency of sessions to once a week and by limiting our sessions to 2-3 individuals per group. RESULTS: Cognitive flexibility (p<0.01) and long-term memory (p<0.01) improved only in the experimental group. These former skills worsened in the control group (p<0.01). Selective attention, short-term memory and verbal fluency improved in both groups (from p<0.05 to p<0.01). DISCUSSION AND CONCLUSIONS: IPT cognitive training, when delivered in the early stages of psychosis (within 18 months from FEP), seems to be particularly effective in improving cognitive flexibility and long-term memory. We did not see improvements in those who had a longer duration of illness who also underwent the same treatment. Cognitive flexibility is linked to clinical insight and social cognition. Therefore, improving this function may lead to a better outcome for patients.

[Shadows and errors of a law: the opinion of clinicians]. / Ombre ed errori di una legge: il parere dei clinici.

A new Italian law (81/14) recently established dismission of all Psychiatric Forensic Hospitals and the transferring of old and new "forensic" patients to the local Mental Health Department, at time in many instances in the same common settings of acute psychiatric services, community and territorial psychiatry mixed with "common" psychiatric patients. The preoccupation is high for communality of psychopaths, insane criminal patients and drug-dependent violent patients together with young first-episode schizophrenic patients, anorexic girls, older depressive patients, and so on. This change already introduced several problems with strong preoccupation among operators, other patients and public opinion as concerns both treatment efficiency and safety of the cure.

Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies.

AIM: In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. METHODS: The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). RESULTS: Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. CONCLUSIONS: Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.

[Integrated day-hospital treatment in subjects with overeating disorders]. / Il trattamento integrato in day-hospital per i disturbi del comportamento alimentare caratterizzati da iperalimentazione.

BACKGROUND: The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). METHODS: The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. RESULTS: Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). CONCLUSIONS: The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Assessment of the capacity to express informed consent for organ donation in patients with schizophrenia.

In Italy, the "silent-consent" principle of donor's willingness regulates organ donation for postmortem transplantation, but civil incompetence excludes it. We investigated decisional capacity for organ donation for transplantation of 30 controls and 30 nonincompetent patients with schizophrenia as related to clinical symptoms, cognition, and functioning. Assessments were carried out through the Competence for Donation Assessment Scale (CDAS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, Life Skills Profile (LSP), Raven's Colored Progressive Matrices (RCPM), Wisconsin Card Sorting Test, Rey RI, Rey RD, and Visual Search. Patients and controls differed on the CDAS Understanding and Choice Expression areas. Patients showed significant inverse bivariate correlations between CDAS Understanding and scores on total BPRS, LSP self-care scale, and RCPM cognitive test. Our results show that decisional capacity for participating in research does not predict decisional capacity for postmortem organ donation in patients with schizophrenic or schizoaffective psychosis; hence, before judging consent for donation, patients must be provided with enhanced information to better understand this delicate issue.

[A trial to measure the effectiveness of an intervention in the assessment and rehabilitation of cognitive functions in psychotic individuals]. / Studio di efficacia nella pratica di un intervento di valutazione e riabilitazione delle funzioni cognitive in soggetti psicotici.

AIMS: The present study aims to evaluate the outcome of two different approach in rehabilitation: IPT Cognitive Training (Brenner's) administered in conjunction with Treatment As Usual (TAU) versus TAU as a sole intervention, on cognitive functions such as attention, memory, and executive functioning in a sample of participants with a diagnosis of a Schizophrenia Spectrum Disorder. Levels of problem-solving have been highlighted in participants not only in relation to the method used but also to the age, between 17-30 years with 1-3 years of mental illness and participants who are 30+ years with over 9 years of mental illness. METHOD: 77 participants completed the study and were matched according to diagnosis and severity of illness. 37 subjects (48%) received TAU and 40 subjects (52%) received IPT Cognitive Training+TAU. Each group have participants aged between 17-30 years with 1-3 years of mental illness and 30+ years with over 9 years of mental illness. A Neuropsychological Protocol particularly made allow assessments and was administered pre-intervention and 24 months post-intervention. RESULTS AND CONCLUSIONS: Participants who received Cognitive Training IPT+TAU showed statistically significant improvements in Selective Attention (p < 0.05) instead of the others with only TAU. By both method significant improvements were also found in all considered outcome variables (p = 0.04-0.001) on working memory, short and long-term memory, semantic memory and logical-deductive ability. Neither rehabilitation treatment produced any improvement in problem solving once compromised. Logical-Deductive Ability showed improvements only in patients aged between 17-30 years with 1-3 years of mental illness in comparison with participants aged over 30 years with 9 or more years of illness.

Cognitive function, social functioning and quality of life in first-episode psychosis: A 1-year longitudinal study.

Abstract Objective. The majority of patients with schizophrenia have cognitive deficits early in the disease. We evaluated the relationship between cognitive function, social functioning and quality of life in patients with first-episode psychosis. Methods. This was a longitudinal study in 15 patients aged 18-30 years who had recently experienced a first psychotic episode and were treated with the atypical antipsychotic aripiprazole, cognitive-behavioural therapy, psycho-educational sessions, family supportive sessions and social interventions. Patients were evaluated at baseline and after 1 year. Cognitive assessment included attention, memory, language skills and problem solving. Social functioning, quality of life, and psychopathological evaluation were performed with validated tools. Results. At baseline, patients had a severe impairment of social functioning and a low quality of life, while a specific pattern of cognitive functions was not identified. After 1-year, we observed a significant improvement in social functioning and quality of life, without a significant decrease in cognitive function. Conclusion. Contrary to previous findings, we found that social functioning and quality of life are related, but independent of cognitive impairment. The use of antipsychotic agents that do not interefere with cognitive function plus psychological assistance is a valuable treatment approach in patients with first-episode schizophrenia.

A new self-report questionnaire called "ABC" to evaluate in a clinical practice the aid perceived from services by relatives, needs and family burden of severe mental illness.

OBJECTIVE: To describe: a) a self-report questionnaire of 34 item, developed by a Family Association of Psychiatric Patients in collaboration with two psychiatrists to evaluate by key-relative in a clinical practice the perceived quality of mental health services, the needs and family burden; b) the methodology of validation. METHODS: It has been studied (a) the Face Validity by two focus groups of 10 relatives for each group, (b) the concurrent validity of family burden items comparing the ABC with QPF, a widely used questionnaire, in 6 Italian mental health centres on a sample of key-relatives, (c) the discriminant validity comparing three different samples of key-relatives of patients with psychiatric illness, Alzheimer or cancer. The internal consistency of items for assessing relatives' opinions on the quality of care has been evaluated by Chronbach' s alpha. The test-retest has been evaluated on a sample of 20 key-relatives. RESULTS: The results indicate a fairly good performance of the questionnaire in this preliminary but almost complete phase of validation. The time to fill in it has been estimated in a 7 minutes average. CONCLUSION: It is possible by this self-report questionnaire to evaluate in a clinical routine setting and in a very short time three important problems for relatives and professionals: opinions and needs of relatives, and objective and subjective family burden of severe mental illness.

Job satisfaction among mental health professionals in Rome, Italy.

Although various surveys on job satisfaction have been performed in mental health care settings, no studies have investigated in-depth the level of satisfaction with the various aspects of work in Italian mental health services. In the present study, all clinical mental health staff working in a large psychiatric catchment area in Rome were invited to anonymously complete a previously validated questionnaire designed to measure job satisfaction among mental health professionals. Of the total 236 health professionals, 196 (83%) agreed to participate. Most participants were not completely satisfied with many aspects of their job, and many were not even moderately satisfied. The level of satisfaction increased with age, and it was significantly lower among hospital-ward staff compared to the staff of outpatient clinics or residential facilities, even after adjusting for age, gender, profession, work setting, and time in current job, using a multiple logistic regression model. Our findings suggest that interventions aimed at increasing job satisfaction among Italian mental health professionals might be warranted, particularly among hospital-ward staff.

Patients' and relatives' satisfaction with psychiatric services in a large catchment area in Rome.

OBJECTIVE: To assess the satisfaction of patients and their relatives with psychiatric care and to identify variables associated with any dissatisfaction. METHODS: The study was performed in a defined psychiatric catchment area in south Rome, Italy. All eligible patients and relatives who had contacts with services during a predefined period were asked to participate. Satisfaction with psychiatric services was measured with a previously validated questionnaire. RESULTS: A total of 890 patients were asked to participate in the study and 855 (96%) accepted. Also, 270 relatives were asked to participate and 265 (98%) agreed. The satisfaction with services expressed by outpatients and their relatives was fairly good, with the exception of poor satisfaction with information about treatment and involvement in the treatment programme. The satisfaction of inpatients and their relatives was significantly lower, with the issue of information-giving by staff appearing particularly critical. Among patients, variables associated with dissatisfaction were being an inpatient, having a diagnosis of psychosis, being in contact with services for more than 6 years, and being single. Among relatives, being female and being the relative of an inpatient were associated with dissatisfaction. For both patients and relatives, receiving inpatient care was the strongest predictor of dissatisfaction. CONCLUSIONS: The results suggest that inpatient care, especially for psychotic patients, needs to be improved and that special attention should be devoted to inform adequately and to engage in treatment both patients and their relatives. Lack of information appears to be a crucial determinant of dissatisfaction with psychiatric care among both patients and their relatives.