Lessons Learnt From Running a Transition-Age Youth Mental Health Outpatient Clinic in Italy: The PRecocity of Intervention in Adolescent Medicine (PRIMA) Experience.

AIM: This study assessed whether transition age between adolescence and young adulthood poses a challenge for both patients and mental health services. METHODS: We retrospectively examined the baseline characteristics, diagnoses and treatments of 99 individuals aged 16-35 presenting to the PRecocity of Intervention in Adolescent Medicine (PRIMA) transition-age mental health outpatient clinic, Italy, over a 24-month period. RESULTS AND DISCUSSION: Most patients were female, aged 20 or younger, employed and did not experience impairment in daily autonomies. About half patients were referred by general practitioners or self-referred, often as initial contact with any adult mental health services, complaining with multiple symptoms (88%), mainly including anxiety, affective disturbances and insomnia. Most of them received a single diagnosis (68%), one out of three being diagnosed with a neurodevelopmental disorder. Patients presenting with anxiety (63% vs. 32%; OR = 3.55, p = 0.01) and affective symptoms (56% vs .23%; OR = 4.26, p = 0.01) and receiving multiple diagnoses (30% vs. 9%; χ2(2) = 19.7, p < 0.01) were more likely to be prescribed with psychopharmacological medication at the first visit. At a 6-month follow-up, one in two patients remained in PRIMA, while the others required different services tailored to their specific conditions, especially neurodevelopmental disorders. CONCLUSION: Findings from this study warrant the need for specialised mental healthcare facilities ensuring timely and high-quality interventions for adolescents transitioning into young adulthood.

Exploring the effects of family and life events on genetic and environmental architecture of schizotypal and hypomanic dimensions: Insights from a twin study.

BACKGROUND: Strategies of prevention for psychiatric disorders need a deep understanding of the aetiological factors involved in the psychopathological processes. Our twin study aims at disentangling the contributions of genes and environment to schizotypal and hypomanic dimensions, considering the role of stressful life events (LEs) and the quality of family relationships. METHODS: The Magical Ideation Scale (MIS) and Perceptual Aberration Scale (PAS) were used to assess positive schizotypy, while Hypomanic Personality Scale (HPS) and its sub-scales were used to investigate proneness to affective disorders. 268 twins (54.5 % female; aged 18.0 ± 6.68) were included. Participants filled out a questionnaire on LEs and their parents provided an evaluation of intra-family relationship (Relationship Quality Index, RQI). Classic univariate twin models for quantitative traits were fitted for scales, and the effects of covariates (LEs and RQI) were assessed. RESULTS: For MIS, HPS and its sub-scales, significant common and unique environmental effects were detected, with genetic factors affecting only HPS Social Vitality sub-scale. Unique environment was the only source of variance of PAS score. The number of recent LEs influenced MIS and PAS models, while RQI score affected MIS model. LIMITATIONS: The main limitation of the study is the small sample size, which reduces statistical power and may potentially lead to an underestimation of heritability. Additionally, the cross-sectional design limits the possibility to draw causal considerations. CONCLUSIONS: Findings provide preliminary evidence for a significant environmental role in modulating states of vulnerability. Moreover, the expression of positive schizotypy resulted influenced by recent stressors and intra-family relationships.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy.

Introduction: Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy. Methods: This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures. Results: In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures. Discussion: Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.

Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9-year chart review study.

Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre-existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty-nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9-year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)-10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between-group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = -1.962; χ2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis-inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.

Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management.

Background: Mentalization is the ability to use internal mental states to manage and understand one's own and others' behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. Methods: Using the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., 'hypo-mentalization' or 'uncertainty': concrete thinking with poor attribution of mental states; 'hyper-mentalization' or 'certainty': rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). Results: Thirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients' mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. Conclusions: OA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.

Changes in Revolving-Door Mental Health Hospitalizations during the COVID-19 Pandemic: A 5-Year Chart Review Study.

This study assessed changes in revolving-door (RD) mental health hospitalizations during the COVID-19 pandemic. A 5-year retrospective hospital chart review was performed, collecting revolving-door hospitalization, sociodemographic, and clinical data. Out of 1036 patients, 5.69% had RD hospitalizations, which accounted for 10.38% of all recorded hospitalizations. Further, a higher number of RD hospitalizations occurred following the pandemic outbreak, which is unlikely to have been a result of the confounding effect of trimester and month of hospitalization. Finally, several sociodemographic and clinical characteristics recurred more frequently in the context of RD hospitalizations, such as being younger, being compulsorily admitted, being an absconding patient, and being referred by a public service. Certain diagnostic categories occurred more frequently among RD hospitalizations, including psychotic, personality, and substance use disorders, as well as intellectual disability. Patients with specific characteristics are more likely to incur in RD hospitalizations, requiring the implementation of supportive treatment plans, especially following the pandemic outbreak.

Prevalence and Risk Factors for Absconding from an Open-Door, No-Restraint Inpatient Psychiatric Unit: A Single-Center Study in Italy.

Absconding from inpatient psychiatric services has been associated with poor outcomes, putting the patient and community at risk and prolonging the recovery process. A retrospective study investigated the absconding rates and risk factors among patients admitted to an open-door, no-restraint inpatient psychiatric unit. Overall, the absconding rate was 4.5%, and the relative risk of absconding was higher for male, younger, and non-Caucasian patients as well as for those who had already absconded, were unknown to health services, compulsorily admitted, admitted for substance abuse, and in the first days of hospitalization. The findings of this study may have important public health implications.

Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset.

OBJECTIVE: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. METHODS: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. RESULTS: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. CONCLUSIONS: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Language production impairments in patients with a first episode of psychosis.

Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations.

Efficacy of a Group Psychoeducation Treatment in Binge Eating Disorder: An Open-Label Study.

Aims: To evaluate the effectiveness of a multidisciplinary group psychoeducation treatment (GPT) in patients with Binge Eating Disorder (BED). Methods: We designed an open-label efficacy study that included a population of 45 patients diagnosed with BED. A measure of eating attitudes and associated psychological constructs was obtained through the use of the self-report instruments Eating Disorder Inventory (EDI-3), Binge Eating Scale (BES) and Body Uneasiness Test (BUT). The Symptom Checklist-90 (SCL-90) was also administered to assess general psychopathology. All participants participated in 12 weekly group psychoeducational treatment meetings, 8 of which were conducted by mental health professionals, and a second module of 4 meetings, oriented on health and nutrition education topics, conducted by a dietician. Results: At the end of treatment, patients showed significant improvements in body mass index (BMI) and binge eating. Paired t-tests showed significant differences at p-value < 0.05 in all eating disorder risk scales and for most of the general psychological scales related to eating disorders. In addition, patients experienced an improvement in their perception of overall body image, a decrease in concerns about physical appearance and less body image avoidance. Finally, results showed that psychoeducation treatment was associated with significant improvements in interpersonal sensitivity. Conclusions: The results of this study may indicate that significant short-term improvements can be achieved through a psychoeducation group for BED patients. Although limited by the lack of a control condition, this study adds to a growing body of evidence with promising results, setting the stage for further case-control studies of BED treatment.

Brain Anatomical Mediators of GRIN2B Gene Association with Attention/Hyperactivity Problems: An Integrated Genetic-Neuroimaging Study.

This study aims to investigate the genetic and neural determinants of attention and hyperactivity problems. Using a proof-of-concept imaging genetics mediation design, we explore the relationship between the glutamatergic GRIN2B gene variants and inattention/hyperactivity with neuroanatomical measures as intermediates. Fifty-eight children and adolescents were evaluated for behavioral problems at three time points over approximately 7 years. The final assessment included blood drawing for genetic analyses and 3T magnetic resonance imaging. Attention/hyperactivity problems based on the Child Behavior Checklist/6-18, six GRIN2B polymorphisms and regional cortical thickness, and surface area and volume were estimated. Using general linear model (GLM) and mediation analyses, we tested whether GRIN2B exerted an influence on stable inattention/hyperactivity over development, and to what extent this effect was mediated by brain morphology. GLM results enlightened the relation between GRIN2B rs5796555-/A, volume in the left cingulate isthmus and inferior parietal cortices and inattention/hyperactivity. The mediation results showed that rs5796555-/A effect on inattention/hyperactivity was partially mediated by volume in the left isthmus of the cingulate cortex, suggesting a key role of this region in translating glutamatergic GRIN2B variations to attention/hyperactivity problems. This evidence can have important implications in the management of neurodevelopmental and psychiatric disorders.

Prenatal Stress and Psychiatric Symptoms During Early Phases of the COVID-19 Pandemic in Italy.

PURPOSE: In February 2020, Italy became the first European country to face the coronavirus disease 2019 (COVID-19) outbreak. The concerns of infection, financial worries, loss of freedom, and isolation during the ongoing pandemic can lead to negative psychological effects, including anxiety, depression, and obsessive-compulsive disorder. The main aim of our study was to evaluate the relationship between pandemic-related stress and pregnancy-specific stress and assess their role in the development of psychiatric symptoms. We predicted that pregnancy-specific stress would mediate an association of pandemic-related stress with psychiatric symptoms. PATIENTS AND METHODS: A total of 258 pregnant women were assessed for general emotional symptoms with the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and an Obsessive-Compulsive Disorder screening (OCD). The Revised Prenatal Distress Questionnaire (NuPDQ) and the Pandemic-Related Pregnancy Stress Scale (PREPS) were administered as measures of pregnancy-specific stress (PSS and pandemic-related, respectively). Mediation effects by NuPDQ for PREPS stress scales on psychiatric outcomes were calculated, using regression series and correcting for general covariates. RESULTS: Almost a third of the sample reported clinically relevant anxiety levels (32.6%), 11.2% were positive for OCD screening and less than 5% were positive for depression screening. The stress related to feeling unprepared for delivery and postpartum (PREPS-PS) predicted PHQ-2 score, both directly and indirectly via PSS, and it predicted GAD-7 score only indirectly. The stress related to fear of infection (PREPS-PIS) was directly associated to GAD-7 score and - through PSS - to PHQ-2 score and OCD. CONCLUSION: The pandemic onset contributed to poor mental health, especially anxiety, in a substantial portion of Italian pregnant women. Our results emphasize the importance of strategies to reduce pregnancy-specific stress, as well as to diminish stress due to the pandemic. Identifying risk factors for psychological suffering is important to prevent potential long-term consequences for mothers and their offspring.

Psychometric properties of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and its correlation with anxiety and depression.

BACKGROUND: In the beginning of 2020, Italy was the first European country to face the COVID-19 outbreak. Restrictions imposed during the pandemic, social isolation, and the cancellation of medical appointments likely resulted in stress that may have affected pregnant women adversely. AIMS: To determine the psychometric validity of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) in assessing COVID-19-related stress in pregnant women and to examine correlations between PREPS scales and symptoms of anxiety and depression. METHODS: 232 pregnant women attending the Obstetric-Gynecologic Clinic of an Academic Hospital were assessed with the PREPS, the Revised Prenatal Distress Questionnaire (NuPDQ), the General Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-2 (PHQ-2). We analyzed the internal consistency and factor structure of the PREPS. Convergent validity was examined by comparison with the NuPDQ. PHQ-2 and GAD-7 were used to measure the association with depression and anxiety. RESULTS: Acceptable-to-good internal consistency was found for the three PREPS scales: Preparedness Stress (PS, α=0.760), Prenatal Infection Stress (PIS, α=0.857), and Positive Appraisal (PA, α=0.747). Correlations of the NuPDQ with both PREPS stress scale scores (PS and PIS) were statistically significant, but on multiple regression analysis only the PS scale was correlated with the NuPDQ. Prenatal infection stress predicted GAD-7 score, while Preparedness stress predicted PHQ-2 score. LIMITATIONS: The main limitations were the small sample size and the cross-sectional design of the study. CONCLUSION: The Italian PREPS exhibited good psychometric properties and associations with clinical symptoms of anxiety and depression.

Cognitive subtypes in recent onset psychosis: distinct neurobiological fingerprints?

In schizophrenia, neurocognitive subtypes can be distinguished based on cognitive performance and they are associated with neuroanatomical alterations. We investigated the existence of cognitive subtypes in shortly medicated recent onset psychosis patients, their underlying gray matter volume patterns and clinical characteristics. We used a K-means algorithm to cluster 108 psychosis patients from the multi-site EU PRONIA (Prognostic tools for early psychosis management) study based on cognitive performance and validated the solution independently (N = 53). Cognitive subgroups and healthy controls (HC; n = 195) were classified based on gray matter volume (GMV) using Support Vector Machine classification. A cognitively spared (N = 67) and impaired (N = 41) subgroup were revealed and partially independently validated (Nspared = 40, Nimpaired = 13). Impaired patients showed significantly increased negative symptomatology (pfdr = 0.003), reduced cognitive performance (pfdr < 0.001) and general functioning (pfdr < 0.035) in comparison to spared patients. Neurocognitive deficits of the impaired subgroup persist in both discovery and validation sample across several domains, including verbal memory and processing speed. A GMV pattern (balanced accuracy = 60.1%, p = 0.01) separating impaired patients from HC revealed increases and decreases across several fronto-temporal-parietal brain areas, including basal ganglia and cerebellum. Cognitive and functional disturbances alongside brain morphological changes in the impaired subgroup are consistent with a neurodevelopmental origin of psychosis. Our findings emphasize the relevance of tailored intervention early in the course of psychosis for patients suffering from the likely stronger neurodevelopmental character of the disease.

Stress, Coping, and Psychiatric Symptoms in Pregnant Women in Outpatient Care During the 2021 Second-Wave COVID-19 Pandemic.

Aims: Women face many sources of stress throughout their lives, and some periods are particularly sensitive; pregnancy is one of them. The COVID-19 pandemic is a likely source of additional stress for pregnant women. Moreover, there is evidence that pregnant women have experienced high levels of anxiety and depression symptoms during the pandemic. Our study aimed to evaluate the association of pregnancy-specific stress, pandemic-related stress, and coping strategies with anxiety, depressive and obsessive-compulsive symptomatology in Italian women during the second wave of the COVID-19 pandemic (December 2020-June 2021). We also investigated whether there were differences in these levels of psychopathology compared to a prior study conducted during the first pandemic wave (April-August 2020) in Italian pregnant women. Methods: We assessed 325 pregnant women receiving outpatient prenatal care, using the Revised Prenatal Distress Questionnaire (NuPDQ), Pandemic-Related Pregnancy Stress Scale (PREPS), the Revised Prenatal Coping Inventory (NuPCI), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and Obsessive-Compulsive Disorder (OCD) screening. The main analysis was conducted comparing multiple logistic regression models predicting each psychopathological outcome from specific covariates and NuPDQ, PREPS, and NuPCI scores. Results: 42.8% of the sample reported significant levels of anxiety, while 10.3% was positive on depression screening and 13.1% on OCD screening. No significant difference was found in the prevalence of high anxiety, depression, or OCD screening scores compared with the first pandemic wave. Controlling for covariates, we found that GAD-7 and PHQ-2 scores were predicted by pregnancy-specific stress; positive OCD screening was not. The model of high anxiety was improved by adding pandemic-related stress as a predictor (in particular, feeling unprepared for delivery and postpartum). Finally, coping strategies (avoidance, spiritual coping, and planning-preparation) significantly improved prediction of all three psychopathological outcomes. Conclusions: The present study suggests the importance of pregnancy-related stress, COVID-19 pandemic stress, and of coping strategies in counteracting or contributing to psychiatric symptomatology during the current pandemic.

Validation of the Italian version of the Revised Prenatal Coping Inventory (NuPCI) and its correlations with pregnancy-specific stress.

BACKGROUND: Pregnancy is a period of happiness but also of physical and psychological changes that can lead to distress. Functional coping strategies can reduce the pregnancy specific-stress. This study aimed to assess the psychometric properties of the Revised Prenatal Coping Inventory (NuPCI) in an Italian sample and to investigate how coping strategies were associated with pregnancy-specific stress. METHODS: In this cross-sectional study, low-risk pregnant women (N = 211) were assessed with NuPCI, NuPDQ (Revised-Prenatal Distress Questionnaire), Brief-COPE (Coping Orientation to the Problems Experienced), and STAI (State-Trait Anxiety Inventory). The reliability of NuPCI was evaluated by assessing its internal consistency and factor structure (with a Confirmatory Factor Analysis, CFA). The concurrent validity between NuPCI and Brief-COPE and NuPDQ and STAI was investigated. Lastly, the relationship between NuPCI and NuPDQ was analyzed, as well as the ability of these scales to predict Apgar score at birth. RESULTS: Internal consistency of NuPCI scales was good for Planning-Preparation (ɑC=0.84) and Spiritual-Positive Coping (ɑC=0.81) scales, acceptable for Avoidance (ɑC=0.76) scale. Moreover, the original three-factor structure was confirmed using a CFA with 29 of the 32 items (χ2374 = 618.06; RMSEA = 0.056, 95% confidence interval: [0.048, 0.063]); CFI = 0.920; and TLI = 0.913). Statistically significant correlations between NuPCI scales and Brief-COPE subscales ranged between r = + 0.217 and r = + 0.624; also, NuPDQ score was positively correlated with STAI scales (State scale: r = + 0.539; Trait scale: r = + 0.462). Concurrent validity was confirmed reporting that NuPDQ score was predicted by NuPCI scores (R2 = 0.423, p < 0.001), positively by Avoidance (ß=+0.572) and Planning-Preparation (ß=+0.215) and negatively by Spiritual-Positive Coping (ß=-0.132). Finally, considering the stress, the effect of the Avoidance and Spiritual-Positive Coping scores respectively in decreasing (+ 155%) and increasing (+ 16%) the Apgar score became stronger. CONCLUSIONS: Italian NuPCI has sound psychometric properties and it is a useful coping measure. NuPDQ showed also a good validity. Our results may suggest a significant role for coping strategies, particularly in modulating the condition of the newborn at birth.

Relationship between parenting measures and parents and child psychopathological symptoms: a cross-sectional study.

BACKGROUND: Increasing evidence suggests a complex role of family influences, such as the exposure to parent psychopathology through parenting behavior, in parent-to-child psychopathology transmission. Parenting behaviour could represent a relevant target of psychoeducative intervention. Given these premises, we aimed to evaluate homotypic and heterotypic relationships between parent and child psychopathology, mediated by parenting behaviours, taking into account the constructs of parent and offspring internalizing and externalizing psychopathology. METHODS: Internalizing and externalizing symptoms in 272 clinically-referred subjects (mean age = 14.5 ± 2.3; F = 23.5%) and their parents (mothers n = 272, fathers n = 242) were assessed through the Child Behavior Checklist and the Adult Self Report; four areas of parenting behaviours were investigated through the Family Life Questionnaire. Multiple mediation models were built, considering mother and father psychopathology scales as independent variables, parenting measures and family functioning as mediators (Affirmation, Rules, Discipline and Special Allowances), child psychopathology scales as dependent variables and demographic variables as covariates. RESULTS: Regression models showed a significant effect of maternal internalizing symptomatology on child externalizing behavioral problems; high levels of maternal pathology predicted high levels of children's psychopathology. A total mediating effect of parenting measures was found: high levels of internalizing symptoms in mothers predicted low levels of affirmation, which in turn predicted high levels of externalizing psychopathology in children. CONCLUSIONS: Our study results confirmed the existence of interdependent links between mothers' psychiatric symptomatology, parenting behaviour and offspring outcomes, specifically in an Italian context. On a clinical and rehabilitation basis, this work offers suggestions about parenting practices, specifically maternal, involved in the maintenance of child psychopathology.

The Assertive Brain: Anterior Cingulate Phosphocreatine plus Creatine Levels Correlate With Self-Directedness in Healthy Adolescents.

Despite various advances in the study of the neurobiological underpinnings of personality traits, the specific neural correlates associated with character and temperament traits are not yet fully understood. Therefore, this study aims to fill this gap by exploring the biochemical basis of personality, which is explored with the temperament and character inventory (TCI), during brain development in a sample of adolescents. Twenty-six healthy adolescents (aged between 13 and 21 years; 17 males and 9 females) with behavioral and emotional problems underwent a TCI evaluation and a 3T single-voxel proton magnetic resonance spectroscopy (1H MRS) acquisition of the anterior cingulate cortex (ACC). Absolute metabolite levels were estimated using LCModel: significant correlations between metabolite levels and selective TCI scales were identified. Specifically, phosphocreatine plus creatine (PCr+Cre) significantly correlated with self-directedness, positively, and with a self-transcendence (ST), negatively, while glycerophosphocholine plus phosphocholine (GPC+PC) and myo-inositol negatively correlated with ST. To the best of our knowledge, this is the first study reporting associations of brain metabolites with personality traits in adolescents. Therefore, our results represent a step forward for personality neuroscience within the study of biochemical systems and brain structures.

Common and different neural markers in major depression and anxiety disorders: A pilot structural magnetic resonance imaging study.

Although anxiety and depression often co-occur and share some clinical features, it is still unclear if they are neurobiologically distinct or similar processes. In this study, we explored common and specific cortical morphology alterations in depression and anxiety disorders. Magnetic Resonance Imaging data were acquired from 13 Major Depressive Disorder (MDD), 11 Generalized Anxiety Disorder (GAD), 11 Panic Disorder (PD) patients and 21 healthy controls (HC). Regional cortical thickness, surface area (SA), volume and gyrification were measured and compared among groups. We found left orbitofrontal thinning in all patient groups, as well as disease-specific alterations. MDD showed volume deficits in left precentral gyrus compared to all groups, volume and area deficits in right fusiform gyrus compared to GAD and HC. GAD showed lower SA than MDD and PD in right superior parietal cortex, higher gyrification than HC in right frontal gyrus. PD showed higher gyrification in left superior parietal cortex when compared to MDD and higher SA in left postcentral gyrus compared to all groups. Our results suggest that clinical phenotypic similarities between major depression and anxiety disorders might rely on common prefrontal alterations. Frontotemporal and parietal abnormalities may represent unique biological signatures of depression and anxiety.

The brief assessment of cognition in affective disorders: Normative data for the Italian population.

BACKGROUND: To date there are no validated tests in Italian to assess cognitive functions in Bipolar Disorder. Therefore, this study aimed to provide normative data for the Italian version of the Brief Assessment of Cognition in Affective Disorders (BAC-A), a battery targeting neuro- and affective-cognition in affective disorders. METHODS: Data were collected from 228 healthy participants (age range: 18-67; mean age: 34.68 ± 12.15 years) across eight recruiting sites. The influence of age, sex and education was measured and adjusted for using multivariate stepwise regression models. Normative values were established by means of the Equivalent Score approach. RESULTS: Most of the BAC-A subtests showed patterns of association with age (inversely associated with overall cognitive performance), education (positively associated with Verbal Memory and Fluency, Digit Sequencing and Affective Processing subtests) and sex (females performed better than males in the Affective Interference Test but worse in the Emotion Inhibition Task, Digit Sequencing and Tower of London). LIMITATIONS: The sample size was not sufficiently large for developing stratified norms, using 10-years ranges. Moreover, the participants included in the study were, on average, highly educated. CONCLUSIONS: The normative data of the BAC-A provided in this study can serve as a cognitive functioning reference for Italian-speaking participants within the age range of the study sample. This can increase the applicability of this test in both clinical and research settings. The reliability and validity of the Italian BAC-A need to be further investigated.