Violence in severe mental disorders: the association with age at onset and gender.

AIM: The aim of this study is to investigate the relation between perpetration and victimization of violence with gender and age at onset of mental disorders in patients with severe mental disorders. METHODS: 216 patients were recruited and evaluated with the Italian version of the Karolinska Interpersonal Violence Scale. RESULTS: We found higher levels of victimization of violence in women than men and more violence in patients with lower age at onset. DISCUSSION: Gender and age at onset impact on violence in the adult life in a sample of patients with severe mental disorders. CONCLUSIONS: Our findings confirmed the need of an early diagnosis and gender-tailored management of interpersonal violence.

Personality disorders (PD) and interpersonal violence (IV) during COVID-19 pandemic: a systematic review.

Not only did the ongoing CoronaVIrus Disease-19 (COVID-19) pandemic cause a massive number of casualties, but also there is growing concern that the burden of its psychological aftermaths will only show up years down the road. This systematic review summarises the existing literature reporting the impact of COVID-19 on personality disorders (PDs)-related violence. MEDLINE and APA PsycINFO were independently searched for relevant studies by two authors. Eligible studies had to be identifiable through database searching, published and fully accessible. This systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. An initial pool of 241 studies were found, out of which 69 met the selection criteria and were, therefore, included. The majority reported a worse Mental Health Outcome (MHO) during the pandemic as related to dysfunctional personality and positive personality traits predicting a better outcome. Furthermore, increased levels of interpersonal violence (IV) and self-directed violence were reported. Further research should be conducted on the reciprocal interaction of PDs and IV during the time of pandemic. Nevertheless, the dramatic impact of restrictive measures on PDs has still to be appropriately addressed.

Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak.

Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrument designed to assess a broad range of trauma-related symptoms with no available validation in the Italian population. Aims: This study aimed to examine the factor structure of the Italian version of the GPS in a general population sample exposed to the COVID-19 pandemic and to evaluate trauma-related symptoms in the context of COVID-19 related risk factors associated with lockdown measures. Methods: We conducted a cross-sectional web-based observational study as part of a long-term monitoring programme of mental health outcomes in the general population. Eighteen thousand one hundred forty-seven participants completed a self-report online questionnaire to collect key demographic data and evaluate trauma-related symptoms using the GPS, PHQ-9, GAD-7, ISI, and PSS. Validation analyses included both exploratory and confirmatory factor analysis and correlation analyses. The relation with putative COVID-19 related risk factors was explored by multivariate regression analysis. Results: Exploratory factor analyses supported a two-factor model. Confirmatory factor analysis showed that the best fitting model was a three-factor solution, with core Post-traumatic Stress Symptoms (PTSS) (re-experiencing, avoidance, hyperarousal), Negative Affect (symptoms of depressed mood, anxiety, irritability), and Dissociative symptoms. GPS Risk factors and specific COVID-19 related stressful events were associated with GPS total and the three factor scores. Conclusions: Our data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic. The GPS symptoms clustered best in three factors: Negative Affect symptoms, Core PTSS, and Dissociative symptoms. In particular, high rates of core PTSS and negative affect symptoms were associated with the COVID-19 pandemic in Italy and should be routinely assessed in clinical practice.

Antecedentes: Evidencias recientes revelaron resultados adversos para la salud mental asociados con la pandemia de COVID-19, incluyendo síntomas relacionados con el trauma. El Mapeo Global de Psicotrauma (GPS, en sus siglas en inglés) es un breve instrumento diseñado para evaluar una amplia gama de síntomas relacionados con el trauma, sin validación disponible en la población italiana.Objetivos: El objetivo de este estudio fue examinar la estructura de factores de la versión italiana del GPS en una muestra de la población general expuesta a la pandemia de COVID-19 y evaluar los síntomas relacionados con el trauma en el contexto de los factores de riesgo relacionados con COVID-19 asociados con las medidas de confinamiento.Métodos: Realizamos un estudio observacional transversal basado en la web como parte de un programa de vigilancia a largo plazo de los resultados de salud mental en la población general. Dieciocho mil ciento cuarenta y siete participantes completaron un cuestionario en línea de autorreporte para recopilar datos demográficos claves y evaluar los síntomas relacionados con el trauma utilizando el GPS, PHQ-9, GAD-7, ISI y PSS. Los análisis de validación incluyeron análisis factoriales y de correlación tanto exploratorios como confirmatorios. La relación con los posibles factores de riesgo relacionados con COVID-19 se exploró mediante un análisis de regresión multivariante.Resultados: Los análisis factoriales exploratorios apoyaron un modelo de dos factores. El análisis factorial confirmatorio mostró que el modelo que mejor se ajustaba era una solución de tres factores, con los principales síntomas de estrés postraumático (PTSS, en sus siglas en inglés) (reexperimentación, evitación, hiperactivación), el efecto negativo (síntomas de depresión, ansiedad, irritabilidad) y los síntomas disociativos. Los factores de riesgo del GPS y los eventos estresantes específicos relacionados con COVID-19 se asociaron con el total del GPS y las tres puntuaciones de los factores.Conclusiones: Nuestros datos sugieren que una amplia gama de síntomas de espectro traumático fueron reportados por una gran muestra italiana durante la pandemia de COVID-19. Los síntomas del GPS se agruparon mejor en tres factores: Síntomas de Afecto Negativo, PTSS Central y Síntomas Disociativos. En particular, las altas tasas de PTSS central y los síntomas de afecto negativo se asociaron con la pandemia de COVID-19 en Italia y deben ser evaluados rutinariamente en la práctica clínica.

Personal and contextual components of resilience mediate risky family environment's effect on psychotic-like experiences.

BACKGROUND: Psychotic-like experiences (PLEs) index an increased risk for subsequent psychotic disorders. A risky family environment is a well-established risk factor for PLEs; however, different contextual and personal resiliency factors may differentially mediate its effect on PLEs. OBJECTIVE: In this study, we propose a two-dimensional model of resilience. Our aim is to address separately the mediational role of personal and contextual resiliency factors between a risky family environment and PLEs in a community sample. METHODS AND MATERIALS: Five-hundred University students completed an on-line questionnaire, including the Resilience Scale for Adults (RSA), the 16-item version of the Prodromal Questionnaire (iPQ-16) and the Risky Family Questionnaire (RFQ). Mediation was assessed using Structural Equation Modelling with bootstrapping estimation of indirect effect. RESULTS: The direct effects of personal and contextual resilience on PLEs were respectively -0.69 [-0.97, -0.41] (P < .001) and - 0.19 [-0.58, 0.20] (ns); the indirect effect through personal resilience was 0.03[0.01, 0.04] (P < .001). Personal resilience mediated 27.4% of the total effect of risky family environment on PLEs. DISCUSSION: Personal resilience, as opposite to contextual resilience, mediates the effect of a risky family environment on PLEs. Low personal resilience may represent an individual risk factor that transmits the effect of risky family environment on PLEs and could represent a central aspect of individualized prevention and treatment strategies.

COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy.

BACKGROUND: The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. METHODS: A web-based survey spread throughout the internet between March 27th and April 6th 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. RESULTS: Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia. CONCLUSION: We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population's mental health.

Mental health outcomes of the CoViD-19 pandemic.

The coronavirus disease 2019 (CoViD-19) caused by the novel Coronavirus strain SARS-CoV-2 is currently a pandemic. On January 30, 2020, the World Health Organization declared that the CoViD-19 outbreak is a public health emergency of international concern. The virus has already had a direct impact on the physical health of million people, and besides, it is supposed to pose a mental health threat of great magnitude globally. This review aims at synthesizing mounting evidence concerning the immediate psychological responses during the initial stage of the CoViD-19 pandemic among the general population, the health-care workers, and clinical populations. Experts point out the need to pay specific attention to other groups at risk of further distress that may need tailored interventions. Providing psychological first aid is an essential care component for populations that have been victims of emergencies and disasters, before, during and after the event. With the aim of dealing better with the urgent psychological problems of people involved in the CoViD-19 pandemic, a new psychological crisis intervention model is needed. Given the recommendation to minimize face-to-face interaction, online mental health services have been widely adopted in China and are urged in other countries.

An Italian validation of the Psychological Maltreatment Review (PMR).

PURPOSE: The aim of the current study was to evaluate the construct validity and the internal consistence of the Italian version of the Psychological Maltreatment Review (PMR), and to assess the concurrent validity to provide adequate and reliable instruments to measure retrospectively child psychological maltreatment in the Italian population. METHODS: The participants to our study were 209 patients and 217 nonclinical subjects. The first group consisted in 209 adult patients, 106 males and 103 females (mean age of 41.43 years; SD=12.34) consecutively admitted at the psychiatric unit of the L'Aquila San Salvatore Hospital. The second group consisted in 217 non-clinical subjects, 96 males and 121 females (mean age of 36.38; SD=10.38) that completed an online survey, including the self-report version of the PMR and the Risky Families Questionnaire (RFQ). All subjects were invited to answer to Sociodemographic Information Form and to take a self-report battery composed by two instruments: the Psychological Maltreatment Review (PMR) and the RFQ. RESULTS: Internal consistency reliability analyses were performed separately for the two samples, all the scales had very good internal consistency in both samples, with Cronbach's alpha coefficients equal or greater than .88. An EFA was performed, using exploratory principal axis factoring, on the data of individuals from the non-clinical sample, separately for paternal and maternal scales, followed by varimax rotation and scree testing. The CFA was performed on the data of the patients' sample, separately for paternal and maternal scales, supported a three factor model yielding the best fit indexes, both for paternal scales, χ 2 =725, p<.001; df=402, CFI=0.92; TLI=0.91, SRMR=0.053, RMSEA=0.063, 90% CI [0.056, 0.07]; and maternal scales, χ 2 =758, p<.001; df=374, CFI=0.89; TLI=0.88, SRMR=0.064, RMSEA=0.07, 90% CI [0.06, 0.07]. The CFA performed on the patient' sample supported a three factor model yielding the best fit indexes. The convergence of the EFA and the CFA in different samples supported the structural validity of the PMR and replicated its factorial structure, for both maternal and paternal ratings. CONCLUSIONS: This study provides evidence on the appropriateness of the Italian version of the PMR to retrospectively measure childhood psychological maltreatment. The three PMR scales (psychological abuse, psychological neglect and psychological support) demonstrated good internal consistency with average alpha coefficients, equal or greater than .88. The findings provide evidence of the construct validity, according to the literature, suggesting that psychological abuse, psychological neglect and parental support are dimensionally separated constructs, as defined in the literature.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study.

BACKGROUND: Interpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness. METHODS: The sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected. RESULTS: Both violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns. CONCLUSIONS: The main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

Resilience as a Mediator Between Interpersonal Risk Factors and Hopelessness in Depression.

Several studies investigated the role of resilience as a mediating factor for psychopathological phenotypes. The aim of the current study is to explore the putative role of resilience as a mediator between different vulnerability factors and depressive symptoms. One hundred and fifty patients with a major depressive disorder diagnosis have been evaluated on the basis of humiliation (Humiliation Inventory), adverse past family experiences (Risky Family Questionnaire), hopelessness (Beck Hopelessness Scale), and resilience (Resilience Scale for Adult) scores. A multiple regression analysis and a bootstrapping method were carried out to assess the hypothesis that resilience could mediate the relationships between these risk factors as predictors and hopelessness as a dependent variable. Our results show that resilience has a mediating role in the relationship between several risk factors that are specifically involved in interpersonal functioning and hopelessness. The main limitations of the study are the cross-sectional nature of the study, the use of self-report instruments, the lack of personality assessment, and the consideration of the resilience as a unique construct. The understanding of the mechanisms through which resilience mediates the effects of different interpersonal risk factors is crucial in the study of depression. In fact, future prevention-oriented studies can also be carried out considering the mediating role of resilience between interpersonal risk factors and depressive symptoms.

ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L'Aquila Earthquake.

An earthquake hit the city of L'Aquila in central Italy in 2009, leaving the city completely destroyed and 309 casualties. Unexpectedly, lower rates of psychotic experiences in persons affected by the earthquake compared to non-affected persons were found 10 months after the earthquake. The very long-term impact of a natural disaster on the prevalence of psychotic experiences deserves more in-depth detailing. The Authors examined resilience and psychotic experiences in a university student sample of 494. No effect of direct exposure to the earthquake (odds ratio = 0.64, 95%CI [0.37, 1.11]), material damages (odds ratio = 0.86, 95%CI [0.60, 1.23]), psychological suffering (odds ratio = 1.06, 95% CI [0.83, 1.36]), or global impact severity (odds ratio = 0.92, 95%CI [0.76, 1.12]) on psychotic experiences was detected. Resilience levels did not differ between affected and non-affected persons. Resilience showed a strong protective effect on psychotic experiences (odds ratio=0.38, 95% CI [0.28, 0.51]. The protective effect of the RSA factor "Perception of Self" was significantly stronger in individuals affected by the earthquake compared to non-affected subjects. Being affected by an earthquake is not a risk factor for psychotic experiences in a university student sample, as no direct effect of the earthquake was detected after 10 years after the event. Resilience is confirmed as a strong protective factor for psychotic experiences irrespectively of large collective traumatic events. Extension of these results to a general population sample could provide interesting insights into recovery from natural disasters.

Early interpersonal violence mediates the effect of family history of mental disorder on suicide attempts in a non-clinical sample.

BACKGROUND: Suicide is a leading cause of death worldwide, with several risk factors, including a family history of mental disorders (FHMD) and interpersonal violence. The relationship between these risk factors needs further investigation. AIM: Addressing the impact of interpersonal violence on suicide attempts, and its interaction with FHMD. METHODS: 192 participants completed an online questionnaire, including the Psychological Maltreatment Review and the Karolinska Interpersonal Violence Scale (putative mediating variables variables), questions about previous suicide attempts and FHMD. Logistic regression and mediation analysis were performed. RESULTS: FHMD (OR=7.09, 95%CI [2.20,22.81]), expressed violence in childhood (OR=2.55, 95%CI [1.26,5.18]) and exposure to violence in childhood (OR=2.80, 95%CI [1.80,4.34]) predicted attempted suicide. Exposure to, and expression of violence in childhood mediated 15.23% and 9.63% respectively of the total effect of FHPD on attempted suicide. LIMITATIONS: Small sample size, reporting bias on FHMD an attempted suicide, self-selection bias due to sampling technique. CONCLUSIONS: The familial load on adult suicidal behavior is partially mediated by exposure to violence in childhood, suggesting that the presence of a relative affected by any psychiatric condition may contribute to exposure to violence in childhood, which eventually enhances the risk of suicide in adulthood.

Further Exploration of Personal and Social Functioning: The Role of Interpersonal Violence, Service Engagement, and Social Network.

Social functioning (SF) has mainly been studied in major psychoses in relation to symptom severity, but other factors may interfere with the achievement of a functional remission. The aim of this study is to explore interpersonal violence (IV), service engagement (SE), and social network (SN), together with demographics, as predictors of SF in a sample of subjects with severe mental illness (SMI). Consecutive adult inpatients were evaluated using self-report and clinician-rated questionnaires. Findings suggest that IV, SE, SN, male sex, and illness duration explained 39.1% of SF variance in people affected by SMI. IV was the strongest predictor, followed by sex and duration of illness. Lifetime expression of violence is a stronger predictor than lifetime exposure to violence. Positive SE and SN were found to predict SF, whereas age was not associated. This study underlines the need of other non-symptom-related variables for the comprehension of SF in mental disorders.

Source monitoring task in a sample of in-patients with verbal auditory hallucinations compared to control sample.

Patients with psychosis, especially those with specific positive symptoms such as auditory verbal hallucinations, show a source monitoring deficit, the cognitive process involved in the recognition of the information source. This defect can lead to the erroneous conclusion that self-generated thoughts are not "proper" but derive from an external source. We evaluated 37 patients diagnosed with psychotic disorder and 40 healthy controls using a modified version of the Reality Monitoring Task developed by Larøi et al. in 2004. The patients were also evaluated with PANSS, VGF, PSP. We have found that the performance of the Source Monitoring Task differs between patients with hallucinations and controls. According to the literature we can therefore state that patients with hallucinations are characterized by a difficulty in identifying the source of the information they perceive. Our study also adds a new finding to the literature: the source monitoring dysfunction is not due to the presence of current hallucinatory symptomatology but could be considered a stable trait in psychotic patients.

Paranoia, depression and lack of insight in schizophrenia: a suggestion for a mediation effect.

INTRODUCTION: Delusional symptoms are heterogeneous and differentially related to insight, depression and another psychological construct, such as deservedness. In this study we explore models of relationships among these constructs, by hypothesizing that lack of insight could predict depression or paranoia, representing these variables outcome or mediator variables alternatively. MATERIALS: We evaluated positive psychotic symptoms, depression, persecution, deservedness and insight in a clinical sample of 81 people with schizophrenia or other psychotic spectrum disorders. Using multiple regression analyses we found 2 significant models. In the first one the lack of insight is negatively associated with depression and negatively related to persecution that, as mediator, is positively associated with depression. In the second model, lack of insight is negatively associated with persecution and negatively related to depression that, as mediator, is positively associated with persecution. CONCLUSIONS: Persecution and depression could be not only predicted by insight but this prediction could also be mediated by the same variables. In both clinical models found in this study, insight does have a relevant role because the awareness about symptom/illness is crucial to the symptoms change. However, having good insight into schizophrenia can also be paradoxically associated with negative subjective states related to depression (the so-called "insight paradox").

Interpersonal violence: identification of associated features in a clinical sample.

Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.