Suicide and COVID-19: a rapid scoping review.

There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies' methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.

The stress response of intensive care unit medical doctors facing repeated severe emergencies.

Objectives: This study assesses the psychopathological distress experienced by doctors working in an Intensive care unit (ICU) during the COVID-19 pandemic. These doctors were the same who faced the consequences of a previous natural disaster, a severe 6.3 magnitude earthquake. A second objective is to evaluate their current mental attitude, professional performances and coping strategies adopted in the pandemic in relation to the conditioning effect of that first emergency, the earthquake. Methods: Thirty-seven ICU medical doctors were recruited and assessed using Rapid Stress Assessment (RSA) rating scale, Symptom Checklist-90 Revised (SCL-90-R), Zung Self-Rating Anxiety Scale, Beck Depression Inventory, Beck Hopelessness Scale, Millon Clinical Multiaxial Inventory III. Comparison between exposure to the earthquake and COVID pandemic has been made in terms of professional role and psychological burden. Results: Comparison between 2009 earthquake catastrophe and COVID pandemic conditions evidenced relevant changes in professional role, team, environment, shifts, and work organization. Conclusion: The doctors, who already experienced the 2009 earthquake reported a feeling of greater insecurity facing this latter catastrophe, the COVID pandemic, as well as perception of greater concern for their family and the global situation. However, having participated in the medical management of another emergency (the 2009 earthquake) appears to have contributed to limiting demoralization and psychological distress. The feeling of having greater decision-making possibilities and participation in the organization of work, strengthen coping skills in the face of the emergency.

[Lifestyle in patients with severe mental disorders: a new target for psychosocial interventions?] / Stili di vita nei pazienti con disturbi mentali gravi: quali opportunità per il trattamento?

INTRODUCTION: Patients with severe mental disorders (namely schizophrenia, major depression and bipolar disorder) have a reduced life expectancy of at least 10 to 25 years compared with the general population. This mortality gap is due to the higher prevalence of comorbid physical disorders (such as diabetes, hypertension and cardiovascular diseases) in these patients compared to the general population. Factors contributing to the mortality gap include lack of access to primary care services, severity of clinical symptoms, internalized stigma and discrimination by healthcare professionals, pharmacological treatments and unhealthy lifestyle behaviours. Several international studies have highlighted the high prevalence of unhealthy lifestyle behaviours in patients with severe mental disorders, but a few data are available from Italian real-world settings. AIM: The present study aims to: 1) describe the lifestyle behaviours adopted by a sample of real-world patients affected by severe mental disorders; 2) identify differences in lifestyle behaviours according to diagnostic category. MATERIALS: The final sample consisted of 402 patients, mainly female (57%), with a mean age of 45.8±11.8 years. 35% of them suffers from moderate obesity and 40% of them is affected by hyperinsulinemia, hypercolestereloemia and hypertrygliceridemia. 70% of patients has sedentary behaviours. Moderate to severe nicotine dependence is reported by 42% of patients. Patients with bipolar disorders are more frequently smokers compared to other patients. No significant differences in lifestyle behaviours have been found among the three diagnostic groups. RESULTS AND CONCLUSIONS: Our data confirm that patients with severe mental disorders adopt unhealthy lifestyle behaviours, regardless their diagnosis. New psychosocial interventions, including motivational and psychoeducational components and targeting lifestyle behaviours, should be developed and disseminated in order to reduce the mortality gap.

Childhood family stress and adult resilience in a sample of depressed patients.

BACKGROUND: The aim of this study is to explore the effect of childhood family stress on depression, personal, and social resilience in depressed patients. METHODS: We assessed childhood family stress (RFQ), depression (BSI, depression subscale), and resilience (RSA) in 152 depressed patients, 70 males, and 82 females. We calculated the 33rd and 66th percentiles of RFQ scores to divide the sample among Low, Medium, and High RFQ subgroups. A one-way ANOVA has been carried out to explore the differences between the variables in the subgroups. Finally, two regression analyses with depression, as the dependent variable, and resilience, divided for stress-sensitive and no stress-sensitive factors as independent variables, have been implemented. RESULTS: The one-way ANOVA showed that the Low subgroup had a positive profile, the Medium had an intermediate profile, while the High had a negative one for depression, personal (structured style and social competence), and interpersonal (social resources) resilience. The other factors (perception of self, planned future, and family cohesion) did not show differences in the subgroups, suggesting they are no stress sensitive. Regression analysis showed that no stress-sensitive factors have a constant and significant predictive value for depression in all subgroups; while, stress-sensitive ones showed a growing predictive value for depression from Low to Medium, but not in High, suggesting a ceiling effect. LIMITATIONS: The use of self-report measures, the cross-sectional nature of the study, and the lack of a non-clinical and/or outpatient samples. CONCLUSIONS: This study provides a contribution to the understanding of the effect of childhood family stress on adult resilience and depression.

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.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis.

INTRODUCTION: Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS: One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS: Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS: The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.

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.

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.

Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS): a validation study in Italian population.

BACKGROUND: Although cognitive deficit in persons with schizophrenia is well documented, the assessment of the patient's perception of its own cognitive functioning is a relevant issue not adequately studied. Several evaluation tools have been elaborated, however none has been validated in Italian. The aim of the study is the validation of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a rating scale designed to measure subjective cognitive deficits complaints in persons with schizophrenia. < span class="text116">Method. 146 persons meeting the DSM-5 diagnostic criteria for schizophrenia have been recruited. The SSTICS was translated in Italian in accordance with international standard methods. Subjects were also evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Subjective Well-being under Neuroleptic scale (SWN). Cronbach's alpha coefficient was used to assess internal consistency. Constructs were examined using exploratory factor analysis (principal component with varimax rotation). The factorial model was then tested via confirmatory factor analysis. RESULTS: The factorial analysis revealed a 4-factor structure, which is more parsimonious than those obtained in previous studies. Correlations between STICSS and the other rating scales were significant for several domains. CONCLUSIONS: The Italian version of the SSTICS showed good psychometric properties and is suitable to measure the patients' subjective perception of cognitive impairment. Subjective evaluation can integrate objective measures of cognitive performances, supporting a multidimensional model of functional impairment in schizophrenia.

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.

Night Eating Syndrome, circadian rhythms and seasonality: a study in a population of Italian university students.

PURPOSE: The aim of this research was to assess the prevalence of Night Eating Syndrome (NES) in a university student population and to clear up the relationship between NES, depression and chronotype. The relation between NES and seasonality was also investigated. METHODS: The data were collected from a sample of 1136 students of the L'Aquila University, Italy. All subjects were invited to answer to the Sociodemographic Information Form and to take a self-report battery composed by four questionnaires: the Night Eating Questionnaire (NEQ), the Morningness Eveningness Questionnaire (MEQ), the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Beck Depression Inventory (BDI). RESULTS: The 5.3% of our population (60 subjects) reached the criteria for NES. The distribution of chronotypes in the sample was: Morning Type 15.3%, Intermediate 64.3% and Evening Type 20.4%. The 36.7% of the participants reaching the criteria for NES, obtained low scores on the MEQ. The data indicated that NEQ and MEQ scores are significantly inversely correlated (r=-.22; p<.01, two-tailed test). The 3.6% of our population (41 subjects) reached the criteria for Seasonal Affective Disorder (SAD) and 10.7% for subclinical SAD (121 subjects). Furthermore, the 11.7% of subjects with NES presented SAD and the 5% presented Subclinical SAD. The data demonstrated that NES and Global Seasonality Score (GSS) are significantly associated (r=.22; p<0.01, two-tailed test). CONCLUSIONS: The main finding of this study is the strong relation between NES and eveningness dimension. Our results help to clear up the literature debate about the role of eveningness dimension in the night eating, suggesting that subjects with NES present a circadian delay, not only in the food intake, but in the entire functioning. At the best of one knowledge this study is the first one to examine the relationship between NES and seasonality. This research found preliminary evidence that, similarly to the findings of previous studies in subjects with Bulimia Nervosa (BN) and Binge Eating Disorder (BED), night eating symptoms may vary significantly across the seasons; subjects with NES experience seasonal variation in their mood and in their eating patterns.

Could the severity of symptoms of schizophrenia affect ability of self-appraisal of cognitive deficits in patients with schizophrenia? Lack of insight as a mediator between the two domains.

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly affects both factors. Our aim is to further asses the relationship between subjective perception of cognitive deficits, symptom severity and lack of insight as a mediator variable. 109 subjects with schizophrenia were evaluated. Positive and Negative Syndrome Scale (PANSS) was modelled as independent variable, Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) as dependent and "Lack of Insight" (LoI) PANSS Item as mediator one. Mediation was assessed using bootstrap estimation approach. LoI acts as a suppressor variable (i.e., it enhances the relation between the independent and dependent variable) between Negative Symptoms and SSTICS, while showing a mediation effect between Depressive symptoms and SSTICS. LoI has a central role in mediating the relationship between negative and depressed symptoms on the one hand and self-appraisals of cognitive deficits (SACD) assessed with SSTICS on the other. Its suppressor role between negative symptoms and STICSS favour a direct effect of negative symptoms on SACD. On the other hand, its mediator role between depression and SSTICS is consistent with several reports of the 'insight paradox' of an enhanced severity of depression in patients with higher awareness of their disability.

Questionnaire on Attitude towards Research and Care (QuARC): a survey of patients with psychosis.

Background: The patients' appraisal, satisfaction and attitude toward research is crucial to obtain reliable information, in psychiatry frequently not objective.Aim: We operationalised the information derived from studies on satisfaction and attitude towards research and developed a standardized measure, whose internal consistency and factor structure was investigated.Method: The Questionnaire on Attitude towards Research and health Care (QuARC) is a 10-item self-report scale, administered to 116 patients with psychotic disorders participating in research protocols. Exploratory factor analysis was conducted and internal consistency evaluated.Results: Two factors have been identified: one labelled External Factor, including items related to information on the received treatment, relationship with third parties, and one labelled Internal Factor with items related to the disorder, perceived well-being and contribution to scientific knowledge. Cronbach's alpha internal consistencies were good.Conclusions: The QuARC is easy to use, well accepted, with good psychometric properties. The constructs identified are different from the original issues addressed (i.e. attitude and satisfaction), prevailing different constructs closer to the patient opinion on the research and personal condition. These constructs identify dimensions useful to delineate and understand the patients' experience of participating in a scientific project as well as their satisfaction.

Hopelessness in persons with epilepsy: Relationship with demographic, clinical, and social variables.

Persons with epilepsy show a higher risk of suicidal ideation and behavior than the general population. Hopelessness, as a feature of demoralization, is considered an emerging risk factor for suicidal ideation. Psychopathological comorbidity, mainly depression, has to be taken into account to predict suicidal attempts but the relationship between suicidality and epilepsy has been also reported independently from depressive disorders. The aim of the study was to investigate hopelessness in a sample of persons suffering from epilepsy without comorbidity with psychiatric disorders and its association with demographic, social, and clinical variables, putatively predictive of suicidal behaviors. Beck Hopelessness Scale (BHS) has been used as measure of suicidal ideation in 72 consecutive outpatients afferent to a third level epilepsy center. Exclusion criterion was psychiatric comorbidity evaluated by clinical approach and quantified by Clinical Global Impression (CGI) Scale. Clinical (focus localization, age at onset, number of drugs), demographic, social variables, and intellectual level were considered. Age, age at onset, gender, intellectual level, socioeconomic status, duration of illness and therapy, number of drugs, seizure frequency, and localization of the epileptic focus and side involved were found associated with BHS score increase. In a sample of persons with epilepsy, without psychiatric comorbidity, our data show an association between factors related to the biological pathophysiology and the clinical course of the disease with the sociodemographic status, as a risk factor for suicidal ideation.

Assessment of de novo copy-number variations in Italian patients with schizophrenia: Detection of putative mutations involving regulatory enhancer elements.

OBJECTIVES: Variants appearing de novo in genes regulating key neurodevelopmental processes and/or in non-coding cis-regulatory elements (CREs), as enhancers, may increase the risk for schizophrenia. However, CREs involvement in schizophrenia needs to be explored more deeply. METHODS: We investigated de novo copy-number variations (CNVs) in the whole-genomic DNA obtained from 46 family trios of schizophrenia probands by using the Enhancer Chip, a customised array CGH able to investigate the whole genome with a 300-kb resolution, specific disease loci at a ten-fold higher resolution, and which was highly enriched in probes in more than 1,250 enhancer elements selected from Vista Enhancer Browser. RESULTS: In seven patients, we found de novo CNVs, two of which overlapped VISTA enhancer elements. De novo CNVs encompass genes (CNTNAP2, MAGI1, TSPAN7 and MET) involved in brain development, while that involving the enhancer element hs1043, also includes ZIC1, which plays a role in neural development and is responsible of behavioural abnormalities in Zic mutant mice. CONCLUSIONS: These findings provide further evidence for the involvement of de novo CNVs in the pathogenesis of schizophrenia and suggest that CNVs affecting regulatory enhancer elements could contribute to the genetic vulnerability to the disorder.

10 anni dopo il terremoto dell'Aquila: dal trauma individuale a quello collettivo. Memorie e mnemotecnologie.

Il trauma collettivo conseguente a un disastro naturale si configura come una crisi di significato. Numerosi studi supportano la trasmissione transgenerazionale di esperienze traumatiche, come pure di modelli protettivi di resilienza. I numerosi eventi culturali e scientifici che si sono tenuti in occasione del decimo anniversario del sisma che ha colpito L'Aquila nel 2009 potrebbero essere visti nella prospettiva delle mnemotecnologie. In tale contesto, l'esteriorizzazione della memoria "traumatica" attraverso le nuove tecnologiche può liberare da emozioni negative generate dal trauma per una nuova memoria collettiva. Le mnemotecnologie, in virtù della loro duplice funzione di rievocazione e integrazione, possono contribuire in modo indiretto, ma sostanziale, al processo di oblio attivo del trauma finalizzato alla ricostruzione di una nuova identità culturale.

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").

Emotional reactivity in mesial temporal lobe epilepsy: A pilot study.

PURPOSE: Emotional reactivity (ER) is the early rapidly evoked response to a salient emotional stimulus which influences an individual's coping mechanisms, eliciting adaptive responses. We investigated ER in patients with mesial temporal lobe epilepsy (MTLE) in order to obtain an emotion-processing measure that can be related to behavioral regulation. METHODS: We measured ER in twelve patients with (MTLE) using the International Affective Picture System (IAPS), the most widely employed instrument to measure ER, and compared their results with those of a matched sample of healthy subjects. Ninety color pictures depicting events with different kinds of affective valence (pleasant, unpleasant, and neutral) were shown to the patients. Unpleasant and pleasant pictures were also distinguished depending on whether or not they involved social human conditions. The ER was rated on the basis of valence and arousal. RESULTS: Patients with MTLE showed higher mean arousal and valence ratings than controls for neutral and socially pleasant pictures. A higher valence for unpleasant pictures and a trend toward significantly higher arousal and valence for pleasant pictures were also recorded. CONCLUSIONS: Patients with MTLE seem to feel the environment in a more sensitive and positive way compared with controls, likely in relationship with social functioning alterations.

The complex relationship between self-reported 'personal recovery' and clinical recovery in schizophrenia.

Self-reported 'personal recovery' and clinical recovery in schizophrenia (SRPR and CR, respectively) reflect different perspectives in schizophrenia outcome, not necessarily concordant with each other and usually representing the consumer's or the therapist's point of view. By means of a cluster analysis on SRPR-related variables, we identified three clusters. The first and third cluster included subjects with the best and the poorest clinical outcome respectively. The second cluster was characterized by better insight, higher levels of depression and stigma, lowest self-esteem and personal strength, and highest emotional coping. The first cluster showed positive features of recovery, while the third cluster showed negative features. The second cluster, with the most positive insight, showed a more complex pattern, a somewhat 'paradoxical' mixture of positive and negative personal and clinical features of recovery. The present results suggest the need for a characterization of persons with schizophrenia along SRPR and CR dimensions to design individualized and integrated treatment programs aimed to improve insight and coping strategies, reduce stigma, and shape recovery styles.