Structural Analysis of Social Behavior: Using Cluster Analysis to Examine Intrapsychic Personality Traits Associated With Depression in Women With Breast Cancer.

BACKGROUND: This study aimed to investigate personality traits associated with depression in breast cancer women (BCW). METHODS: Sample: 236 BCW recently diagnosed (early stages). Tests: SASB-Structural-Analysis of Social-Behavior; IPAT-CDQ-Depression. Statistical analysis: cluster K-Means analysis to explore SASB personality-traits considering the 8 SASB clusters (Cl); CDQ scores dichotomized by 50th percentile cutoff (high/low); Pearson's chi square test to compare CDQ levels and SASB traits. RESULTS: Cluster analysis results supported two distinguishable SASB personality traits (for all SASB Cl-Scales P < .001) classified as "Love and Autonomy" (62.2%) and "Control and Hate" (37.8%). Patients with Love/Autonomy traits are spontaneous, accept their deepest feelings and desire to be close to other people (Cl1, Cl2, Cl3, Cl4). They show a medium value of self-control and a low tendency to self-abusive and self-critical behaviors (Cl5, Cl6). They pay attention to themselves and to their needs at emotional and physical levels also if may be occasionally engaged in self-destructive behaviors (Cl7, Cl8). Women with Control/Hate traits are not spontaneous and do not always express emotions (C1, Cl2, Cl3, Cl4) and flexibility in their relationship with others (Cl5, Cl6). In stressful situations, they may ignore the option of choices for self-growth and neglect their needs and those of others (Cl7, Cl8). BCWs with Control/Hate traits scored higher in depression (P <.001) than those with the Love/Autonomy profile. CONCLUSIONS: Healthcare professionals should be aware of these personality traits and their association with depression to identify the psychologically most vulnerable BCW and improve the care they provide them. The psychotherapeutic intervention should be planned to face on the personality problems.

New determinants of mental health: the role of noise pollution. A narrative review.

Urbanisation processes and anthropogenic actions led to a significant increase in pollution levels, with relevant consequences on global health. In particular, noise pollution demonstrated an association with cardiovascular, metabolic, and respiratory diseases. Furthermore, increasing evidence underlined the possible role of air and noise pollution in the development of psychiatric disorders. In this narrative review, evidence concerning the relationship between noise pollution and the emergence of psychiatric symptoms or psychiatric disorders is summarised. After the literature search process was completed, 40 papers were included in the present review. The exposure to road-, rail-, and air- traffic represented a risk factor for the emergence of affective disorders. This could also be mediated by the occurrence of circadian rhythms disturbances or by noise annoyance and noise sensitivity, both influencing psychological well-being and health-related quality of life. Fewer studies concentrated on special populations, particularly pregnant women and children, for whom noise pollution was confirmed as a risk factor for psychopathology. The better clarification of the complex interaction between noise pollution and mental health may help to identify subjects at risk and targeting specific prevention and intervention strategies in the urban environment.

Elderly Helping Other Elderly: A Comparative Study of Family Caregiver Burden Between Patients With Dementia or Cancer at the End of Life.

A new reality is being observed around the world as the population ages: family caregivers, who are themselves older adults helping their ill older relatives. The aim of this study is to assess the burden of the older family caregiver assisting older patients in his or her end-of-life who are suffering from dementia or cancer. In this context, the elderly person is involved in the dual role of patient and caregiver. In this comparative study, a total of 87 older family caregivers (age ≥ 65 years) completed the Caregiver Burden Inventory (CBI) measurement. The sample was divided into 2 subgroups based on the individuals' advanced disease: Alzheimer's disease (AD) or cancer. Compared to cancer caregivers, the AD subgroup reported significantly higher scores in the CBI-emotional subscale (P = 0.006), confirmed by the evaluation of the generalized linear model (multivariate). There were no significant differences in the other CBI subscales and overall scores. According to the findings of this study, elderly who help elderly with AD are at a higher risk of experiencing an emotional burden than cancer caregivers. This data could be considered in designing interventions to reduce the caregiver burden of older family caregivers as they provide informal end-of-life care.

Becoming an older caregiver: A study of gender differences in family caregiving at the end of life.

OBJECTIVES: Older people are not traditionally expected to become caregivers. For this reason, the experience of caregiving in older persons has not been explored adequately in the research on gender differences. The objective of this study was to assess the caregiver burden among older family members who care for cancer patients facing the end of their lives, in order to compare their differences according to gender (male vs. female). METHODS: This is a cross-sectional study. A total of 102 older caregivers (aged ≥65 years) of hospice patients were interviewed through the Caregiver Burden Inventory (CBI). The sample group was divided into two gender subgroups. RESULTS: Compared with male caregivers, the older female group reported significantly higher scores in the CBI-physical subscale (P = 0.028), and in the CBI, the overall score (P = 0.0399) confirmed by the generalized linear model (multivariate) evaluation that included possible predictors in the model. There were no significant differences in the other CBI subscale scores (time-dependent, developmental, social, and emotional). SIGNIFICANCE OF RESULTS: Older female caregivers are at higher risk of experiencing burden and worse physical health compared with men. Further research is needed in modern palliative care to assess the role of gender differences in the experience of caregiving when the caregiver is an older person.

Schizotypal personality disorder in clinical obsessive-compulsive disorder samples: a brief overview.

Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.

Suicidality in Individuals with Schizoid Personality Disorder or Traits: A Clinical Mini-Review of a Probably Underestimated Issue.

Schizoid personality disorder (SZPD) is a Cluster A personality disorder whose essential feature is a lifelong pattern of detachment from social relationships and a restricted range of emotional expression. Although SZPD has been in every edition of the Diagnostic and Statistical Manual of Mental Disorders, empirical research on this disorder is actually limited, due to the fact that SZPD is rarely encountered in clinical settings. In fact, individuals with SZPD rarely present for treatment, as their isolation is often ego-syntonic; therefore, the prevalence of SZPD is not clearly established. Suicide ideation may be a running theme for individuals with SZPD. However, suicidality in SZPD is actually an underestimated topic. Aiming to draw more attention to this underestimated issue, with this paper the authors intend to provide a list of studies on suicidality in individuals with SZPD or traits, in the form of a clinical mini-review. Reported studies show that an underlying SZPD, or the presence of schizoid traits too, appear to be definitely a major risk factor for completed suicide and serious suicide attempts. This maladaptive personality disorder seems to not allow the individual to ask for help and to deny him the comforts of intimacy. Therefore, clinicians should be aware that schizoid traits suchs as solitary lifestyle, loneliness, emotional detachment, and impaired communication ability, are features associated with a vulnerability to suicidal behavior. We recommend the clinical assessment of this symptoms' constellation, in order to address patients with SZPD to most proper treatment.

COVID-19, Air Pollution and Mental Illness: Heads of the Same "Beast"?

The Covid-19 outbreak are generating relevant consequences under several aspects. Covid-19 pandemic together with air pollution and a dysfunctional anthropization/urbanization might affect public and mental health with a synergistic effect. The current paper explore hypothesis about existing links among Covid-19, air pollution and mental illness.

Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review.

Background and objectives: A deeper comprehension of the role that environmental risk factors play in the development of adolescent Bipolar Disorder (BD), as well as in the evolution of high-risk states for BD, may entangle further prevention and treatment advances. The present systematic review is aimed at critically summarizing evidence about the role that environmental risk factors play in the development of BD in adolescence and their interaction with BD high-risk states. Materials and Methods: MEDLINE/Pubmed, Scopus and Web of Science datasets were systematically searched until 4 September 2020. Original studies that reported information about the role of environmental risk factors in the development of BD during adolescence, or assessing their influence on the development of psychopathology in high-risk states for BD, were considered for inclusion. Two blind researchers performed title/abstract, full-text screening, and hand-screening of relevant references. The risk of bias was assessed by means of the Newcastle-Ottawa Scale. Results: Fourteen studies were included in the review. Negative stressful life events, particularly sexual and physical abuse, but also emotional mistreatment, were associated with more severe psychopathology in adolescents with BD, as well as with higher risk for developing mood disorders in BD offspring. Similar findings were detected for familial environment-related features, such as parental rejection and low perceived care, while no univocal results were found when analyzing familial functioning. Conclusions: The present systematic review confirmed the relevant role that environmental risk factors, particularly negative stressful live events and family-related features, play in the development of BD psychopathology during adolescence. Future studies are expected to clarify possible further environmental factors that may be implicated in the development of BD during youth that may serve as target of prevention and early treatment strategies.

Cannabis Use, Psychotic Like Experiences and Aberrant Salience in a Sample of Belgian Students.

The main goal of our study was to investigate the association between psychotic-like experiences, aberrant salience, and cannabis use in a nonclinical sample of Belgian students. The participants were asked to complete a self-report questionnaire on cannabis use. The Community Assessment of Psychic Experiences and the Aberrant Salience Inventory were used to assess psychotic-like experiences and aberrant salience. The final sample was of 257 students. Cannabis users showed significantly higher Aberrant Salience Inventory score and, concerning the Community Assessment of Psychic Experiences, higher total, positive, and negative dimension scores. Years of cannabis use and frequency of use showed a positive correlation with Aberrant Salience Inventory score. Our results support the evidence that cannabis use is associated with an increased rate of psychotic experiences in individuals without a clinical form of psychosis. Future studies are required to better investigate the meaning of the association between cannabis use, psychotic-like experiences, and aberrant salience.

Musical hallucinations: a brief review of functional neuroimaging findings.

Musical hallucinations are uncommon phenomena characterized by intrusive and frequently distressful auditory musical percepts without an external source, often associated with hypoacusis, psychiatric illness, focal brain lesion, epilepsy, and intoxication/pharmacology. Their physiological basis is thought to involve diverse mechanisms, including "release" from normal sensory or inhibitory inputs as well as stimulation during seizures, or they can be produced by functional or structural disorders in diverse cortical and subcortical areas. The aim of this review is to further explore their pathophysiology, describing the functional neuroimaging findings regarding musical hallucinations. A literature search of the PubMed electronic database was conducted through to 29 December 2015. Search terms included "musical hallucinations" combined with the names of specific functional neuroimaging techniques. A total of 18 articles, all clinical case reports, providing data on 23 patients, comprised the set we reviewed. Diverse pathological processes and patient populations with musical hallucinations were included in the studies. Converging data from multiple studies suggest that the superior temporal sulcus is the most common site and that activation is the most common mechanism. Further neurobiological research is needed to clarify the pathophysiology of musical hallucinations.

Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: A multicenter-observational study.

OBJECTIVE: Comorbidities between psychiatric diseases and use of traditional substances of abuse are common. Nevertheless, there are few data regarding the use of novel psychoactive substances (NPS) among psychiatric patients. Aim of this multicentre survey is to investigate the consumption of a number of psychoactive substances in a young psychiatric sample. METHODS: Between December 2013 and September 2015, a questionnaire was administered in 10 Italian psychiatric care facilities to a sample of 671 patients, aged 18-26 (mean age 22.24; SD 2.87). RESULTS: About 8.2% of the sample declared to have used NPS at least once, and 2.2% had consumed NPS in the previous 3 months. The three psychiatric diagnoses most frequently associated with NPS use were bipolar disorder (23.1%), personality disorders (11.8%), and schizophrenia and related disorders (11.6%). In univariate regression analysis, bipolar disorder was positively associated with NPS consumption, an association that did not reach statistical significance in the multivariate analysis. CONCLUSIONS: The use of NPS in a young psychiatric population appears to be frequent, and probably still underestimated. Bipolar disorder shows an association with NPS use. Careful and constant monitoring and an accurate evaluation of possible clinical effects related to NPS use are necessary.

Personality disorders features in a sample of women with perinatal depression in Perugia, Italy.

BACKGROUND: Antepartum depression (APD) and postpartum depression (PPD) are a significant public health problem. Aim of the study was to determine which personality disorders features could be found in women with APD and PPD compared to women without perinatal depression. SUBJECTS AND METHODS: The Edinburgh Postnatal Depression Scale and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were administered during peripartum to a sample of 54 women recruited at the Obstetrics and Gynaecology Unit, Perugia (Italy). RESULTS: Results were grouped according to the EPDS ranges 0-8 and ≥9, and to the MMPI-2 scores on each clinical scale. Women with APD had high scores on the MMPI-2 Hypomania, Cynicism, and Antisocial Practices scales; women with early onset PPD (detected in the first week after childbirth) had high scores on the Paranoia and Low Self-Esteem scales; women with late onset PPD (detected up to three months after childbirth), had high scores on the Fears, Obsessiveness, and Depression scales. CONCLUSIONS: Based on the high scores of specific MMPI-2 scales, our study would suggest that: cluster B personality features may represent a vulnerability factor for APD; passive-aggressive personality features may be a vulnerability factor for early onset PPD; cluster C personality features may act as a vulnerability factor for late onset PPD.

Schizo-Obsessive Disorder: A Brief Report of Neuroimaging Findings.

BACKGROUND: The term 'schizo-obsessive disorder' was coined to describe schizophrenia (SCZ) patients who are also affected by obsessive-compulsive symptoms (OCS) or also meet the criteria for obsessive-compulsive disorder (OCD). Several studies have investigated the clinical and epidemiological features of OCS/OCD in SCZ, but the neuroimaging literature is sparse. The aim of this brief report is to describe some of the most important neuroimaging findings regarding schizo-obsessive disorder. METHODS: A literature search of the PubMed electronic database was conducted up to July 25, 2015. Search terms included 'schizo-obsessive' combined with the names of specific neuroimaging techniques. RESULTS: Neuroimaging studies suggest that there may be a specific pattern of neuroanatomic dysfunction in schizo-obsessive patients, but the number of studies is limited and conclusions are preliminary because reports are of an exploratory nature. CONCLUSIONS: Further neurobiological research is needed to definitely determine whether schizo-obsessive disorder might have unique neuroanatomical and functional alterations.

Traumatic events in childhood and their association with psychiatric illness in the adult.

INTRODUCTION: Child maltreatment is a well-known condition that is currently considered to be associated with the development of severe psychiatric conditions. Consequently, the authors decided to review the current literature in order to give a complete scenario of the situation in the world and to give recommendations about prevention and treatment as well as research goals. METHODS: An electronic search was conducted through the means of MEDLINE database in order to find the most up to date peer-reviewed papers, including only those papers published in 2015. RESULTS: 15 papers were included and analyzed the current situation in different countries: US (n.3), Australia (n.2), Ireland (n.2), Israel (n.2), China (n.2), Indonesia (n.1), Pakistan (n.1) and Norway (n.1). DISCUSSION: Even though sexual abuse has been studied extensively, both physical and emotional abuse and neglect appear to be more represented within the population of patients that had suffered from abuse. Psychiatric disorders (mainly personality disorders, depression and anxiety), interpersonal, social and legal outcomes are important consequences of child maltreatment. CONCLUSIONS: Interventions and strategies are needed at different levels, from prevention to treatment and further research is important in order to better understand the phenomenon.

Personality and psychotic symptoms as predictors of self-harm and attempted suicide.

BACKGROUND: Nonfatal suicidal behaviours (NSB), including suicide ideation, suicide plan and suicide attempt, constitute a serious problem for public healthcare services. Suicide gesture (SG) which refers to self-injurious behaviour with no intent to die, differs from NSB in a variety of important ways. The aim of this study was to investigate demographic and clinical characteristics of NSB and SG to examine whether self-injurers with intent to die differ significantly from self injurers without such intent. METHODS: All admissions for NSB and SG to the Psychiatric Inpatient Unit of University / General Hospital Santa Maria della Misericordia, Perugia, Umbria, Italy, from January 2015 to June 2015 were included in a medical record review. Basic descriptive statistics and distributional properties of all variables were first examined. Bivariate analyses were performed using Chi-square tests for group comparisons and t-test for independent samples used when appropriated. RESULTS: The study sample included 38 patients. Of these 23 had committed NSB (13.1%), 15 had commetted SG (8.5%). Number of married NSB was significantly higher than the number of married SG (p=0.08). We found a significant difference between NSB and SG related to the item of impulse control that was poorer in SG than NSB (p=0.010). BPRS items of hostility (p=0.082), suspiciousness (p=0.042) and excitement (p=0.02) were found to be significantly higher in SG than NSB. Borderline personality disorder (p=0.032) and Passive-Aggressive personality disorder (p=0,082) diagnosed by the means of the SCID-II, were more represented in SG than NSB (p=0.044). Schizoid personality disorder was significantly related to NSB (p=0.042). No others significant differences were found. CONCLUSIONS: NSB and SG are different for many psychopathological characteristics. These results confirm the importance of classifying individuals on the basis of the intent to die. Additional research is needed to understand and elucidate psychopatological and clinical characteristics of the different categories of self-injurers to find risk factors specific to suicide attempts.

Perinatal depression: a study of prevalence and of risk and protective factors.

BACKGROUND: International literature has shown that Postpartum Depression (PPD) has a significant social and relational impact on mothers and their partners, on the interaction between mother and child, as well as on the cognitive and emotional development of the child. The goal of this study is to increase the epidemiological knowledge of PPD and to evaluate both risk and protective factors. SUBJECTS AND METHODS: Our study is based on the administration of three tests, Paykel's Life Events Scale, EPDS and MMPI-2, at three distinct time point (during the third trimester, 72 hours after delivery, and three months after delivery, respectively) to a sample of women recruited in the Prenatal Medicine Clinic at the Hospital of Perugia. The data collected was statistically analyzed. RESULTS: The prevalence of PPD 72 hours after delivery was 11%, while the prevalence of PPD three months after delivery was 16.7%. Antepartum Depression (APD), measured using EPDS cut-offs scores of 9 and 14, was found to be a statistically significant risk factor for the development of PPD, while desired life-events during pregnancy can represent a protective factor. CONCLUSIONS: The prevalence of PPD that we measured, in agreement with that found in the literature, demonstrates that despite the fact that the diagnostic criteria of the DSM-IV refer to PPD only if it develops within 4 weeks after delivery, PPD can also develop after this period. Furthermore, it appears that monitoring APD and encouraging a psycho-socially serene pregnancy are important for prevention of PPD. In the case of APD it was shown that monitoring women with even light depressive symptoms is important, because these women are more likely to then develop PPD.

Schizophrenia and obsessive-compulsive disorder: from comorbidity to schizo-obsessive disorder.

Current genetic, neurobiological, clinical-descriptive and pharmacological data about obsessive-compulsive symptoms (OCS) and/or obsessive-compulsive disorder (OCD) in schizophrenia hypothesize that schizophrenia combined with OCD is more than a mere comorbidity. To prove this hypothesis, "dimensional diagnosis", based on the identification of a dysfunctional area common to different clinical cases, should replace "categorical diagnosis", that focuses on discrete parameters that define specific disorders. It is our hope that the DSM-V will make reference to principles based on psychopathological "spectra" because these reflect the integration of pharmacotherapeutic, descriptive and etiopathogenetic aspects (genotypes common to various disorders, temperamental predispositions, neurobiological and chemical alteration). These three aspects explain how obsessive phenomena can develop into delusional phenomena.

Neural Correlates of Schizotypal Personality Disorder: A Systematic Review of Neuroimaging and EEG Studies.

BACKGROUND: Schizotypal Personality Disorder (SPD) is a cluster A personality disorder affecting 1.0% of the general population, characterised by disturbances in cognition and reality testing dimensions, affected regulation, and interpersonal function. SPD shares similar but attenuated phenomenological, genetic, and neurobiological abnormalities with Schizophrenia (SCZ) and is described as part of schizophrenia spectrum disorders. OBJECTIVE: The aim of this work was to identify major neural correlates of SPD. METHODS: This is a systematic review conducted according to PRISMA statement. The protocol was prospectively registered in PROSPERO - International prospective register of systematic reviews. The review was performed to summarise the most comprehensive and updated evidence on functional neuroimaging and neurophysiology findings obtained through different techniques (DW- MRI, DTI, PET, SPECT, fMRI, MRS, EEG) in individuals with SPD. RESULTS: Of the 52 studies included in this review, 9 were on DW-MRI and DTI, 11 were on PET and SPECT, 11 were on fMRI and MRS, and 21 were on EEG. It was complex to synthesise all the functional abnormalities found in a single, unified, pathogenetic pathway, but a common theme emerged: the dysfunction of brain circuits including striatal, frontal, temporal, limbic regions (and their networks) together with a dysregulation along the dopaminergic pathways. CONCLUSION: Brain abnormalities in SPD are similar, but less marked, than those found in SCZ. Furthermore, different patterns of functional abnormalities in SPD and SCZ have been found, confirming the previous literature on the 'presence' of possible compensatory factors, protecting individuals with SPD from frank psychosis and providing diagnostic specificity.

Social Determinants of Mental Health As Mediators and Moderators of the Mental Health Impacts of the COVID-19 Pandemic.

Contracting COVID-19, being exposed to it, or being affected by societal containment measures can have consequences that are themselves social determinants of health. Preexisting social determinants of health also drive the disproportionately high prevalence of COVID-19 infection and deaths among minority, marginalized, and other vulnerable populations. Thus, the social determinants of mental health act as both mediators and moderators of the pandemic's impacts, and like all social determinants, the effects of the pandemic are underpinned by public policies and social norms. The major economic impacts of containment measures have had cascading effects that will affect mental health for years to come.

The Influence of the Urban Environment on Mental Health during the COVID-19 Pandemic: Focus on Air Pollution and Migration-A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic caused a crisis worldwide, due to both its public health impact and socio-economic consequences. Mental health was consistently affected by the pandemic, with the emergence of newly diagnosed psychiatric disorders and the exacerbation of pre-existing ones. Urban areas were particularly affected by the virus spread. In this review, we analyze how the urban environment may influence mental health during the COVID-19 pandemic, considering two factors that profoundly characterize urbanization: air pollution and migration. Air pollution serves as a possibly risk factor for higher viral spread and infection severity in the context of urban areas and it has also been demonstrated to play a role in the development of serious mental illnesses and their relapses. The urban environment also represents a complex social context where minorities such as migrants may live in poor hygienic conditions and lack access to adequate mental health care. A global rethinking of the urban environment is thus required to reduce the impact of these factors on mental health. This should include actions aimed at reducing air pollution and combating climate change, promoting at the same time a more inclusive society in a sustainable development perspective.