A machine learning approach on whole blood immunomarkers to identify an inflammation-associated psychosis onset subgroup.

Psychosis onset is a transdiagnostic event that leads to a range of psychiatric disorders, which are currently diagnosed through clinical observation. The integration of multimodal biological data could reveal different subtypes of psychosis onset to target for the personalization of care. In this study, we tested the existence of subgroups of patients affected by first-episode psychosis (FEP) with a possible immunopathogenic basis. To do this, we designed a data-driven unsupervised machine learning model to cluster a sample of 127 FEP patients and 117 healthy controls (HC), based on the peripheral blood expression levels of 12 psychosis-related immune gene transcripts. To validate the model, we applied a resampling strategy based on the half-splitting of the total sample with random allocation of the cases. Further, we performed a post-hoc univariate analysis to verify the clinical, cognitive, and structural brain correlates of the subgroups identified. The model identified and validated two distinct clusters: 1) a FEP cluster characterized by the high expression of inflammatory and immune-activating genes (IL1B, CCR7, IL12A and CXCR3); 2) a cluster consisting of an equal number of FEP and HC subjects, which did not show a relative over or under expression of any immune marker (balanced subgroup). None of the subgroups was related to specific symptoms dimensions or longitudinal diagnosis of affective vs non-affective psychosis. FEP patients included in the balanced immune subgroup showed a thinning of the left supramarginal and superiorfrontal cortex (FDR-adjusted p-values < 0.05). Our results demonstrated the existence of a FEP patients' subgroup identified by a multivariate pattern of immunomarkers involved in inflammatory activation. This evidence may pave the way to sample stratification in clinical studies aiming to develop diagnostic tools and therapies targeting specific immunopathogenic pathways of psychosis.

Description of Twenty-Nine Animal Hoarding Cases in Italy: The Impact on Animal Welfare.

The hoarding of animals is a psychiatric disease, characterized by a compulsive collection of animals, with a relevant impact upon the care and welfare of animals, as well as on human society. In Italy, there are neither substantial reports nor information shared about such a phenomenon, making it difficult to draw a clear picture of the hoarder profile. Therefore, in the present work, we sought to detail 29 cases of animal accumulators in Italy, who lived within two areas of the Lazio region, and accumulated a total of 1080 animals from 2019 to 2022. In line with other international studies, we observed a prevalence of middle-aged (in their fifties) women, who lived mainly alone in a high level of social and health degradation. Most of the hoarded animals exhibited severe signs of dehydration and malnutrition, muscle hypotrophy, dermatological injuries, and behavioral disorders. Animal hoarding is not yet fully understood nor recognized as a psychosocial disorder, although it produces a deep suffering for the hoarder themselves, as well as corresponding family members, and the animals accumulated. Therefore, given the crucial impact of animal hoarding upon human and animal welfare, cross-cultural networks aimed at properly raising awareness of the problem could be established.

Classification of Psychoses Based on Immunological Features: A Machine Learning Study in a Large Cohort of First-Episode and Chronic Patients.

For several years, the role of immune system in the pathophysiology of psychosis has been well-recognized, showing differences from the onset to chronic phases. Our study aims to implement a biomarker-based classification model suitable for the clinical management of psychotic patients. A machine learning algorithm was used to classify a cohort of 362 subjects, including 160 first-episode psychosis patients (FEP), 70 patients affected by chronic psychiatric disorders (schizophrenia, bipolar disorder, and major depressive disorder) with psychosis (CRO) and 132 health controls (HC), based on mRNA transcript levels of 56 immune genes. Models distinguished between FEP, CRO, and HC and between the subgroup of drug-free FEP and HC with a mean accuracy of 80.8% and 90.4%, respectively. Interestingly, by using the feature importance method, we identified some immune gene transcripts that contribute most to the classification accuracy, possibly giving new insights on the immunopathogenesis of psychosis. Therefore, our results suggest that our classification model has a high translational potential, which may pave the way for a personalized management of psychosis.

Altered syntactic abilities in first episode patients: An inner phenomenon characterizing psychosis.

BACKGROUND: Research has consistently shown that language abilities represent a core dimension of psychosis; however, to date, very little is known about syntactic comprehension performance in the early stages of psychosis. This study aims to compare the linguistic abilities involved in syntactic comprehension in a large group of First Episode Psychosis (FEP) patients and healthy controls (HCs). METHODS: A multiple choice test of comprehension of syntax was administered to 218 FEP patients (166 non-affective FEP patients [FEP-NA] and 52 affective FEP patients [FEP-A]) and 106 HCs. All participants were asked to match a sentence they listen with one out of four vignettes on a pc screen. Only one vignette represents the stimulus target, while the others are grammatical or non-grammatical (visual) distractors. Both grammatical and non-grammatical errors and performance in different syntactic constructions were considered. RESULTS: FEP committed greater number of errors in the majority of TCGB language domains compared to HCs. Moreover, FEP-NA patients committed significantly more non-grammatical (z = -3.2, p = 0.007), locative (z = -4.7, p < 0.001), passive-negative (z = -3.2, p = 0.02), and relative (z = -4.6, p < 0.001) errors compared to HCs as well as more passive-affirmative errors compared to both HCs (z = -4.3, p < 0.001) and FEP-A (z = 3.1, p = 0.04). Finally, we also found that both FEP-NA and FEP-A committed more grammatical (FEP-NA: z = -9.2, p < 0.001 and FEP-A: z = -4.4, p < 0.001), total (FEP-NA: z = -8.2, p < 0.001 and FEP-A: z = 3.9, p =  0.002), and active-negative (FEP-NA: z = -5.8, p < 0.001 and FEP-A: z = -3.5, p = 0.01) errors compared to HCs. CONCLUSIONS: This study shows that the access to syntactic structures is already impaired in FEP patients, especially in those with FEP-NA, ultimately suggesting that language impairments represent a core and inner feature of psychosis even at early stages.

Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials.

OBJECTIVE: Various studies have tested psychological therapies in the treatment of depression in primary care. Yet, concerns over their clinical effectiveness, as compared to usual general practitioner (GP) care or treatment with antidepressants, have been raised. The present meta-analysis was aimed at assessing currently available evidence on the topic. METHOD: A systematic search of electronic databases identified 10 randomized controlled trials comparing psychological forms of intervention with either usual GP care or antidepressant medication for major depression. Meta-analytical procedures were used to examine the impact of psychological intervention in primary care on depression, as compared to usual GP care and antidepressant treatment. RESULTS: The main analyses showed greater effectiveness of psychological intervention over usual GP care in both the short term [standardized mean difference (SMD)=-0.42, 95% confidence interval (CI)=-0.59 to -0.26, n=408] and long term (SMD=-0.30, 95% CI=-0.45 to -0.14, n=433). The heterogeneity test was not significant in the short term at the P<.05 level (df=5, P=.57, I(2)=0%), but it was significant in the long term (df=5, P=.004, I(2)=70.9%). The comparison between psychological forms of intervention and antidepressant medication yielded no effectiveness differences, for either the short term or the long term. CONCLUSIONS: Psychological forms of intervention are significantly linked to clinical improvement in depressive symptomatology and may be useful for supplementing usual GP care.

Non literal language comprehension in a large sample of first episode psychosis patients in adulthood.

To date no data still exist on the comprehension of figurative language in the early phases of psychosis. The aim of this study is to investigate for the first time the comprehension of metaphors and idioms at the onset of the illness. Two-hundred-twenty eight (228) first episode psychosis (FEP) patients (168 NAP, non-affective psychosis; 60 AP, affective psychosis) and 70 healthy controls (HC) were assessed. Groups were contrasted on: a) type of stimulus (metaphors vs idioms) and b) type of response (OPEN = spontaneous explanations vs CLOSED = multiple choice answer). Moreover, a machine learning (ML) approach was adopted to classifying participants. Both NAP and AP had a poorer performance on OPEN metaphors and idioms compared to HC, with worse results on spontaneous interpretation of idioms than metaphors. No differences were observed between NAP and AP in CLOSED tasks. The ML approach points at CLOSED idioms as the best discriminating variable, more relevant than the set of pre-frontal and IQ scores. Deficits in non-figurative language may represent a core feature of psychosis. The possibility to identify linguistic features discriminating FEP may support the early recognition of patients at risk to develop psychosis, guiding provision of personalized and timely interventions.

Consensus conference on the appropriateness of palivizumab prophylaxis in respiratory syncytial virus disease.

Respiratory syncytial virus infection represents a clinical burden among young children under 24 months. Palivizumab is the only drug licensed in Italy for the prevention of serious lower respiratory tract disease requiring hospitalization caused by respiratory syncytial virus in children at high risk. However recommendations for palivizumab prophylaxis are heterogeneous. Not all the published documents agree about the clinical indications of palivizumab; this could lead to different clinical practices and concerns about the appropriateness of prophylaxis. These issues and the lack of evidence about palivizumab prophylaxis efficacy in specific medical conditions brought on the idea of a consensus conference on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications. The goal was to perform a review of the evidence regarding the efficacy and the safety of palivizumab and give recommendations in order to harmonize its use. A structured and validated method to conduct the consensus process was adopted. The consensus conference recommends palivizumab prophylaxis in infants born before 29 weeks and younger than 12 months at the start of the epidemic season. According to evidence from literature and experts' opinion, palivizumab prophylaxis is not recommended in preterm infants of gestational age ≥29 weeks, without co-morbidity (i.e., cardiac, bronchopulmonary diseases). The experts identified some clinical rare conditions for which the decision of prophylaxis should be entrusted to the specialists. The evaluation of the appropriateness of palivizumab prophylaxis in the single patient should be documented by the specialists. Pediatr Pulmonol. 2016;51:1088-1096. © 2016 Wiley Periodicals, Inc.

Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants.

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.

Diagnosis and prognosis of congenital CMV infection: a case report and review of the literature.

Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensori-neural hearing loss and neurodevelopmental sequelae. Despite these alarming facts, the general public healthcare system is often not aware of CMV and not enough is done to prevent congenital CMV infection.We describe the clinical and laboratory monitoring of a case with primary CMV infection occurring before the first trimester of gestation. Specific literature review is included in order to point out major goals achieved in the diagnosis and prognosis of congenital CMV infection and the many questions still unanswered. Serological diagnosis of primary CMV infection was performed based on serum-CMV specific-IgM antibodies, combined with low avidity anti-CMV IgG antibodies. The maternal infection was asymptomatic, as it is for most infections in immunocompetent patients. Therefore, disclosing primary infection depended on specific serological tests during the initial period of pregnancy (before weeks 12-16 of gestation). The invasive (amniocentesis) and non-invasive (ultrasonographic examination) prenatal tests, carried out at 21 weeks gestation, revealed a severe CMV infection in a fetus small for gestational age with ventriculomegaly. The presence of overt ultrasound abnormalities combined with high viral load in the amniotic fluid sampled at the appropriate times was highly suggestive of an unfavourable prognosis. The autopsy performed on the fetus confirmed severe disseminated CMV infection with histological brain damage.

Cognitive status, depressive symptoms, and health status as predictors of functional disability among elderly persons with low-to-moderate education: The Faenza Community Aging Study.

OBJECTIVE: The authors examined the impact of very early dementia and symptoms of depression on functional disability in a community-based group of 216 elderly people with low-to-moderate education level. METHODS: The combined effect of very early dementia and symptoms of depression on functional disability was assessed with a logistic-regression model in which functional disability was the dependent variable. The same model was repeated with each item on the Instrumental Activities of Daily Living scale as the dependent variable. RESULTS: Very early dementia alone was strongly associated with functional disability, and this association tripled in subjects with both very early dementia and symptoms of depression. In fact, whereas subjects with very early dementia had an 11-fold higher risk than normal persons for disability, subjects with both very early dementia and symptoms of depression showed a 37-fold higher risk for functional dependence. CONCLUSIONS: Elderly people who suffer from very early dementia and who also have symptoms of depression are at very high risk for functional disability and have a great need for accurate diagnostic assessment. If confirmed, the results are relevant for prevention because people who suffer from very early dementia and have symptoms of depression may be a suitable target group for intervention before the development of severe disability.