Anomalous self-experiences and their relationship with symptoms, neuro-cognition, and functioning in at-risk adolescents and young adults.

Empirical and theoretical studies support the notion that anomalous self-experience (ASE) may constitute a phenotypic aspect of vulnerability to schizophrenia, but there are no studies examining the relationship of ASE with other clinical risk factors in a sample of ultra-high risk (UHR) subjects. The aim of the present study was to explore the relationship between ASE, prodromal symptoms, neurocognition, and global functioning in a sample of 45 UHR adolescents and young adults (age range 15-25years) at first contact with Public Mental Health Services. Prodromal symptoms and global functioning were assessed through the SIPS interview. ASE was evaluated through the Examination of Anomalous Self-Experience (EASE); for neurocognition, we utilized a battery of tests examining seven cognitive domains as recommended by the Measurement And Treatment Research to Improve Cognition in Schizophrenia. In the UHR group, higher levels in two domains of the EASE (stream of consciousness and self-awareness) were found in comparison with help-seeking subjects. Correlational analysis corrected for possible confounding variables showed a strong association (p>0.001) between higher EASE scores and global functioning. A principal factor analysis with Varimax rotation yielded a two-factor solution, jointly accounting for 70.58% of the total variance in the UHR sample. The first factor was comprised of SOPS domains, while the second was comprised of EASE-total, EASE-10, and GAF variables. Our findings provide support for the notion that disorders of self-experience are present early in schizophrenia and are related to global functioning. As such, they may constitute a potential marker of risk supplementing the UHR approach.

Effectiveness of short-term olanzapine in patients with bipolar I disorder, with or without comorbidity with substance use disorder.

OBJECTIVES: Prognosis of comorbid bipolar disorder (BD) and drug abuse is poor. We assessed the efficacy of olanzapine in manic or mixed BD patients, with (SUD) or without (N-SUD) comorbidity with substance use disorder (SUD) and its effect on drug abuse, days of abuse, and craving. METHODS: Eighty patients with BD-I (40 SUD) were hospitalized for a manic or mixed episode and received add-on olanzapine. Assessments were conducted at admission, discharge, and 4 and 8 weeks after discharge. Primary outcome was the proportion of responders and remitters in each group. We used a logistic regression model to adjust for possible confounders. We assessed craving and drug-abuse days with a visual analog scale and the Timeline Follow-Back. RESULTS: SUD and N-SUD were similar on response and remission, adjusted for sex, age, years ill, age at first episode, first episode depressive, number of hospitalizations, and duration of hospitalization (odds ratio, 1.09; 95% confidence interval, 1.02-2.29). Mood rating scores dropped significantly from baseline to end point in both groups. Timeline follow-back decreased in SUD from 22.5 to 7.3 at 8 weeks postdischarge, whereas craving dropped from 8.3 to 5.1 (P < 0.03). CONCLUSIONS: The effectiveness of short-term olanzapine in BD-I mania or mixed mania did not differ according to SUD comorbidity. Treatment was followed by less substance use/abuse and craving in comorbid bipolar-SUD patients.

Psychological Characteristics of Women with Perinatal Depression Who Require Psychiatric Support during Pregnancy or Postpartum: A Cross-Sectional Study.

Antenatal depression may be distinct from postpartum depression in terms of prevalence, severity of symptoms, comorbidities, prognosis, and risk factors. Although risk factors for perinatal depression have been identified, it is unclear whether there are differences in the onset of perinatal depression (PND). This study explored the characteristics of women requiring mental health support during pregnancy or postpartum. A sample of 170 women (58% in pregnancy; 42% postpartum) who contacted the SOS-MAMMA outpatient clinic was recruited. Clinical data sheets and self-report questionnaires (EPDS, LTE-Q, BIG FIVE; ECR; BSQ; STICSA) were administered, hypothesizing possible risk factors, such as personality traits, stressful life events, body dissatisfaction, attachment style, and anxiety. Hierarchical regression models were carried out in the pregnancy (F10;36 = 8.075, p < 0.001, adjR2 = 0.877) and postpartum groups (F10;38 = 3.082, p < 0.05, adjR2 = 0.809). Recent stressful life events and conscientiousness were associated with depression in both the pregnant (29.3%, 25.5% of variance) and postpartum groups (23.8%, 20.7% of variance). In pregnant women, "openness" (11.6%), body dissatisfaction (10.2%), and anxiety (7.1%) symptoms were predictive of depression. In the postpartum group, "neuroticism" (13.8%) and insecure romantic attachment dimensions (13.4%; 9.2%) were the strongest predictors. Perinatal psychological interventions should consider the differences between mothers with depression during pregnancy and postpartum.

Somatization in a primary care service for immigrants.

AIM: To study somatization in a large sample of immigrants attending a first visit to a primary care service. Differences in somatization among four large immigrant groups (Europeans, Asians, South Americans, and Africans) and 16 subgroups based on nationality were assessed. DESIGN: A total of 3105 patients were asked to participate in the study, of whom 3051 completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or higher on the BSI-21 were considered to be somatizers. A multiple logistic regression analysis adjusting for intervening variables tested the relative risk of somatization in and among the groups. RESULTS: Among the 3051 patients who completed the BSI-21, 782 (25.6%) were somatizers. Somatizers were significantly more prevalent among South Americans (30.1%). After adjusting for covariates, Asians and Europeans, but not Africans, showed a significantly lower risk of somatization compared to South Americans. Among national subgroups, somatization occurred more frequently in Peruvians (32.9%). Compared to Peruvians, migrants from Eastern Europe, Morocco, the Philippines, Sri Lanka, and El Salvador demonstrated a significantly lower risk of somatization. CONCLUSIONS: Approximately one-fourth of socially disadvantaged immigrants who accessed primary care services used somatization to express their distress. However, the likelihood of somatization varied widely among the different groups, and was significantly higher in South Americans and in some African groups, and lower in some Asian groups.

[Immigration, trauma, living difficulties and psychopathology: a preliminary study in a primary care setting]. / Immigrazione, traumi, difficoltà vitali e psicopatologia: uno studio preliminare in un setting di medicina generale.

AIM: Investigate the prevalence of Post-Traumatic Stress Disorder (PTSD), anxiety, depression and somatizations in a sample of immigrants visited in a transcultural primary care service. The relationship among psychopathological symptoms, pre-migratory events and post-migration living difficulties is also considered. METHODS: We studied 101 outpatients, attending the "Caritas" Primary Care Unit for immigrants in Rome. All participants fulfilled a socio-demographic questionnaire, a checklist of traumatic events (Harvard Trauma Questionnaire, HTQ), a checklist of post-migration living difficulties (Post-Migration Living Difficulties, PMLD) and the following questionnaires: the HTQ for the assessment of post-traumatic symptoms, the Hopkins Symptom Checklist (HSCL-25) for anxiety and depression, the Bredford Somatic Inventory (BSI) for somatization. RESULTS: 40 patients (39.60%) had an anxiety disorder, 47 (46.13%) a depressive disorder, 16 (15.84%) a PTSD and 39 (38,6%) a somatization syndrome. All these syndromes were significantly correlated. The number of traumatic events and of post-migration difficulties significantly increased the scores on the psychopathological scales. DISCUSSION: The prevalence of psychopathological syndromes in our primary care transcultural unit was high. This not only in refugees, but also in immigrants for other reasons. Moreover, the levels of psychopathological distress were significantly influenced by the number of pre-migratory traumas and of living difficulties in the host country.

Tuning the functional properties of metal complexes containing polytopic heteroaromatic nitrogen ligands.

The preparation, characterization, and optimization of the functional properties of mono- and polynuclear coordination complexes containing heteroaromatic nitrogen ligands are discussed here, taking the advantage of numerous studies performed in our laboratories on exploring a variety of different metal ions and polytopic ligands. We highlight how very minor changes in connectivity, composition, and polarity of the molecular entities employed in the self-assembly steps may significantly affect the structural, thermal, sorptive, magnetic, and mesomorphic behavior of the resulting materials. Examples from three different classes are included: 1) pyrazolate-based polynuclear coordination compounds, 2) homoleptic and heteroleptic coordination polymers, and 3) 2,2'-bipyridine metal-based liquid crystals.

The relationship between somatization and posttraumatic symptoms among immigrants receiving primary care services.

Traumatic experiences and somatization are related in studies on complex trauma, though this relation is rarely studied in immigrants. The relationship between somatization and self-reported traumatic experiences and posttraumatic symptoms in patients attending a primary care service for immigrants was studied. The sample consisted of 101 patients attending a primary healthcare service dedicated to immigrants. Participants completed two self-assessment questionnaires specifically designed for use in transcultural research: the Bradford Somatic Inventory and the Harvard Trauma Questionnaire. Both were translated and back-translated into eight languages. Somatization was significantly related to traumatic events and posttraumatic symptoms. In primary care centers for immigrants, physicians should give particular attention to somatization as a possible sign of unreported posttraumatic symptoms.

Unsuspected mesomorphism in "tail-free" cyclopalladated 3,5-disubstituted-2-(2'-pyridyl)pyrroles.

The first cyclopalladation of 3,5-disubstituted-2-(2'-pyridyl)pyrroles leads to columnar metallomesogens of non-conventional molecular shape.

Functional properties of metallomesogens modulated by molecular and supramolecular exotic arrangements.

New concepts for the synthesis of metallomesogens have been recently developed in order to use the metal centre as a scaffold for grafting different functionalities and inducing non-conventional shapes and properties in the resulting complexes. Our strategy was based on the synthesis of mesogenic coordination complexes whose molecular architectures are controlled by the modulation of different and tunable molecular motifs: the nature of the metal ion and the surrounding ligands as central unit, the number of flexible chains at the periphery, and the nature of counter-ions in ionic complexes. The appropriate choice of molecular construction motifs allows control at global architectures and induces pre-selected properties from the level of single molecule to supramolecular network, confirming that metal coordination provides a helpful tool for obtaining multifunctional soft materials.

Evolution of forensic psychiatry in Italy over the past 40 years (1978-2018).

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help.

A "jellyfish" shaped green emitting gallium(III)-containing metallomesogen.

The synthesis of the first gallium(III)-based liquid crystal has been achieved grafting around the metal centre two chelating 2-methylquinolin-8-olate anions and one monodentate 3,4,5-tris(hexadecyloxy)benzoyloxy ligand, allowing the resulting complex to be a soft luminescent material with the typical high quantum yield of pentacordinated gallium species.

Curcumin and cyclopalladated complexes: a recipe for bifunctional biomaterials.

The first examples of binuclear and mononuclear ortho-palladated complexes based on a functionalized 2-phenylquinoline ligand have been synthesized and fully characterized. Conjugating cyclopalladated fragments to curcumin family biologically active beta-diketones gives in one single molecule two different functionalities. The structural variations based on the curcuminoid structure have been tested for their in vitro cytotoxic activity. The activity of complexes comprised of a cyclopalladated fragment conjugated to functionalized bioactive ligands, represents the potential of organometallic systems in generating new bifunctional biomaterials.

Does the efficacy of asenapine in bipolar disorder increase in the presence of comorbidity with a substance use disorder? A naturalistic study.

BACKGROUND: Asenapine is a second-generation antipsychotic approved in Europe for treating moderate-to-severe manic episodes in adults affected by type I bipolar disorder (BD-I). We aimed to compare its efficacy in psychiatric inpatients with BD-I, with or without substance use disorder (SUD). METHODS: We administered flexible asenapine doses ranging from 5-20 mg/day to 119 voluntarily hospitalized patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) BD-I diagnosis, with or without SUD. Patients were assessed with clinician-rated questionnaires [i.e. Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF)]. Assessments were carried out at baseline (T0, prior to treatment), and 3 (T1), 7 (T2), 15 (T3), and 30 days (T4) after starting treatment for all clinical scales and at T0 and T4 for the GAF. RESULTS: Patients improved on all scales (p < 0.001) across all timepoints, as shown both by paired-sample comparisons and by applying a repeated-measures, generalized linear model (GLM). Patients without comorbid SUD showed greater reductions in BPRS scores at T2 and T3, greater reduction in YMRS scores at T3, and lower HARS scores at all timepoints. HDRS scores did not differ between the two groups at any timepoint. However, the reduction in HARS scores in the comorbid group was stronger than in the BD-I only group, albeit not significantly. Side effects were few and mild-to-moderate. CONCLUSIONS: The open-label design and the relatively short observation period may expose to both type I and type II statistical errors (false positive and false negatives). Asenapine showed effectiveness and safety in hospitalized BD-I patients. Its effect was stronger in patients without comorbid SUD.

Synthesis and anticancer activity of cyclopalladated complexes containing 4-hydroxy-acridine.

The synthesis and the characterization (elemental analysis, (1)H NMR and X-ray) of the first cyclopalladated complexes containing 4-hydroxyacridinate as complementary ligand are described. 4-Hydroxyacridine acts as a bidentate [N,O] chelating ligand, giving rise to square planar Pd(II) complexes in the coordination of a cyclopalladated fragment of phenylpyridine or phenylpyrimidine, characterized by the presence of two almost coplanar metalated rings. The biological activity studies conducted on these new Pd(II) complexes proved that the phenylpyridine Pd(II) derivative is more efficient than cis-platinum. The intrinsically substitutional inertness of the cyclopalladated ring and the presence of the [N,O] chelated acridine ligand make these systems of particular interest in their promising biological activity.

Acridine Orange based platinum(II) complexes inducing cytotoxicity and cell cycle perturbation in spite of GSTP1 up-regulation.

A series of new ionic Pt(II) complexes of general formula [Pt(II)(A)n(Cl)(AO)]X (A=en, NH3; n=1, 2; X-=BF4-, NO3-, PF6-, CF3SO3-), 1-5, containing Acridine Orange (AO) bound to the metal atom through the endocyclic N atom, have been tested in human melanoma cells (M14, JR8 and PLF2), human neuroblastoma cell line SH-SY5Y and its cis-platin resistant subline SH-SY5Yres. The Pt(II) compounds, and in particular complexes 1 and 4, exhibit higher cytotoxic activity at lower concentration compared to cis-DDP in melanoma cells, affecting cell growth behavior and causing cell cycle perturbation. Moreover, M14 and JR8 cell lines were not able to rescue the impairment due to the new Pt(II) complexes since perturbation of cell cycle phases and cell proliferation inhibition were found after 72 h of recovery time. In order to evaluate whether GSTP1 may play a role in chemo-resistance of our melanoma model, we investigated the effect of the treatment with these Pt(II) compounds on GSTP1 gene expression. Up-regulation of GSTP1, evaluated by Qreal-time PCR was observed after treatment with complexes 1 and 4, showing that the effect of these Pt(II) compounds is GSTP1 indipendent. The lack of resistance of the new Pt(II)-AO complexes and their cytotoxicity, cell growth and cell cycle recovery in melanoma cells provide the basis for the development of new platinum anticancer compounds, directed to those tumors that over express GSTs enzymes.

Excess in the spring and deficit in the autumn in birth rates of male schizophrenic patients in Italy: potential role of perinatal risk factors.

OBJECTIVE: The aim of this study was to evaluate whether there were different seasonal variations of births in an Italian population of patients with schizophrenia, with other psychotic disorders, and with personality disorders than in the general population. METHODS: Birth dates of 1270 patients admitted to one university psychiatric unit in Rome between 1990 and 2003, with a diagnosis of schizophrenia, other psychotic disorder (OPD) and personality disorder/cluster A (PD) were analyzed according to seasonal variation. RESULTS: A significant excess of births in spring (with a peak in May) and a deficit in autumn (with a trough in October) was found in the sample of male schizophrenics (n = 506). No statistically significant variations were found in either the sample of female schizophrenics (n = 88) or in the combined sample with OPD and PD (n = 676). CONCLUSIONS: The findings serve to strengthen the existing hypotheses that schizophrenia is related to environmental factors acting on the development of the central nervous system intrauterinely.

Characteristics of HCV positive patients in an Italian urban psychiatric unit.

OBJECTIVES: 1) to assess the prevalence of hepatitis C virus (HCV) infection in a population of acute psychiatric in-patients; 2) to find out relationships between HCV comorbidity and clinical features of psychiatric patients. METHODS: Prospective observational study in a 6-year period. RESULTS: 2396 cases (1492 patients) were admitted in the considered period. Forty-two patients (2.8%) were affected by HCV infection. HCV infection was more frequent in patients with less years of education, lower social class, lower last year best Global Assessment of Functioning score, more hostile or violent behavior in hospital, with a lifetime history of previous suicide attempt, and with substance-related disorders. CONCLUSION: HCV infection in psychiatric patients constitutes a major threat to the health of psychiatric patients and is related with unfavorable social background, worse global functioning, hostile or violent behavior, substance-related disorders. It appears also to be a significant risk of suicidal behavior.

Development of Hiccup in Male Patients Hospitalized in a Psychiatric Ward: Is it Specifically Related to the Aripiprazole-Benzodiazepine Combination?

OBJECTIVES: The aim of this study was to identify hiccup cases among patients hospitalized in a psychiatric ward and focus on their treatment, so to establish intervention risk. METHODS: We reviewed records of 354 consecutively admitted patients during the year 2013 to identify hiccup cases. RESULTS: Hiccup occurred in 7 patients on both aripiprazole and benzodiazepines and in one on delorazepam. No patient on aripiprazole alone developed hiccup. No patient on drugs other than aripiprazole or benzodiazepines developed hiccup. The symptom subsided in 3 cases upon discontinuing aripiprazole and in 5 cases after discontinuing the benzodiazepine (including the case on delorazepam alone); in 2 cases of persistent hiccup, the symptom resolved after adding the calcium channel blocker, pregabalin. All patients developing hiccup were male. There was a 70-fold increase in the risk for developing hiccup in the aripiprazole/benzodiazepine intake condition versus all other conditions, and it further increased if limiting to the male sex. LIMITATIONS: The retrospective nature of the study was its limitation. CONCLUSIONS: Hospitalized psychiatric patients on both aripiprazole and benzodiazepines may be at significant risk of hiccup. This clinical awareness could lead to antipsychotic and/or benzodiazepine discontinuation or switch or to the addition of calcium channel blocker inhibitors.

[Integrated day-hospital treatment in subjects with overeating disorders]. / Il trattamento integrato in day-hospital per i disturbi del comportamento alimentare caratterizzati da iperalimentazione.

BACKGROUND: The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). METHODS: The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. RESULTS: Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). CONCLUSIONS: The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Traumatic events, post-migration living difficulties and post-traumatic symptoms in first generation immigrants: a primary care study.

OBJECTIVES: To study potentially traumatic events (PTE), post-traumatic stress disorder (PTSD), anxiety, depression, somatization and post-migration living difficulties (PMLD) in primary care immigrants. DESIGN: Patients self-rated transculturally validated questionnaires. Those with and without PTSD were compared on all variables. The influence of the number of PTE and of PMLD on PTSD was measured. RESULTS: 391 patients completed the questionnaires. Prevalence of PTSD was 10.2%. PTE and PMLD were frequent in the whole sample but more common in PTSD subjects. Either the number of PTE and of PMLD significantly increased the likelihood to have a PTSD. CONCLUSIONS: PTE, PMLD, PTSD and related conditions (anxiety, depression and somatization) are frequent among immigrants in primary care, and either PTE and PMLD significantly influence resulting psychopathology. The implications in clinical practice are discussed.