Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors

OBJECTIVE

Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation.

METHODS

In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected.

RESULTS

3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation.

DISCUSSION

The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.

The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis

The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.

Identification of psychological flexibility and inflexibility profiles during the COVID-19 pandemic

BACKGROUND

The first coronavirus disease 2019 (COVID-19) wave and lockdown adversely affected the lives of people in diverse ways.

AIMS

This study used a person-centered approach to identify patterns of engagement in the 12 psychological flexibility (PF) and inflexibility (PI) processes to manage the first COVID-19 wave and lockdown hardships.

MATERIALS & METHODS

A total of 1035 Italian adults completed an online survey.

RESULTS

Latent profile analyses conducted on the 12 PI/PF processes measured by the Multidimensional Psychological Flexibility Inventory identified five profiles; three reflected gradations of high to low PF with corresponding inverse levels of PI, while two represented more complex relationships between PI and PF. After controlling for relevant socio-demographic and COVID-19/lockdown factors, the five profiles differed in mental health (depression, anxiety, and COVID-19 distress). Essentially a gradient of progressive decreases in all PI processes (except experiential avoidance) corresponded with increments in mental health across all profiles. Two profiles, which evidenced the highest levels of mental health (highly flexible and moderately flexible profiles), also had the greatest proportion of the sample 56.42% (n = 584), and the highest levels of PF and experiential avoidance.

DISCUSSION

Findings from this and similar studies suggest intersecting complex relationships among the PI/PF processes that are likely to shift in response to changing contexts. We suggest this network of relationships is better represented by a three-dimensional PF/PI hexaflex than a simplistic two-dimensional depiction of the model.

CONCLUSION

Distinguishing different PF/PI profiles identified groups most at risk for the adverse mental health impacts of the pandemic and exposed variations in the mental health protective and risk roles of PF and PI processes, respectively, that can inform ACT-based mental health promotion interventions.

The efficacy of a brief acceptance-based group intervention in a sample of female patients with fibromyalgia and comorbid obesity: a randomised controlled trial

OBJECTIVES

A two-arm parallel randomised controlled trial was conducted to evaluate the efficacy of a group acceptance-based treatment (ABT) in improving pain acceptance, pain catastrophising, kinesiophobia, pain intensity and physical functioning compared to treatment as usual in patients with fibromyalgia (FM) and comorbid obesity.

METHODS

Female individuals diagnosed with FM and obesity (n = 180) were randomly assigned to either a three-weekly group acceptance-based treatment plus treatment as usual (ABT+TAU) or only TAU. The variables of interest were assessed at baseline (T0) and after the interventions (T1). The treatment protocol for the ABT+TAU condition, designed for an inpatient rehabilitation context, is based on acceptance and commitment therapy but focuses specifically on pain acceptance, a crucial factor in fostering a more functional adaptation to chronic pain.

RESULTS

Participants in the ABT+TAU group showed significant improvements in pain acceptance (i.e. the primary outcome), but also in pain catastrophising, kinesiophobia, and performance-based physical functioning (i.e. the secondary outcomes) compared to those in the TAU group. However, there were no significant differences in pain intensity between the two groups.

CONCLUSIONS

These findings indicate that a brief group-based ABT intervention is effective in enhancing pain acceptance, reducing pain catastrophising and kinesiophobia, and improving performance-based physical functioning. Furthermore, the observed improvements in kinesiophobia and physical functioning may have particular relevance for individuals with comorbid obesity, as they can facilitate greater adherence to physical activity and promote weight loss.

A Risk Profile for Disordered Eating Behaviors in Adolescents with Type 1 Diabetes: A Latent Class Analysis Study

(1) Background: This multi-center study aimed to identify a risk profile for disordered eating behaviors (DEBs) in youth with type 1 diabetes (T1D) based on their dietary intake, lipid profile, body mass index (BMI-SDS), and glycometabolic control. (2) Methods: Adolescents aged 11 to 18 years from five centers across Italy were recruited. Lipid profile, HbA1c, BMI-SDS, and dietary intake data were collected. The risk for developing DEBs was assessed via the Diabetes Eating Problems Survey-R (DEPS-R) questionnaire. A latent class analysis (LCA) was performed using a person-centered approach. (3) Results: Overall, 148 participants aged 11–18 (12.1, ±3.34), 52% males with a mean diabetes duration of 7.2 (±3.4), were enrolled. Based on the results of the DEBS-R score, LCA allowed us to highlight two different classes of patients which were defined as “at-risk” and “not at-risk” for DEB. The risk profile for developing DEBs is characterized by higher BMI—SDS (23.9 vs. 18.6), higher HbA1c (7.9 vs. 7.1%), higher LDL cholesterol (99.9 vs. 88.8 mg/dL), lower HDL cholesterol (57.9 vs. 61.3 mg/dL), higher proteins (18.2 vs. 16.1%), and lower carbohydrates (43.9 vs. 45.3%). Adolescents included in the “at-risk” class were significantly older (p = 0.000), and their parents’ SES was significantly lower (p = 0.041). (4) Conclusions: This study allowed us to characterize a risk profile for DEBs based on dietary behavior and clinical parameters. Early identification of the risk for DEBs allows timely intervention and prevention of behavior disorders.

The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis

OBJECTIVE

The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain.

METHODS

A total of 67 patients (71.6% female, M_age = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire.

RESULTS

Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η² = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6).

CONCLUSION

Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.

Caregiving Responsibilities and Mental Health Outcomes in Young Adult Carers during the COVID-19 Pandemic: A Longitudinal Study

This study investigated caregiving responsibilities and associated mental health outcomes in young adult carers during the COVID-19 pandemic and had three aims: (1) to investigate differences in caregiving responsibilities across two groups of young adult carers (parental illness context vs. ill non-parent family member context) relative to non-carers, (2) to identify COVID-19/lockdown correlates of caregiving responsibilities, and (3) to examine the longitudinal associations between caregiving responsibilities and mental health outcomes. Of the 1048 Italians aged 18-29 (Mage = 24.48, SDage = 2.80; 74.33% female) who consented to complete online surveys at Time 1, 813 reported no ill family member (non-carers). Young adult carers included 162 with an ill parent and 73 with an ill non-parent family member. The study included 3 time points: 740 participants completed Time 2 assessment (Mage = 24.35, SDage = 2.81; 76.76% female), while 279 completed Time 3 assessment (Mage = 24.78, SDage = 2.72; 79.93% female). Key variables measured were 13 COVID-19/lockdown factors at Times 1 and 2, caregiving responsibilities at Time 2, and mental health outcomes at Time 3 (fear of COVID-19, anxiety, depression, wellbeing). Two COVID-19/lockdown factors were significantly correlated with higher caregiving responsibilities: insufficient home space, and greater time spent working and learning from home. As predicted, young adult carers reported higher caregiving responsibilities than non-carers, and this effect was greater in young adults caring for an ill parent compared to young adults caring for an ill non-parent family member. As expected, irrespective of family health status, caregiving responsibilities were longitudinally related to poorer mental health outcomes, operationalised as higher fear of COVID-19, anxiety, and depression, and lower wellbeing. Elevated young adult caregiving is an emerging significant public health issue that should be addressed through a multipronged approach that includes education about young adult carer needs for personnel across all relevant sectors and flexible care plans for ill family members that include a 'whole family' biopsychosocial approach.

Maladaptive Daydreaming and Its Relationship with Psychopathological Symptoms, Emotion Regulation, and Problematic Social Networking Sites Use: a Network Analysis Approach

The present study investigated the patterns of mutual associations between maladaptive daydreaming-related variables (MD, i.e., interference with life and somatosensory retreat), psychopathological symptoms (i.e., depression, anxiety, somatization, obsessive–compulsive, interpersonal sensitivity, psychoticism), emotion regulation strategies (i.e., cognitive reappraisal and expressive suppression), and problematic social networking sites use (PSNSU). A total of 531 young adults completed self-report measures through an online survey shared on social network groups. Two network models were performed on 297 young adults with probable MD (MDers) (Mage = 23.2, SD = 2.7) vs. 234 non-MDers (Mage = 23.4, SD = 2.6). Results showed that, compared to non-MDers, MDers showed significantly higher scores in all the study variables, except for cognitive reappraisal. Moreover, in the MDers network, the following patterns were identified: (i) no connections between the cluster of psychopathological symptoms, and neither cognitive reappraisal nor expressive suppression; (ii) a connection, through obsessive–compulsive (OC) symptoms, between the cluster of psychopathological symptoms and MD-interference with life; and (iii) a connection between PSNSU and MD-interference with life. Accordingly, the Network Comparison Test evidenced that the network structures of MDers vs. non-MDers were significantly different (M = .24; p = .01). Overall, higher scores on psychopathological symptoms in MDers provide support to the assumption that MD is a clinical condition, in which OC symptoms may play a critical role. Additionally, the association of PSNSU and MD-interference with life suggests that MDers might rely on PSNSU as a maladaptive emotion regulation strategy. Under this scenario, MD may be regarded as a potential vulnerability factor for PSNSU.

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale–Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study

BACKGROUND

Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles.

METHODS

A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles.

RESULTS

Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period.

LIMITATIONS

A reliance on self-report measures and convenience sampling constitute key study limitations.

CONCLUSIONS

Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Suicidal Thinking and Behavior in First Episode Schizophrenia: Findings from the 24-Month Follow-Up of the "Parma Early Psychosis" Program

Although suicide risk is relevant in First Episode Schizophrenia (FES), little data are reported on suicidal ideation and its longitudinal stability. Aim of this study was: (1) to evaluate incidence rates of suicide attempts, completed suicide and suicidal thinking in FES patients at baseline and along a 24-month follow-up period, (2) to investigate any relevant association of baseline suicidal ideation with psychopathology, and (3) to longitudinally monitor suicidal thinking during the 2-years of follow-up. Participants (n = 149; age = 12-35 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale. FES participants showed a 40.8% percentage of baseline suicidal ideation (i.e., BPRS item 4 cutoff score of ≥3) and a 2-year cumulative incidence rate of attempted suicide of 6.1%. One completed suicide (0.7%) was also found during the follow-up. Baseline suicidal ideation was positively correlated with depression and negatively correlated with younger age. These results support a routine monitoring of suicide risk in this young population at the point of entry into early intervention services.

Young Adult Carers during the Pandemic: The Effects of Parental Illness and Other Ill Family Members on COVID-19-Related and General Mental Health Outcomes

The mental health impacts of the COVID-19 pandemic on young adult carers have been neglected. This study aimed to identify COVID-19 related risk factors for young adult carers and to investigate their mental health relative to non-carer peers. Of the 1823 Italians aged 18–29 who completed an online survey, 1458 reported no ill family member (non-carers). Young adult carers included 268 with an ill parent, and 97 with an ill non-parent family member. Two mental health outcome categories were measured: COVID-19-related (risky health behaviors, loneliness, home violence, fear of COVID-19) and general (anxiety, depression, wellbeing). Six COVID-19 related risk factors were significantly correlated with poorer mental health in young adult carers. These factors constituted a COVID-19 Context Index. Compared to non-carers, young adult carers reported poorer mental health across all outcomes, as expected. The prediction that young adult carers caring for an ill parent would report poorer mental health than those caring for ill non-parent family members was evident only for the COVID-19-related mental health outcomes. The elevated rates of clinically significant distress and pandemic-related mental health problems among young adult carers highlight this group as a priority for mental health promotion interventions and whole-of-family support across multiple sectors.

Personal health budget in patients with first episode psychosis: A new rehabilitation model based on a community care system in Italy

AIM

Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first-episode psychosis (FEP) across a 2-year follow-up period.

METHODS

Participants (n = 104; 18-50 years) were recruited within the 'Parma-Early Psychosis' program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed-design analysis of variance (ANOVA) and Kaplan-Maier survival analysis (as drop-out measure) were performed.

RESULTS

A significant effect of time on all BPRS, HoNOS and GAF scores along the follow-up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed-design ANOVA results showed a significant 'time x group' interaction effects on BPRS 'Disorganization', HoNOS 'Psychiatric Symptoms' and GAF scores in FEP participants with PHB. Kaplan-Meyer survival analysis showed a longer survival mean for FEP patients with PHB.

CONCLUSIONS

Our results support the applicability of a PHB model within an 'Early Intervention in Psychosis' program in public community mental health services.

Mental Pain, Psychological Distress, and Suicidal Ideation During the COVID-19 Emergency: the Moderating Role of Tolerance for Mental Pain

The psychosocial stressors related to the ongoing COVID-19 pandemic and associated lockdowns have been shown to lead to an exacerbation of suicide risk. The present study aims to examine (a) the contribution of mental pain intensity to psychological distress and suicidal ideation during the COVID-19 pandemic and (b) the protective role of mental pain tolerance in buffering these adverse mental health effects. A total of 652 adults (74.2% female, M = 33.99 years, SD = 13.74) were assessed through an online survey during the first mandatory lockdown in Italy. Participants completed measures of mental pain intensity and tolerance, psychological distress, and suicidal ideation. Results showed that mental pain intensity significantly predicted increases in psychological distress and suicidal ideation while mental pain tolerance significantly buffered the adverse effects of mental pain intensity on psychological distress and suicidal ideation. The findings highlight that tolerance for mental pain may act as a powerful protective factor during the pandemic. Evidence-based public health interventions fostering tolerance for mental pain during a pandemic are needed in order to effectively reduce suicide in potential risk groups.

Personal Health Budget as a new rehabilitation model for severe mental illness within a caring community: An Italian evaluation study of beneficial effects

OBJECTIVE

Personal Health Budget has been provided to consumers with severe mental illness within a policy shift toward a person-tailored mental healthcare treatment based on individual unmet needs. Evidence of beneficial effects of Personal Health Budget is still scarce. The aim of this study was to provide preliminary data on clinical and social benefits of adding Personal Health Budget to a standard pharmacotherapy in patients with severe mental illness across a 24-month follow-up period.

METHODS

Participants (n = 137) were individuals with severe mental illness, aged 18-50 years, recruited in one of the adult mental health services of the Parma Department of Mental Health. They completed the Global Assessment of Functioning scale, the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale. This age range was chosen to limit Personal Health Budget interventions to adults with a non-prolonged illness duration. Friedman's test for repeated measure was used to assess the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also performed.

RESULTS

A significant decrease in all Global Assessment of Functioning scale, Health of the Nation Outcome Scale and Brief Psychiatric Rating Scale scores along the 24 months of follow-up was observed. Regression analysis results specifically showed a relevant association between a Personal Health Budget multiaxial intervention and the longitudinal reduction in Brief Psychiatric Rating Scale 'Negative Symptoms' and Health of the Nation Outcome Scale 'Social Problems' subscores.

CONCLUSION

Our findings support the useful implementation of a Health of the Nation Outcome Scale approach for severe mental illness patients within the Italian mental health service network.

Therapeutic Factors in a Psychiatric Group Therapy: a Preliminary Validation of Therapeutic Factors Inventory-8, Italian Version

Several studies support group therapy effectiveness due to the activation in patients of unique psychological mechanisms defined as non-specific therapeutic factors (Therapeutic Factors-TFs), which shape the setting and, at the same time, enhance the specific group therapeutic factors. The objectives of this study were to preliminarly validate Therapeutic Factors Inventory-8 (TFI-8) Italian version and identify group therapeutic factors. In a psychiatric residential facility, a weekly psychotherapeutic group was evaluated during 1 year. One scale on group process (TFI-8, Ferrara-Group Experience Scale) and three clinical scales (Brief Symptom Inventory-53, Sheehan Disability Scale, WHO Quality of Life-Bref) were administered to participating patients. Internal consistency, Exploratory Factor Analysis (EFA), convergent validity of TFI-8 were assessed. Correlations between TFI-8 and other scale scores and selected variables were pwerformed. Our sample consisted of 64 participants. TFI-8 showed good internal consistency (Chronbach's alpha = 0.84), concurrent validity with Fe-GES (Rho = 0.42, p = 0.0008). EFA highlighted a single Factor, accounting for 92% of variance. TFI-8 was not significantly related to clinical scale scores. TFI-8 Italian version proved to be a valid and reliable tool which allowed us to identify one therapeutic factor indicating relational attraction in group therapy, composed of three dimensions: infusion of hope, cohesion and social learning.

The 'Parma-Early Psychosis' programme: Characterization of help-seekers with first episode psychosis

AIM

Research on early psychosis paradigm has demonstrated the importance of early intervention (EI) in reducing illness severity and persistence. From January 2013, the Parma Department of Mental Health developed a specific care pathway [the 'Parma-Early Psychosis' (Pr-EP) programme] as a diffused EI infrastructure aimed to offer an evidence-based protocol of care to help-seekers with a first episode psychosis (FEP). Aim of this study was to investigate sources of referral, drop-out rate, sociodemographic and clinical characteristics of patients enrolled in the Pr-EP programme during the first 6 years of activity.

METHODS

Participants (n = 279) were individuals (aged 12-54 years) completing an ad-hoc socio-demographic/clinical schedule.

RESULTS

At baseline, the most frequent diagnoses were schizophreniform disorder (30.5%) and schizophrenia (29.4%). Only 31 (11.1%) subjects dropped out during the first year of treatment. FEP participants were mainly referred by general practitioners (36.9%) and emergency room/general hospital (28.7%). FEP individuals who were referred by emergency room/general hospital showed a higher percentage of current suicidal ideation compared to those entering the Pr-EP protocol through other sources of referrals.

CONCLUSIONS

EI in FEP help-seekers within Italian public mental health services is feasible and desirable, also in adolescence, where the risk of falling through the child-adult service gap is high.

Examination of the tripartite model of youth caregiving in the context of parental illness

OBJECTIVE

This study refined the conceptualisation of youth caregiving by testing the tripartite model of youth caregiving proposed by Pakenham and Cox, comprising caregiving responsibilities, experiences, and tasks. We also investigated convergent validity of the model by examining the unique and joint contributions of the three youth caregiving components to youth adjustment outcomes.

DESIGN

A total of 681 Italian youth, 325 young carers and 356 non-carers, aged 11 to 24 years participated in a cross-sectional study.

MAIN OUTCOME MEASURES

Participants completed a questionnaire assessing demographics, youth caregiving, and psychosocial adjustment.

RESULTS

Confirmatory factor analyses revealed that compared to a one-factor model, the three-factor youth caregiving model provided a better fit to the data in the young carer and non-carer subgroups. The three youth caregiving components predicted variations in youth adjustment. Caregiving experiences were the strongest predictor of poorer youth adjustment while caregiving tasks predicted improvement in two youth adjustment outcomes in diverse youth caregiving contexts.

CONCLUSIONS

Findings support the validity of a three-factor model of youth caregiving, indicating that caregiving responsibilities, experiences, and tasks represent empirically distinct but related youth caregiving components. Interventions should mitigate the adverse and cultivate the positive effects of youth caregiving.

New insights on metal allergy in total joint arthroplasty

Metal allergy is an uncommon and not completely understood cause of failure in total joint arthroplasty (TJA). However, either immunopathology neither histologic studies clarified the mechanisms through which the metal ions could lead to the complications related to them. The lack of evidence around this topic also reflects the difficulties to diagnose the MRP in TJA. In fact, the diagnosis is generally based on the exclusion of other causes. Currently, skin-patch testing and lymphocyte transformation test (LTT) are being commonly used to investigate about metal hypersensitivity and a delayed type-IV hypersensitivity is the immuno-histologic response to metals involved in TJA loosening. A review of the recent publications about this topic has been made focusing on immunology, histopathology, and clinics to better understand a still debated topic in orthopedic practice.

Tolerance for Mental Pain Scale (TMPS): Italian validation and evaluation of its protective role in depression and suicidal ideation

Mental pain and tolerance for mental pain have been receiving international recognition as transdiagnostic constructs related to many psychiatric conditions as well as increased probability of suicide. The purpose of this study was to adapt and validate the Tolerance for Mental Pain Scale (TMPS) in Italian and to examine its protective role in depression and suicidal ideation. To this aim, psychometric proprieties of the instrument were explored as well as their association with depression and suicidal ideation on an Italian adult community sample (N = 204). Participants filled out the TMPS together with scales tapping intensity of mental pain, depression and other clinically relevant variables. Compared to the original version, the TMPS-10 demonstrated better psychometric properties and was validated in Italian. The two-factor structure of the Italian TMPS-10 (Managing the Pain, Enduring the Pain) was replicated. The instrument showed adequate construct validity and gender measurement invariance. Furthermore, regression analyses evinced a significant protective role of tolerance for mental pain in depressive symptomatology and suicidal ideation. The Italian TMPS-10 is a valid and reliable measure to assess tolerance for mental pain and seems to be a promising instrument to identify those at risk for depressive psychopathology and suicide.

Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one's chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.

Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach

BACKGROUND

The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings.

METHODS

Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data).

RESULTS

Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them.

CONCLUSIONS

RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.

Suicidal Ideation in Patients Experiencing a First-episode Psychosis: Findings From the 2-Year Follow-up of the "Parma Early Psychosis" Program

OBJECTIVE

Although suicide behavior is relevant in first-episode psychosis (FEP), little is known about suicidal ideation and its longitudinal stability. The aim of this study was (1) to assess incidence rates of suicide attempts, completed suicide, and suicidal thinking in FEP individuals at baseline and over a 24-month follow-up period; (2) to explore any significant association of suicidal ideation with psychopathology at baseline; and (3) to monitor longitudinally suicidal thinking along the 2-year follow-up.

METHODS

Participants (134 FEP patients, aged 13-54 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was also performed.

RESULTS

FEP patients showed a 31.3% percentage of suicidal ideation (i.e., BPRS item 4 cutoff score of ≥ 3) and a 2-year cumulative incidence rate of attempted suicide of 11%. No completed suicide was found. In the FEP total sample, suicidal thinking was positively correlated with general psychopathology (especially depression) and negative symptoms.

CONCLUSIONS

Suicidal ideation is relevant in FEP patients, supporting a routine monitoring of suicide risk during the baseline assessment of adolescents and adults with early psychosis.

Deep representation learning of electronic health records to unlock patient stratification at scale

Deriving disease subtypes from electronic health records (EHRs) can guide next-generation personalized medicine. However, challenges in summarizing and representing patient data prevent widespread practice of scalable EHR-based stratification analysis. Here we present an unsupervised framework based on deep learning to process heterogeneous EHRs and derive patient representations that can efficiently and effectively enable patient stratification at scale. We considered EHRs of 1,608,741 patients from a diverse hospital cohort comprising a total of 57,464 clinical concepts. We introduce a representation learning model based on word embeddings, convolutional neural networks, and autoencoders (i.e., ConvAE) to transform patient trajectories into low-dimensional latent vectors. We evaluated these representations as broadly enabling patient stratification by applying hierarchical clustering to different multi-disease and disease-specific patient cohorts. ConvAE significantly outperformed several baselines in a clustering task to identify patients with different complex conditions, with 2.61 entropy and 0.31 purity average scores. When applied to stratify patients within a certain condition, ConvAE led to various clinically relevant subtypes for different disorders, including type 2 diabetes, Parkinson's disease, and Alzheimer's disease, largely related to comorbidities, disease progression, and symptom severity. With these results, we demonstrate that ConvAE can generate patient representations that lead to clinically meaningful insights. This scalable framework can help better understand varying etiologies in heterogeneous sub-populations and unlock patterns for EHR-based research in the realm of personalized medicine.

Psychosocial adjustment of young offspring in the context of parental type 1 and type 2 diabetes: a systematic review

AIMS

To identify all available research on psychosocial outcomes in young people who have a parent with type 1 or type 2 diabetes.

METHODS

Embase, PsychInfo, Scopus, Web of Science, PubMed and ProQuest Social Sciences databases were searched according to a registered study protocol (PROSPERO CRD42019125301). Quality assessment, data extraction and data synthesis were carried out.

RESULTS

The initial search yielded 11 599 articles, 10 of which met the criteria for this review: six for type 1 diabetes and four for type 2 diabetes. Through thematic analysis, five categories emerged related to offspring psychosocial adjustment: offspring mental health, offspring physical health, offspring personal resources, parental illness characteristics and offspring caregiving. Overall, there were few studies focusing solely on the effects of parental type 1 and type 2 diabetes on young people. From the limited available research, there is weak evidence suggesting both parental types of diabetes can adversely impact young offspring. Illness-related variables were only explored in parental type 1 diabetes studies, while offspring caregiving was only examined in parental type 2 diabetes studies.

CONCLUSIONS

Research on the effects of parental diabetes on young people is scarce; however, there was weak evidence to suggest some young people are at risk of adverse psychosocial impacts. Given the rise in the incidence of diabetes globally, there is a pressing public health need to conduct more rigorously designed studies to ascertain the extent to which young people are at risk of mental and physical health problems and to identify risk and protective factors associated with youth adjustment in the context of parental diabetes.

The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy

The Moderating Roles of Psychological Flexibility and Inflexibility on the Mental Health Impacts of COVID-19 Pandemic and Lockdown in Italy. Preliminary data suggest the COVID-19 pandemic has adverse effects on mental health in approximately a quarter of the general population. Few prior studies have identified contextual risk factors and no published study has explored factors that might moderate their adverse effects on mental health. Psychological flexibility is the cornerstone of psychological health and resiliency. This study investigated the roles of psychological flexibility and inflexibility in moderating the effects of COVID-19 risk factors on three mental health outcomes: COVID-19 peritraumatic distress, anxiety, depression. We hypothesized that psychological flexibility would mitigate and psychological inflexibility would exacerbate the adverse effects of COVID-19 risk factors on mental health. During the Italian national lockdown (M = 39.29 days, SD = 11.26), 1035 adults (79% female, M = 37.5 years, SD = 12.3) completed an online survey. Twelve COVID-19 risk factors were identified (e.g. lockdown duration, family infected by COVID-19, increase in domestic violence and in unhealthy lifestyle behaviours) and constituted a COVID-19 Lockdown Index. As predicted, results showed that after controlling for sociodemographic variables, global psychological flexibility and four of its sub-processes (self-as context, defusion, values, committed action), mitigated the detrimental impacts of COVID-19 risk factors on mental health. In contrast and as expected, global psychological inflexibility and four of its sub-processes (lack of contact with present moment, fusion, self-as-content, lack of contact with personal values) exacerbated the detrimental impacts of COVID-19 risk factors on mental health. Findings converge with those from the broader psychological flexibility literature providing robust support for the use of ACT-based interventions to promote psychological flexibility and mental health during the COVID-19 pandemic.

Validation of the Italian Young Carer of Parents Inventory-Revised (YCOPI-R)

Purpose: Parental illness or disability has wide ranging impacts on offspring. Due to the lack of an Italian contextually sensitive measure of youth caregiving, this study explored the factor structure, reliability, and validity of the Italian version of the Young Carer of Parents Inventory-Revised (YCOPI-R).Materials and methods: Seven hundred and seventy-four youth aged 11-24 (386 young carers and 388 young non-carers) completed a questionnaire regarding youth caregiving, parental illness, caregiving context variables, and youth adjustment.Results: The Italian YCOPI-R demonstrated good psychometric properties. Part A factor structure was replicated while two new factors emerged for Part B: Caregiving Stigma and Caregiving Resentment. Discriminant and convergent validity were evinced by differentiation between young carers and non-carers and associations between YCOPI-R factors and measures of caregiving activities and caregiving context. Predictive validity was supported as most Italian YCOPI-R factors were related to poorer youth adjustment, while Caregiving Confidence and Worry about Parents predicted higher levels of health-related quality of life.Conclusions: The Italian YCOPI-R is a psychometrically sound measure of caregiving experiences in Italian youth. Findings confirm the multidimensional nature of youth caregiving, the mix of costs and rewards associated with it, and the link between youth caregiving and diverse adjustment outcomes.Implications for rehabilitationGiven the global rise in the number of youth caring for an ill or disabled family member and the association between youth caregiving and greater risks for mental and physical health problems, elevated youth caregiving is a significant public health issue.The Italian version of the YCOPI-R is a valid and reliable measure of youth caregiving experiences in the Italian context.The Italian YCOPI-R offers a promising tool for better identifying young carers who are at risk for adverse psychosocial outcomes and in evaluating young carer support services and preventive interventions.

Negative symptom configuration in first episode Schizophrenia: findings from the "Parma Early Psychosis" program

Purpose: Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology. Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS).Materials and Methods: All 147 participants, aged 12-35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptom structure in the FES total sample.Results: A 2-factor model (i.e. "Expressive Deficits" and "Asociality" dimensions) was identified. Only "Expressive Deficits" domain had a significant negative correlation with baseline GAF score.Conclusions: This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services.

Experimental Determination of Irreversible Entropy Production in out-of-Equilibrium Mesoscopic Quantum Systems

By making use of a recently proposed framework for the inference of thermodynamic irreversibility in bosonic quantum systems, we experimentally measure and characterize the entropy production rates in the nonequilibrium steady state of two different physical systems-a micromechanical resonator and a Bose-Einstein condensate-each coupled to a high finesse cavity and hence also subject to optical loss. Key features of our setups, such as the cooling of the mechanical resonator and signatures of a structural quantum phase transition in the condensate, are reflected in the entropy production rates. Our work demonstrates the possibility to explore irreversibility in driven mesoscopic quantum systems and paves the way to a systematic experimental assessment of entropy production beyond the microscopic limit.

Factor V Gene Mutation Is a Risk Factor for Cerebral Venous Thrombosis

To evaluate the association between coagulation defects and cerebral venous thrombosis, a case-control study was conducted in 25 patients who had no autoimmune, neoplastic or infectious disease and 75 healthy individuals. There were no patients with deficiency of protein C or protein S. Four had resistance to activated protein C (APC) and one had APC resistance associated with antithrombin deficiency. APC resistance was investigated by DNA analysis, and diagnosed by the presence of a point mutation in the factor V gene, which predicts replacement of Arg506 with Gin at one of the two APC cleavage sites in activated factor V. The prevalence of APC resistance was 20% in patients and 2.7% in controls. This difference was statistically significant (p = 0.01) and the odds ratio was 9.1. A circumstantial factor predisposing to cerebral venous thrombosis (such as oral contraceptive intake, pregnancy, puerperium, trauma or prolonged immobilization) was reported in 72% of cases. In conclusion, APC resistance is the most frequent coagulation abnormality associated with cerebral venous thrombosis.

Doppler Flowmetry and the Diagnosis of Breast Lumps

The aim of the study was to ascertain the reliability of a Doppler signal in the diagnosis of breast cancer. Computerized blood flow analysis was performed on 117 patients who presented with a breast lump at the Division of Diagnostic Oncology of the Istituto Nazionale Tumori of Milan. The values of systolic peak and diastolic frequency were evaluated in relation to the histologic diagnosis. Ten patients had a spontaneous regression of the lump and were excluded from the study. The number of evaluable cases with histologic confirmation was 107: 69 carcinomas and 38 benign lesions. Systolic peak values for the 69 carcinomas ranged from 1500 to 7400 Hz, with a mean value of 3243.4 Hz; diastolic frequency ranged from 200 to 3700 Hz, with mean value of 1413.9 Hz. No diagnostic signals were found in 4 breast cancers (false negatives). Twenty-three of 38 benign lesions (60.5 %) and 65 of 69 malignant nodes (94.2 %) were correctly diagnosed. The Doppler signal with computerized spectral analysis in addition to more specific ultrasonographic parameters could be considered a useful tool in the diagnosis of breast cancer.

Clinical improvement, relapse and treatment adherence with paliperidone palmitate 1-month formulation: 1-year treatment in a naturalistic outpatient setting

PURPOSE

To evaluate paliperidone palmitate 1-month formulation (PP1M) effectiveness in a naturalistic outpatient psychiatric setting.

MATERIALS AND METHODS

We collected data from 50 outpatients affected by schizophrenia disorders treated with PP1M for 12 months in an Italian Mental Health Department. After analyzing selected demographic, clinical and pharmacological variables, we performed mirror analysis to compare psychiatric hospitalizations and urgent consultations required by the same patient 6 and 12 months before and after PP1M implementation (primary outcome). We analyzed clinical improvement in symptom (Clinical Global Impression-severity and improvement) and functioning (Global Assessment of Functioning) scales and drop-out rate during the 12-month PP1M treatment (secondary outcome). Data were statistically analyzed.

RESULTS

The mean PP1M dose was 93.5 mg (±27.7 SD) with a mean interval between each injection of 27.1 d (±4.5 SD). Twenty-three patients (46%) reported adverse effects (sexual dysfunctions, weight gain and extrapyramidal symptoms).Fifteen patients (30%) dropped out after 137.2 d (±103.1 SD) on average: six due to the lack of therapeutic adherence, six due to inefficacy and three due to adverse events. The drop-out patients presented more severe clinical profile in CGI-S and GAF scores at T0 in comparison with others. At mirror analysis, 12-month but not 6-month PP1M treatment statistically significantly reduced psychiatric hospitalizations (t = 2.3, p < .05) and urgent consultations (t = 2.1, p < .05). Both scale scores showed statistically significant improvement at T12 in comparison to T0.

CONCLUSIONS

This naturalistic study indicates that long-term PP1M treatment was safe and effective in preventing hospitalizations and urgent consultations as well as in improving clinical course.

Transcranial Random Noise Stimulation Does Not Improve Behavioral and Neurophysiological Measures in Patients with Subacute Vegetative-Unresponsive Wakefulness State (VS-UWS)

Background: The absence of efficient treatments capable to promote central nervous system recovery in patients in vegetative state (VS) due to a severe acquired brain injury highlights the need of exploring alternative neuromodulatory treatments that can lead to neurobehavioral gains. Some encouraging preliminary observations suggest that transcranial direct current stimulation could be effective in disorders of consciousness (DoC) patients, especially when applied on the dorsolateral prefrontal cortex (DLPFC) in patients with minimally conscious state (MCS) but not in those with VS. Objective: The primary aim of the present study was to verify if the application of transcranial random noise stimulation (tRNS) on the DLPFC might favor improvements of consciousness recovery in subacute VS-UWS. Methods: Nine patients with DoC due to traumatic brain injury (n = 1), anoxia (n = 3), and vascular damage (n = 5), have undergone a randomized, double-blind, sham-controlled, neuromodulatory trial with tRNS of bilateral DLPFC. All patients were in a post-acute phase and the DoC onset ranged from 30 days to 4 months. The diagnosis of DoC was based on internationally established criteria from the Multi-Society Task Force on PVS, and classified as VS or MCS using the JFK Coma Recovery Scale-Revised scores (CRS-R). We used CRS-R, Synek Scale, Ad-Hoc semi-quantitative scale and the Clinical Global Impression-Improvement scale to measure behavioral and electrophysiological changes during tRNS intervention. All patients were also treated with daily conventional rehabilitation treatment. Results: No significant differences emerged between active and sham groups regarding improvements of level of consciousness, as well as on electroencephalographic data. Only one patient showed emergence from VS-UWS, evolving from VS to MCS after the tRNS stimulation, at a distance of 3 weeks from the enrolment into the study. Conclusion: Repeated applications of tRNS of the DLPFC, even if applied in a subacute phase of VS-UWS state, did not modify behavioral and neurophysiological outcomes differently than sham stimulation.

Differences between graphene and graphene oxide in gelatin based systems for transient biodegradable energy storage applications

A comparison between graphene flakes and graphene oxide as filler in gelatin based systems for low-cost transient biodegradable energy storage applications has been carried out. The two bio-composites have been prepared and characterized by rheological measurements, cyclic voltammetry measurements, chronopotentiometry measurements and impedance spectroscopy. Differences in dielectric and mechanical properties have been correlated to the different structural organizations determinate by the hydrophobic/hydrophilic character of the used filler. In particular, the addition of the graphene oxide to the gelatin causes an increase in the elastic modulus with a parallel increase in the mechanical stability with time as compared to the composites obtained by adding graphene. Conversely, the surface capacitance is slightly increased by the graphene oxide addition compared to the pure gelatin sample. On the other hand, the introduction of the graphene flakes into the gelatin leads to a marked increase of the dielectric properties of the resulting bio-composite.

Light irradiation tuning of surface wettability, optical, and electric properties of graphene oxide thin films

In this work the preparation of flexible polymeric films with controlled electrical conductivity, light transmission and surface wettability is reported. A drop casted graphene oxide thin film is photo-reduced at different levels by UV light or laser irradiation. Optical microscopy, IR spectroscopy, electrical characterization, Raman spectroscopy and static water contact angle measurements are used in order to characterize the effects of the various reduction methods. Correlations between the optical, electrical and structural properties are reported and compared to previous literature results. These correlations provide a useful tool for independently tuning the properties of these films for specific applications.

Weight control and behavior rehabilitation in a patient suffering from Prader Willi syndrome

BACKGROUND

This study reports a case of Prader Willi syndrome (PWS), a genomic imprinting disease related to chromosome regions 15q11.2-q13 15, which includes hypothalamic dysfunction leading to hyperphagia, obesity, shortness, sleep abnormalities. Our case is extremely severe, in comparison to other PWS cases described in literature, due to the association with severe emotional and psychiatric symptoms: oppositional behaviour, rigidity of thought, skin picking and pathological hoarding.

CASE PRESENTATION

We described the case of a Caucasian male patient suffering from PWS, treated in outpatient care by local Mental Health Centre and supported by Social Service, who was admitted to a residential rehabilitative facility. After a 2-year follow-up, the patient showed a global improvement in symptoms and functioning, as registered by the rating scales administered. At the end of observation period, we also reported an important improvement in weight control, reducing the risk of obesity and related diseases, therefore improving the prognosis of life.

CONCLUSION

This case highlights the need for long-term, individualized and multi-professional treatment in patients suffering from a complex genetic syndrome with both organic and psychological alterations, for which medical care setting and pharmacological treatments are not sufficient. Clinical observation of this case leads us to compare PWS to drug addiction and indirectly endorse the neurophysiological hypothesis that food and drugs stimulate the same brain circuits in the limbic system.

Paliperidone Palmitate Treatment in Outpatient Care Setting: A Naturalistic Study

OBJECTIVES

To evaluate paliperidone palmitate (PP) effectiveness, safety and adherence to treatment.

METHODS

We collected data of all patients (n = 50) affected by Schizophrenia Disorders, treated with PP for a 3 month minimum period in the outpatient setting of Mental Health Department in Modena, from 01/01/2014 to 31/01/2015. We evaluated reasons and modality for PP implementation, improvement in symptom and functioning scales, adverse effects, discontinuations and relapses. We statistically correlated socio-demographic and clinical variables of our sample with PP therapeutic variables.

RESULTS

We registered an improvement in all scales, with a superior percentage in PANSS positive subscale. The mean PP dose in some patients was lower than official indications, although our sample was clinically severe. Illness relapses affected 60% and dropout 18% of patients. PP was well tolerated and in just a few cases adverse events required treatment interruption. The risk factors for discontinuation were represented by "lack of therapeutic compliance" (HR = 4.11, p < 0.0001) and "inefficacy" (HR = 1.67, p < 0.0001).

CONCLUSIONS

With limitations of observational design, this research highlights that PP was well tolerated and effective in improving both psychotic symptoms and functioning, but moderately effective in preventing relapse, probably due to clinical severity of our patients associated with extremely cautious and flexible PP prescriptions.

A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services

OBJECTIVE

To highlight which demographic, familial, premorbid, clinical, therapeutic, rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient.

METHODS

Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients' clinical and functioning conditions during the study period were evaluated.

RESULTS

Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P<0.001), and 60% of the sample presented a positive familial history for psychiatric or addiction disease or premorbid traumatic factors. The onset age of substance use was related to the period of psychiatric treatment follow-up (P<0.001) and the time spent in rehabilitative facilities (P<0.05), which, in turn, was correlated with personality disorder diagnosis (P<0.05). Complications, which presented in 67% of patients, were related to the high number of psychiatric hospitalizations (P<0.05) and professionals involved in each patient's treatment (P<0.05). Males more frequently presented familial, health, and social complications, whereas females more frequently presented self-threatening behavior (P<0.005).

CONCLUSION

It was concluded that the course of dual diagnosis may be chronic, severe, and disabling, requiring many long-term therapeutic and rehabilitative programs to manage various disabilities.