Comorbid bipolar disorder and obsessive-compulsive disorder: An old debate renewed

Abstract assent

Meaning-centered therapy in Ukraine's war refugees. An attempt to cope with the absurd?

No abstract availabl

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio in Bipolar Disorder

Background: Several inflammatory hypotheses have been suggested to explain the etiopathogenesis of bipolar disorder (BD) and its different phases. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios have been proposed as potential peripheral biomarkers of mood episodes. Methods: We recruited 294 patients affected by BD, of which 143 were experiencing a (hypo)manic episode and 151 were in a depressive phase. A blood sample was drawn to perform a complete blood count. NLR, PLR, and MLR were subsequently calculated. A t-test was performed to evaluate differences in blood cell counts between depressed and (hypo)manic patients and a regression model was then computed. Results: Mean values of neutrophils, platelets, mean platelet volume, NLR, PLR, and MLR were significantly higher in (hypo)manic than depressed individuals. Logistic regression showed that PLR may represent an independent predictor of (hypo)mania. Conclusions: Altered inflammatory indexes, particularly PLR, may explain the onset and recurrence of (hypo)manic episodes in patients with BD. As inflammatory ratios represent economical and accessible markers of inflammation, further studies should be implemented to better elucidate their role as peripheral biomarkers of BD mood episodes

Anti-hypothalamus autoantibodies in anorexia nervosa: a possible new mechanism in neuro-physiological derangement?

Purpose: Anorexia nervosa (AN) is a serious and complex mental disorder affecting mainly young adult women. AN patients are characterized by low body weight in combination with self-induced starvation, intense fear of gaining weight, and distortion of body image. AN is a multifactorial disease, linked by recent evidence to a dysregulation of the immune system. Methods: In this pilot study, 22 blood serums from AN patients were tested for the presence of autoantibodies against primate hypothalamic periventricular neurons by immunofluorescence and by a home-made ELISA assay. Cellular fluorescence suggests the presence of autoantibodies which are able to recognize these neurons (both to body cell and fiber levels). By means of ELISA, these autoantibodies are quantitatively evaluated. In addition, orexigenic and anorexigenic molecules were measured by ELISA. As control, 18 blood serums from healthy age matched woman were analysed. Results: All AN patients showed a reactivity against hypothalamic neurons both by immunofluorescence and ELISA. In addition, ghrelin, pro-opiomelanocortin (POMC), and agouti-related peptide (AGRP) were significantly higher than in control serums (p < 0.0001). In contrast, leptin was significantly lower in AN patients than controls (p < 0.0001). Conclusions: Immunoreaction and ELISA assays on AN blood serum suggest the presence of autoantibodies AN related. However, it is not easy to determine the action of these antibodies in vivo: they could interact with specific ligands expressed by hypothalamic cells preventing their physiological role, however, it is also possible that they could induce an aspecific stimulation in the target cells leading to an increased secretion of anorexigenic molecules. Further studies are needed to fully understand the involvement of the immune system in AN pathogenesis

The Impact of COVID-19 Lockdown Announcements on Mental Health: Quasi-Natural Experiment in Lombardy, Italy

Background: Evidence showed that mental health problems have risen markedly during COVID-19. It is unclear if part of the mental sufferings relates to the climate of uncertainty and confusion originated by rough communication by health officials and politicians. Here we test the impact of unanticipated policy announcements of lockdown policies on mental health of the older population. Methods: We used a representative telephone-based survey of 4,400 people aged 65\u2009years or older in Italy's Lombardy region to compare information on self-reported symptoms of anxiety, depression, and poor-quality sleep of subjects interviewed on the days of policy announcement with that of subjects interviewed on other days. We used regression models adjusting for potential socio-demographic confounders as well study design with inverse probability weighting. Results: On days when policy makers announced to extend the lockdown, mental health deteriorated on average by 5.5 percentage points [95% CI: 1.1 to 9.8] for self-reported anxiety symptoms and 5.1 percentage points [95% CI: 2.7 to 7.4] for self-reported depressive symptoms. The effect of announcement to shorten the lockdown is more moderate but statistically significant. These associations were short term in duration; after just one day, self-reported mental health and sleep quality return to levels better than pre-announcement until a new policy change. Conclusions: Our research shows that lockdown policy announcements are associated with short term worsening in mental distress, highlighting the importance of appropriate communication strategies and political determinations in crisis times

Indoor environmental quality e condizioni abitative: l'esperienza del progetto HO.ME.

Introduzione -Il periodo di lockdown trascorso per contenere la diffusione della pandemia di COVID-19 ha portato la popolazione a trascorrere la maggior parte del tempo all’interno delle proprie abitazioni. Nonostante gli indubbi benefici nel contenere la diffusione del virus, il confinamento domestico ha certamente impattato negativamente sulla qualità di vita e sul benessere psicofisico. Alla luce delle ripercussioni sociali della pandemia, l’obiettivo della ricerca è stato quello di fornire strumenti per mitigare e contrastare gli effetti di future epidemie o periodi di lockdown sul benessere psicofisico della popolazione. È infatti fondamentale ripensare alle abitazioni in ottica di qualità, comfort e capacità adattiva in situazioni di confinamento prolungato per proteggere la salute fisica e mentale degli abitanti. Materiali e metodi - Il progetto di ricerca “HOusing conditions and MEntal health [HO.ME.] - Strategie resilienti per il miglioramento della qualità abitativa durante periodi di lockdown.” ha voluto perseguire i seguenti Obiettivi Specifici: - fornire strumenti per mitigare e contrastare gli effetti di eventuali future emergenze sanitarie sul benessere psicofisico della popolazione, attraverso la progettazione di strategie di resilienza e flessibilità per il recupero delle abitazioni in ottica di salute, sicurezza e capacità adattiva in situazioni di confinamento prolungato; - raccogliere informazioni da un campione rappresentativo della popolazione nazionale sulle caratteristiche delle loro abitazioni (dimensioni, caratteri distributivi, viste, qualità indoor reale VS percepita, etc.) da correlare con il benessere psicofisico (depressione, ansia, insonnia, etc.) degli occupanti/users stessi; - definire i requisiti igienico-sanitari di carattere prestazionale degli edifici – da tradurre in un Decreto Ministeriale – sulla base delle indicazioni qualitative e quantitative emerse dal progetto di ricerca svolto, al fine di introdurre un approccio prestazionale e basato sull’evidenza. Risultati - La ricerca HO.ME. ha conseguito i seguenti risultati: aggiornamento dello stato dell’arte e della letteratura scientifica di riferimento; definizione delle strategie e prototipazione del manuale per la messa a punto di una norma sanitaria aggiornata in termini di requisiti sanitari prestazionali degli edifici, con particolare attenzione agli impatti dell’architettura e dell’ambiente costruito sul benessere degli occupanti, sulle condizioni abitative e sulla prevenzione del disagio abitativo. Conclusioni - La ricerca HO.ME. arricchisce la conoscenza delle condizioni abitative della popolazione italiana e quantificherà l’impatto delle diverse caratteristiche sulla salute mentale. La ricerca ha dimostrato la necessità di un approccio multifattoriale e multidisciplinare capace di riunire competenze architettoniche, epidemiologiche e di salute mentale per supportare il miglioramento delle condizioni abitative e promuovere il benessere psicofisico della popolazione

The role of attitudes toward medication and treatment adherence in the clinical response to LAIs: findings from the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network "Depot Study" was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions-conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently-showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders

COVID-19 lockdown impact on familial relationships and mental health in a large representative sample of Italian adults

Purpose: Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens' health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resulted in mental health worsening. Methods: A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April-3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess the impact of confinement on mental health, through validated scales before and during lockdown. Results: Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR = 1.74, 95% confidence interval, CI 1.49-2.03) and quantity (OR = 1.50, 95% CI 1.28-1.76), depressive (OR = 1.32, 95% CI 1.14-1.53) and anxiety symptoms (OR = 1.53, 95% CI 1.32-1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR = 2.32, 95% CI 1.76-3.05), and quantity (OR = 1.80, 95% CI 1.36-2.37), depressive (OR = 1.79, 95% CI 1.39-2.31) and anxiety symptoms (OR = 1.90, 95% CI 1.48-2.46) was also associated with reduced babysitting help. Mental health outcomes were worse in subjects with poorer housing and teleworking during lockdown. Conclusion: Confinement came along with reduced familial support from parents, negatively impacting household members' mental health. Our findings might inform evidence-based family and welfare policies to promote population health within and beyond pandemic times

Older Adults' Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project

: The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults' changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient's decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05-1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00-1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run