Impact of COVID-19 on the Italian Mental Health System: A Narrative Review

: Italy has been severely affected by the COVID-19 pandemic, consequently producing a heavy burden on the Italian National Health Service. From February 2020 until the end of the same year, the Italian Mental Health System (MHS), comprising an extensive network of community services, was subjected to a significant decrease in standards of care followed at the beginning of 2021 by a slow return to usual levels of activity. Data reported in the present article highlight how the Italian MHS - as was the case in the majority of countries-was largely unprepared for this emergency, suggesting an impelling need to develop appropriate supplementary national plans with the aim of preventing similar situations from developing in the future. The upheaval caused by the pandemic has highlighted the need to reinforce, both at a local and national level, the organization and standards of care of the Italian MHS in order to protect and support the mental health of patients with severe mental disorders, health workers, and the general population, thus preventing a potential "pandemic" of mental disorders

Practical approach to respiratory emergencies in neurological diseases

Many neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxemic ARF. On the basis of the clinical onset, two main categories of ARF can be identified: (i) acute exacerbation of chronic respiratory failure, which is common in slowly progressive neurological diseases, such as movement disorders and most neuromuscular diseases, and (ii) sudden-onset respiratory failure which may develop in rapidly progressive neurological disorders including stroke, convulsive status epilepticus, traumatic brain injury, spinal cord injury, phrenic neuropathy, myasthenia gravis, and Guillain-Barr\ue9 syndrome. A tailored assistance may include manual and mechanical cough assistance, noninvasive ventilation, endotracheal intubation, invasive mechanical ventilation, or tracheotomy. This review provides practical recommendations for prevention, recognition, management, and treatment of respiratory emergencies in neurological diseases, mostly in teenagers and adults, according to type and severity of baseline disease

Karyomorphological analyses and chromatin characterization by banding techniques in Euphorbia characias L. and E. wulfenii Hoppe (= E. veneta Willd.) (Euphorbiaceae)

Abstract Karyomorphological analysis of Euphorbia characias L. using Giemsa and fluorescent techniques revealed a characteristic C-banding pattern. Intraspecific variation in C-banding pattern was observed within of chromosomal complements of some populations of this species. Using fluorochrome Chromomycin A3 (CMA), E. characias exhibit trait patterns of CMA+ bands in intercalary and telomeric regions. Many bands correspond to Giemsa C-band. After the double staining with chromomycin A3/DAPI numerous chromosomes have showed a distribution of rich pattern in basic G-C (CMA+/DAPI-). The present studies indicate that to determine this characteristic C-banding pattern has intervened a deep restructuring of the karyotype. The karyotypes of E. characias and E. wulfenii were indistinguishable with very similar karyomorphologies and banding patterns, and these data suggest that both entities might be geographical biotypes

Well-being in patients with schizophrenia, mood and personality disorders attending psychiatric services in the community. A controlled study

Background: Poor attention is paid by recent research to the prevalence of mental well-being in psychiatric patients and the comparison between groups with different diagnoses. Data suggest that the presence of mental illness does not necessarily mean the absence of well-being, particularly in stable outpatients. Methods: A consecutive series of 375 patients attending two community mental health centers was given the Mental Health Continuum Short Form (MHC-SF) and the Clinical Global Impression – Severity scale. Diagnoses were made after the MINI Neuropsychiatric Interview and a chart review of all relevant clinical information. The flourishing category and the three components of MHC-SF were used to rate well-being. A total of 274 controls were taken from the employees at a local firm. Results: The rates of flourishing mental health were: 33.1% schizophrenia, 36.6% bipolar disorder, 23.3% unipolar depression, 24.4% cluster B personality disorder, and 53.3% controls (p < 0.001). The comparison of the three MHC components across diagnostic groups found that unipolar depression and cluster B personality patients had significantly lower scores compared to bipolar and schizophrenia patients. Flourishing mental health was detected more often in males than females (34.9% vs. 24.1% - p < 0.05). For schizophrenia patients indices of well-being were better in those on depot medications. Conclusions: Psychiatric outpatients with major mental illness have lower rates of well-being compared to controls, although about one-third is flourishing. Patients with unipolar depression and cluster B personality disorder may deserve special attention when planning intervention for fostering well-being. Keywords: Well-being, Flourishing, Mental health, Schizophrenia, MHC-SF, Depressio