Differenze di genere nella prevalenza di PTSD secondo DSM-5 versus DSM-IV-TR: uno studio su 512 adolescenti sopravvissuti al terremoto di L'Aquila 2009.

I nuovi Criteri per il PTSD presenti nel DSM-5, selezionati dopo un lungo dibattito, impongono la necessità di indagare l’impatto della nuova impostazione nosografica sulla diagnosi del disturbo post-traumatico. La task force per il DSM-5 ha più volte ribadito l’intenzione di rendere più reattivi i criteri diagnostici, aumentando la specificità e riducendo quindi le potenziali sovrapposizioni con altri disturbi psichiatrici. Alcuni studi condotti precedentemente alla pubblicazione del DSM-5, hanno analizzato differenti campioni sulla base dei criteri del DSM-IV-TR, confrontandoli poi con quelli proposti per il DSM-5 (Forbes et al., 2011; Calhoun et al., 2012; Elhai et al., 2012). Tali studi si sono occupati soprattutto di analizzare possibili modelli alternativi per la diagnosi, valutandone l’impatto sulla prevalenza. Attraverso le varie edizioni del DSM è stata confermata una differenza di genere significativa tra i tassi di PTSD ma, prendendo in esame il DSM-5, ancora non ci sono dati riguardanti tale differenze. L’obiettivo di questo studio è proprio quello di andare a investigare le eventuali differenze di genere tra i pazienti con PTSD reclutati all’interno di un campione di 512 studenti dell’ultimo anno delle scuole superiori esposto al terremoto che ha colpito L’Aquila il 6 Aprile del 2009. Tutti i soggetti erano presenti durante la catastrofe e sono stati quindi esposti a un trauma che soddisfa automaticamente il Criterio A del DSM-5

The Italian ICD-11 field trial: clinical utility of diagnostic guidelines for schizophrenia and related disorders

Background The 11th revision of the International Classification of Diseases and Related Disorders (ICD-11) has been released. In order to test the clinical consistency and the clinical utility of the proposed guidelines the World Health Organization (WHO) has carried out the Ecological Implementation Field Studies in various countries. In this paper the results of the Italian field trials on the clinical utility of the ICD-11 diagnostic guideline concerning schizophrenia and related disorders will be presented. Methods In Italy, field trials have been carried out at the Department of Psychiatry of the University of Campania “L. Vanvitelli”. All patients showing any psychotic symptom and referring to the outpatient and inpatient units have been recruited. Patients were interviewed by two clinicians with whom they had not had any prior clinical contact. At the end of each interview, clinicians were asked to complete 12 questions about the clinical utility of the diagnostic guidelines as applied to each patient. Results Fourteen clinicians and 100 patients have been involved. The ICD-11 clinical guidelines were perceived as easy to use, with an adequate goodness of fit, clear and understandable and with an adequate level of details and specificity to describe the essential features of the diagnoses. Clinicians rated very positively their usefulness in describing the threshold between patient’s disorder and normality. Despite still very positive, the guidelines have been perceived as less useful to select a treatment, to assess patients’ prognosis and to communicate with other mental health professionals. Conclusions The 11th revision of the chapter on Mental, Behavioural and Neurodevelopmental Disorders has made substantive changes to the conceptualization of mental disorders which could have impacted on their reliability and clinical utility. Results of the Italian field studies, in line with those reported by the international sample, highlight that ICD-11 has been rated as highly clinically useful by participating clinician, more than the ICD-10. This could be considered a good reason to be optimistic about the implementation of the ICD-11 among global clinicians. Trial registration The study has been approved by the Ethical Review Board of the University of Campania “L. Vanvitelli” (N. 416, 2016

The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar i disorder: Results from a controlled, real-world, multicentric study

Background: Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients\u2019 personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives\u2019 coping strategies in BD. Methods: A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania \u201cLuigi Vanvitelli\u201d has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group. Results: The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as \u201cmaintenance of social interests\u201d (odds ratio [OR]=0.309, CI=0.04\u20130.57; p=0.023), \u201cpositive communication with the patient\u201d (OR=0.295, CI=0.13\u20130.46; p=0.001), and \u201csearching for information\u201d (OR=0.443, CI=0.12\u20130.76; p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt \u201cresignation\u201d (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and \u201ccoercion\u201d (OR=-0.268, CI=-0.46 to -0.08; p=0.006) strategies, compared to TAU relatives. Conclusion: PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention

Reducing stigma in media professionals: is there room for improvement? Results from a systematic review

OBJECTIVE: The mass media may increase stigma against people with mental health problems by reinforcing common stereotypes. Media professionals thus represent a target group for antistigma interventions. This paper aims to review available literature on antistigma interventions for mass media professionals, seeking to clarify what kind of interventions have been found to be effective in reducing mental health stigma among mass media professionals. METHOD: Six electronic databases (MEDLINE, PsycINFO, Embase, Cochrane Reviews Library and Cochrane Central Register of Controlled Trials, Web of Science, and Applied Social Sciences Index & Abstracts) were systematically searched through March 2017 for studies addressing antistigma interventions on mass media professionals.\u2002 Results: A total of 27 studies on antistigma interventions targeted to media professionals were found. Reviewed articles were classified into 3 categories: media-monitoring projects/reporting guidelines ( n = 23), interventions for educating journalists ( n = 2), and interventions for educating journalism students ( n = 2). Overall, antistigma interventions for media professionals seem to have some effect in improving reporting style, thus providing a more balanced portrayal of people with mental health problems: the most promising interventions are contact-based educational approaches and the provision of guidelines by authoritative institutions. CONCLUSION: It should be useful to promote and disseminate contact-based educational interventions targeted to journalists and to include specific modules on mental health topics in the training curricula of journalism students. However, as research in the field suffers from several limitations, high-quality studies exploring the long-term effect of antistigma interventions for media professionals are needed

The relationship between childhood maltreatment and non-suicidal self-injury: A systematic review

Introduction: Childhood maltreatment (CM) has been associated with an increased risk of non-suicidal self-injury (NSSI) and suicidal behaviors. However, the exact nature of the association between CM and NSSI is currently unclear. The present review aimed to systematically investigate the association between CM and NSSI in adolescence and early adulthood. Methods: A systematic search of four major electronic databases covering both medical and social science research (PubMed, Scopus, Science Direct, and PsycINFO) was conducted. Results: Overall, 20 cross-sectional studies including a total of 22,517 individuals, 3 longitudinal follow-up studies including 1,728 individuals, and 3 retrospective studies including 62,089 individuals were selected. It appears that CM is a significant risk factor for both NSSI and suicide attempts. The increased vulnerability to NSSI seems to be related to experiences of CM, particularly sexual abuse. Gender differences were also found. Generally, when compared to males, females who experienced CM seem to be more vulnerable to presenting with NSSI and suicidal behaviors. Conclusion: There is a positive association between CM and NSSI. The importance of early detection and risk reduction of self-injurious behavior for adolescents is discussed

Improving physical health of patients with severe mental disorders. a critical review of lifestyle psychosocial interventions

People with severe mental disorders have a mortality rate that is more than two times higher than the general population, with at least a decade of potential years of life lost. People with mental disorders have a significantly higher risk of obesity, hyperglycemia and metabolic syndrome, which are related to modifiable risk factors, such as heavy smoking, poor physical activities, and inappropriate unhealthy diet, which can be improved through lifestyle changes. Areas covered: Lifestyle behaviours are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. In the present review, the authors aim to: 1) critically analyze studies involving multimodal lifestyle interventions; 2) discuss the way forward to integrate these interventions in clinical routine care. Expert commentary: The psychoeducational approaches developed for the improvement of healthy lifestyle behaviours differ for several aspects: 1) the format (individual vs. group); 2) the setting (outpatient vs. inpatient vs. home-based); 3) the professional characteristics of the staff running the intervention (psychiatrists or nurses or dietitians or psychologists); 4) the active ingredients of the intervention (education only or inclusion of motivational interview or of problem solving); 5) the duration of treatment (ranging from 3 months to 2 years)

[The Italian ICD-11 field trial: inter-rater reliability in the use of diagnostic guidelines for schizophrenia and related disorders]

The World Health Organization (WHO) is about to publish the 11th revision of the International Classification of Diseases and Related Disorders (ICD-11). A pre-final version has been disseminated in 2018, in order to allow the 194 member States to provide suggestions for amendments and to prepare shared strategies for the implementation of the diagnostic system. Furthermore, the Ecological Implementation Field Studies (EIFS) have been conducted in various countries, with the aim to assess the reliability and clinical utility of the ICD-11 diagnostic guidelines. In this paper we present the overall methodology of the EIFS and discuss the results of the Italian field trials concerning the reliability in the use of ICD-11 diagnostic guidelines concerning schizophrenia and related disorders. In Italy the field trials have been carried out at the Department of Psychiatry of the University of Campania "L. Vanvitelli", WHO Collaborating Centre. The inter-rater reliability of the diagnostic guidelines for schizophrenia and related disorders has been assessed on the basis of clinical interviews with 100 patients conducted by 14 psychiatrists. The results show an almost perfect reliability for the diagnosis of schizophrenia (kappa=0.85) and a good reliability for the diagnosis of schizoaffective disorder (kappa=0.79). These Italian data are in line with those of the international sample, and the kappa values are higher than those previously reported in the ICD-10 field trials. They suggest the feasibility of the implementation of ICD-11 diagnostic guidelines in ordinary clinical practice in our country