Anxiety-Related Disorders

Anxiety is a common experience, a physiologic mechanism that lets us cope with a stressor, but if it occurs without a stimulus or it is exaggerated and general functioning is impaired, it becomes pathological. Treating anxiety disorders requires pharmacotherapy to lower anxiety levels and psychological therapies to learn to cope with stressors adaptively. Obsessive-compulsive disorder (OCD) has been considered as part of the Anxiety Disorders chapter up to the fourth edition of the DSM (DSM IV-TR), while from the fifth edition (DSM-5) it is placed in a separate chapter. The nosographic autonomy of this disorder depends on the fact that the anxious manifestations, even if present, would be secondary and dependent on the obsessive contents. A group of conditions related to OCD from a clinical, epidemiological, and sometimes aetiopathological perspective is included in the DSM chapter about “obsessive-compulsive and related disorders”. After a traumatic experience, one person physiologically develops a limited-in-time reaction. In some cases, more pronounced depressive, anxious, intrusive, and/or dissociative symptoms occur. The biological basis for trauma-related disorders is not fully understood, but insights so far have let us choose pharmacological treatments alongside with psychotherapy in order to control symptoms and elaborate the traumatic experience

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Psychopathology

Psychopathology is a discipline that applies systematic methods to study abnormal functioning of psychic activity, with the intent to elaborate subdivisions, classifications, and theories, to identify the causes of mental illnesses. Psychopathology relies on the direct observation of the clinical manifestations of mental illnesses with the goal of being used in diagnostic systems (e.g., Diagnostic and Statistical Manual of Mental Disorders-5) which specify which signs, symptoms, and features are required to establish a diagnosis. Psychopathology can be broadly divided into two main subgroups: Descriptive psychopathology, which involves the careful description and denomination of mental states and abnormal behaviors of the patient, avoiding theoretical assumptions and personal interpretations. Interpretative psychopathology, which involves the description and understanding of human subjective experiences, but aims at explaining these phenomena through recourse to theoretical models. The ability to carefully assess and precisely describe signs and symptoms in a qualified manner is a core attribute of mental health professionals and the basis of the diagnostic process in psychiatry

Adult Consequences of Neurodevelopmental Disorders

Neurodevelopmental disorders are a miscellaneous group of mental conditions characterized by the impairment in one or more emotional, social, and cognitive skills at different stages of childhood or adolescence. Their early manifestation, together with the lack of immediate life-threatening consequences, is responsible for the delayed or absent achievement of developmental milestones, causing a marked impact on various areas of functioning, such as personal, social, academic, or occupational. Even though precociously recognized in many cases, the impairment may persist throughout the entire life span, with functional repercussions on adult life and an increased risk of co-occurring medical and psychiatric comorbidities. This chapter focuses on neurodevelopmental conditions, namely, autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disabilities (ID), concentrating on the characteristic epidemiology, clinical manifestations, diagnosis, and treatment recommendations in adults’ life

Organic Mental Disorders and Psychiatric Issues in the Elderly

Cognition includes all forms of knowledge and awareness, such as perceiving, learning, conceiving, remembering, reasoning, judging, imagining, speaking, and conducting interpersonal relationships, performing actions, and solving problems. Along with affect and conation, cognition is one of the three traditionally recognized components of the mind. This chapter aims at discussing the main clinical conditions that may present with cognitive alterations: delirium and neurocognitive disorders. Delirium is a sudden and transient organic mental disorder characterized by a disturbance in consciousness, cognition, perception, and attention, while neurocognitive disorders (NCD) are conditions characterized by an insidious and progressive decline in cognition involving one or more domains. Several medical and neurological conditions can lead to organic mental disorders that, in turn, are often associated with psychological and behavioral symptoms, such as depression, anxiety, apathy, sleep disturbance, agitation, and psychosis. As these symptoms presents sometimes as the first manifestation of an underlying NCD, psychiatrists play a critical role in the assessment, diagnosis, and treatment of these complex conditions

Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19

The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids