The stigma of schizophrenia from patients' and relatives' view: A pilot study in an Italian rehabilitation residential care unit

OBJECTIVE: To identify the constituent elements of the stigma from the perspective of those having first-hand experiences of it. METHODS: Subjective experiences of stigma were explored in six focus groups: three with people suffering from schizophrenia and three with patients' relatives. Focus group sessions were tape-recorded, transcribed and analyzed by means of an inductive method, forming categories from the texts, as a basis for coding. Analysis aimed at establishing a typology of stigmatization experiences from the spoken words of the focus group participants. RESULTS: Four dimensions of stigma were identified: access to social roles; internalization of stigma; quality of mental health services, public image of mental illness. CONCLUSION: The most frequently found topics concerned experiences of marginalization and discrimination that people with schizophrenia experience in their daily life. These results mirror the findings of similar studies obtained in other cultural contexts

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

Abstract Problem: The global coronavirus (COVID‐19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents. Methods: This cross‐sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID‐19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e‐research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale. Findings: A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide. Conclusions: This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathol ogies and the promotion of adolescent mental health due to the pandemic

Socio‐emotional, cognitive, affective disorders and substance use in a sample of students in first‐ and second‐grade high school in Italy: A comparison among students', parents', and teachers' perceptions

Abstract The closure of schools, social hubs, and extracurricular activities due to lockdown measures imposed to curb the spread of SARS‐CoV‐2, has increased the risk factors for students' mental health. This cross‐sectional study, conducted from March 2020 to March 2021, aimed to estimate socio‐emotional, cognitive, and affective disorders and substance use in a sample of first‐ and second‐grade high school students in Northern Italy. This study compared data from 284 Italian students' self‐perceptions along with the perceptions of their parents and teachers through a web‐based survey. The differences in the perceptions of the three groups (students, parents, and teachers) were analyzed using an analysis of variance test, applying a Bonferroni correction. The χ 2 test was used to assess the comparison between students, parents, and teachers in the substance use questions. The results showed statistically significant differences among the three groups. The most important outcomes were sociality, scholastic performance, extracurricular activity, emotional symptoms, affective disorders (depression and anxiety), and substance use. These findings could be interesting for the promotion of mental health and prevention of psychopathological risks in students

PARTECIPAZIONE E GRADIMENTO DI UN PERCORSO DI ACCOMPAGNAMENTO PSICOLOGICO RIVOLTO ALLE MATRICOLE DELLA FACOLTÀ DI MEDICINA

Obiettivi: valutare la partecipazione e il gradimento delle matricole che aderiscono al “Progetto Accoglienza”, un percorso di accoglienza e accompagnamento psicologico, attivo da quattro anni, presso il Corso di Laurea in Medicina e Chirurgia dell’Università degli Studi di Brescia. Metodo: il percorso si fonda sull’implementazione della figura di studenti senior (tutor), adeguatamente formati e supervisionati da docenti della Sezione di Psicologia Clinica, attraverso l’utilizzo di modalità gruppali, in accordo con specifiche metodologie utilizzate da tempo in psicologia clinica. I tutor fungono da riferimenti rassicuranti e identificatori per le matricole, che a loro volta aderiscono al progetto in modo volontario e ricevono crediti opzionali, al fine di riconoscere il valore formativo dello scambio fra studenti del primo anno e studenti senior. Per la valutazione del livello di gradimento è stato predisposto un questionario ad hoc, elaborato in parte sulla base di strumenti utilizzati nei corsi professionali in cui è previsto l’accreditamento e in parte sulla base di proposte e riflessioni fra i docenti di psicologia dell’Ateneo, che non hanno preso parte al progetto. Risultati: il numero di studenti che partecipa con regolarità al percorso di accoglienza è cresciuto nei quattro anni: da 125 a 164. Gli studenti hanno in media un’età di 19.3 anni (±1.7) e sono in prevalenza femmine. Il questionario di gradimento viene compilato in media dall’85% delle matricole coinvolte. Quasi la totalità di esse riferisce che ripeterebbe l’esperienza, anche senza crediti formativi; il 98% la consiglierebbe ad una nuova matricola. Per quanto riguarda rilevanza, efficacia e utilità del percorso rispetto alle proprie esigenze formative, anche in questo caso la maggior parte degli studenti riporta una valutazione positiva. Conclusioni: i dati raccolti mostrano un gradimento medio-alto, che si mantiene costante negli anni. Si ritiene che tale percorso possa fornire un aiuto concreto per fronteggiare le difficoltà associate all’ingresso nell’Università. Fra gli indicatori di efficacia di consimili interventi nel lungo periodo, riteniamo utile la ricaduta in termini di prevenzione del drop out e dell’ allungamento temporale del corso di studi

Beliefs and attitudes among Italian high school students toward people with severe mental disorders

The negative attitudes surrounding mental disorders and their treatment are a major obstacle to the correct identification and treatment of emerging psychopathologies. The purpose of this study was to investigate mental health literacy in a large and representative sample of high school students in Italy, via a booklet containing several questionnaires delivered to 1032 teenagers. The items in the questionnaires probed knowledge about mental health and illness, stigmatization, stereotypes, behaviors, opinions, and attitudes. In general, the students had a reasonable knowledge of mental disorders and were able to distinguish these from somatic disorders. However, a large portion of the students nourished some misconceptions about mental disorders and was also rather skeptical about the effectiveness of treatment or the chance of recovery for people with severe mental disorders. Nevertheless, roughly half of the students reported being willing to provide help to someone with a mental disorder when in need. Poor mental health literacy is a major barrier to seeking help and receiving effective treatment. Young people are the ideal target of raising awareness and antistigma campaigns because they are at a higher risk for developing a psychopathology

[Patterns of experienced and anticipated discrimination in patients with schizophremia. Italian results from the INDIGO international multisite project]

To describe patterns of experienced and anticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO)

Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial

BACKGROUND: Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices. The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi – in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia. METHOD: Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores. RESULTS: 31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning. Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study). CONCLUSION: The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated

Medical physics challenges in clinical MR-guided radiotherapy

The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART.Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation.Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing.The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization

7U-Thulium Laser Enucleation of the Prostate (7U-ThuLEP): description of the technique

Objective: To present a modification to the classical ThuLEP technique, called 7U-ThuLEP and to compare its clinical intra- and post-operative outcomes to those of conventional ThuLEP in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS)

Conformational altered p53 as an early marker of oxidative stress in Alzheimer\u27s disease

In order to study oxidative stress in peripheral cells of Alzheimer\u27s disease (AD) patients, immortalized lymphocytes derived from two peculiar cohorts of patients, referring to early onset AD (EOSAD) and subjects harboured AD related mutation (ADmut), were used. Oxidative stress was evaluated measuring i) the typical oxidative markers, such as HNE Michel adducts, 3 Nitro-Tyrosine residues and protein carbonyl on protein extracts, ii) and the antioxidant capacity, following the enzymatic kinetic of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GRD). We found that the signs of oxidative stress, measured as oxidative marker levels, were evident only in ADmut but not in EOSAD patients. However, oxidative imbalance in EOSAD as well as ADmut lymphocytes was underlined by a reduced SOD activity and GRD activity in both pathological groups in comparison with cells derived from healthy subjects. Furthermore, a redox modulated p53 protein was found conformational altered in both EOSAD and ADmut B lymphocytes in comparison with control cells. This conformational altered p53 isoform, named unfolded p53 , was recognized by the use of two specific conformational anti-p53 antibodies. Immunoprecipitation experiments, performed with the monoclonal antibodies PAb1620 (that recognizes p53wt) and PAb240 (that is direct towards unfolded p53), and followed by the immunoblotting with anti-4-hydroxynonenal (HNE) and anti- 3-nitrotyrosine (3NT) antibodies, showed a preferential increase of nitrated tyrosine residues in unfolded p53 isoform comparing to p53 wt protein, in both ADmut and EOSAD. In addition, a correlation between unfolded p53 and SOD activity was further found. Thus this study suggests that ROS/RNS contributed to change of p53 tertiary structure and that unfolded p53 can be considered as an early marker of oxidative imbalance in these patients