Comparing re‐hospitalisation rates in a real‐world naturalistic 24‐month follow‐up of psychotic patients with different treatment strategies: Oral versus LAI antipsychotics

AIM & BACKGROUND Non-adherence to antipsychotic treatment is a major issue in the management of severe psychiatric disorders, because it is usually related to future relapses and re-hospitalisations. Long-Acting-Injection (LAI) antipsychotics can be useful to increase treatment adherence in these patients. The aim of the present study was to compare the re-hospitalisation rates of psychotic patients discharged from a psychiatric ward and then, divided into three groups upon the treatment received: LAI antipsychotic, oral antipsychotic at home or oral antipsychotic administered daily by psychiatric nurse staff as patients lived in a long-term care facility. METHODS Data on all inpatients consecutively admitted to the Psychiatric Unit of the Nuovo Ospedale Apuano (Massa, Italy), between January 2017 and December 2018, were obtained by the registration record system. Information about eventual re-hospitalisations of these patients, occurred within a 24-month timeframe since discharge, were collected from the same database. RESULTS In a Kaplan-Meyer analysis, patients treated with LAI antipsychotics showed significantly lower re-hospitalisation rates in the first 24 months after discharge than those treated with oral ones. CONCLUSIONS This study highlights the impact of LAI antipsychotics in preventing re-hospitalisation in severe psychotic patients at high risk in a naturalistic setting. The benefits appear relevant also with respect to a controlled long-term oral antipsychotic treatment, however, further studies are needed to develop more tailored intervention strategies in such complex psychiatric population

Do Autistic Traits Correlate with Post-Traumatic Stress and Mood Spectrum Symptoms among Workers Complaining of Occupational Stress?

The adult autism subthreshold spectrum model appears to be a useful tool for detecting possible vulnerability factors in order to develop mental disorders in the contest of work-related stress. The aim of the present study is to analyze the relationship between autism, mood, and post-traumatic spectrum in a cohort of subjects complaining of work-related stress before the COVID-19 pandemic. The authors carried out a retrospective investigation of both medical records and self-assessment tools of a sample of subjects evaluated at the Occupational Health Department of a University hospital in central Italy. Data showed significant correlations between the AdAS spectrum, TALS-SR, and MOODS total and domain scores. A multiple linear regression evidenced that both the AdAS spectrum and TAL-SR significantly predict the MOODS scores. In particular, mediation analysis showed both a direct and indirect, mediated by TALS-SR, effect of the AdAS Spectrum on the MOODS-SR. These results corroborate the role of autistic traits in influencing the traumatic impact of work-related stress and the development of mood spectrum symptoms

Correlazione tra sintomi maniacali lifetime, PTSD e spettro post-traumatico da stress in studenti sopravvissuti al terremoto di L'Aquila 2009: differenze di genere.

Correlazione tra sintomi maniacali lifetime, PTSD e spettro post-traumatico da stress in studenti sopravvissuti al terremoto di L'Aquila 2009: differenze di genere

A dimensional approach to the assessment of psychiatric comorbidity in treatment-seeking subjects with Gambling Disorder

Gambling disorder (GD) is defined as “persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress” and in the last edition of the DSM-5, it was categorized into the substance related and addictive disorders group. GD has also been consistently associated with a range of co-morbid psychiatric conditions, including alcohol and substance use disorders, mood and Post-Traumatic Stress Disorder (PTSD), and neurodevelopmental disorders. The present study was aimed at examining in a sample of 48 treatment-seeking subjects with GD rates of psychiatric comorbidity by the use of the SCID-5, besides evaluating mood, posttraumatic stress and autistic spectrum symptoms by means of the MOODS-SR, TALS-SR and AdAS Spectrum scales. Secondary objective was to investigate the possible relationship between the psychiatric comorbidity and the severity of the GD. The study sample was found to be affected by high rates of psychiatric comorbidity. Furthermore, relevant mood, posttraumatic stress and autistic spectrum symptoms were reported by the subjects, with levels significantly higher than in healthy controls. The various symptomathological dimensions assessed by the three spectrum tools appear to be also related to the severity of specific features of GD. Future longitudinal studies on the relationship between these different psychopathological cluster and the GD are needed in order to identify specific and also better treatment strategies for these complex condition

Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report

This paper highlights the clinical challenges faced when assessing patients with stalking behaviors with psychotic disorders, suggesting the need for an accurate assessment of adult autism spectrum symptoms. A 25-year-old man with a diagnosis of delusional disorder, erotomanic type, was hospitalized for acute psychotic symptoms occurred in the framework of a repeated stalking behavior towards his ex girlfriend. When assessed for adult autism spectrum symptoms upon an accurate clinical evaluation, he reported elevated scores in the mentalizing deficit and social anxiety domains by means of the 14 item Ritvo Autism and Asperger Diagnostic Scale (RAADS-14). Authors discuss a possible role of adult (subthreshold) autism spectrum symptoms, generally disregarded in adult psychiatry, on the type of psychotic features and stalking behavior developed that may help for appropriate diagnosis and treatment

Il lutto complicato nell’era del DSM-5 [Complicated Grief in DSM-5 era]

An increasing number of data has been recently focused on recognizing pathological grief reactions and on the distinction from physiological processes. Particularly, several studies have supported Complicated Grief (CG) as an independent disorder, in order to define the failure of spontaneous physiological mourning resolution. Upon these studies, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with the name of "Persistent Complex Bereavement Disorder". This article aims at retracing the history of clinical research about the physiological and psychopathological processes related to grief and aims at presenting the main scientific studies that have described the features of the CG defining it as a distinct disorder. Similarities and distinctions among CG and Depression, Posttraumatic Stress Disorder and Adjustment Disorder were also reported

Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective

Background: Mental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD).Aim: To evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences.Methods: Five hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum-Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum-Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted.Outcomes: TALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms.Results: Around 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (...less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender x PTSD interaction.Clinical Implications: SD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation.Strengths & Limitations: Strengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake.Conclusions: Our results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender-related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved