Complicated Grief: What to Expect After the Coronavirus Pandemic

The COVID-19 pandemic is one of the worst public health crises in a century, with an expected amount of deaths of several million worldwide and an even bigger number of bereaved people left behind. Although the consequences of this crisis are still unknown, a significant number of bereaved people will arguably develop Complicated Grief (CG) in the aftermath of this emergency. If the current pandemic is unprecedented, the grief following the coronavirus outbreak is likely to share features with grief related to natural disasters and after Intensive Care Unit (ICU) treatment. The aim of this paper is to review the most prominent literature on CG after natural disasters, as well as after diseases requiring ICU treatment. This body of evidence may be useful for helping bereaved people during the acute phase of the COVID-19 pandemic and for drawing clinical attention to people at risk for CG

The Adult Autism Subthreshold Spectrum (AdAS) model: A neurodevelopmental approach to mental disorders

A growing interest has been devoted to adult presentations of Autism Spectrum Disorders. This led to focus on comorbidity between ASD and other mental disorders, mainly (but notlimited to) Borderline Personality Disorders, Post Traumatic Stress Disorders, Mood Disorders and Eating Disorders. The presence of any psychiatric comorbidity can mask ASD, in particular in subjects with no intellectual impairment. To address this psychopathological issue, studies adopting the AdAS questionnaire, an instrument with strong convergent validity with alternative dimensional measures of ASD and excellent internal consistency and test-retest reliability, able to detect subthreshold forms of ASD in adulthood, have been reviewed. Based on these evidences, the Subthreshold Autism Spectrum Model has been developed,which includes threshold-level manifestations but also mild/atypical symptoms of the disorder, gender-specific features, behavioral manifestations and personality traits associated with ASD. This model encompasses, although not coinciding with, the Broad Autism Phenotype. This is a subthreshold form of autism described in the context of the neurodevelopmental trajectory that – starting from autistic traits – might lead to the broad range of mental disorders. Therefore, the Adult Autism Spectrum can be considered a transnosographic dimension. This approach should help to detect individual features for certain autistic cognitive and behavioural patterns that may predispose to other mental disorders

Is There a Major Role for Undetected Autism Spectrum Disorder with Childhood Trauma in a Patient with a Diagnosis of Bipolar Disorder, Self-Injuring, and Multiple Comorbidities?

This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrum disorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eating disorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of a recrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration in neurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a history of childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patient was assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Total scores of 38/50 in the AQ, 146/240 in the RAADS-R, 99/160 in the AdAS Spectrum emerged, compatible with ASD, 47/116 in the TALS-SR, and 64/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense that caused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioning ASD

Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum

Eating disorders have been defined as "characterized by persistence disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs health or psychosocial functioning". The psychopathology of eating disorders changed across time under the influence of environmental factors, determining the emergence of new phenotypes. Some of these conditions are still under investigation and are not clearly identified as independent diagnostic entities. In this review, the historic evolution of the eating disorder concept up to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has been evaluated. We also examined literature supporting the inclusion of new emergent eating behaviors within the eating disorder spectrum, and their relationship with anorexia, autism, and obsessive-compulsive disorder. In particular, we focused on what is known about the symptoms, epidemiology, assessment, and diagnostic boundaries of a new problematic eating pattern called orthorexia nervosa that could be accepted as a new psychological syndrome, as emphasized by an increasing number of scientific articles in the last few years

Tele-Psychiatry Assessment of Post-traumatic Stress Symptoms in 100 Patients With Bipolar Disorder During the COVID-19 Pandemic Social-Distancing Measures in Italy

The acute phase of the COrona VIrus Disease-19 (COVID-19) emergency determined relevant stressful burdens in psychiatric patients, particularly those with chronic mental disorders such as bipolar disorder (BD), not only for the threat of being infected but also for the strict lock-down and social-distancing measures adopted, the economic uncertainty, and the limited possibilities to access psychiatric services. In this regard, telepsychiatry services represented a new important instrument that clinicians could adopt to monitor and support their patients. The aim of the present study was to investigate acute post-traumatic stress symptoms (PTSS) reported by patients with BD followed in the framework of a telepsychiatry service, set up in the acute phase of the COVID-19 outbreak at the psychiatric clinic of the University of Pisa (Italy). A sample of 100 patients were consecutively enrolled and assessed by the IES-r, GAD-7, HAM-D, and YMRS. Patients reported a mean (±SD) IES-r total score of 18.15 ± 13.67. Further, 17% of the sample reported PTSS (IES-r > 32), 17% depressive symptoms (HAM-D > 17), and 26% anxiety symptoms (GAD-7 > 10). Work and financial difficulties related to the COVID-19 pandemic and anxiety symptoms appeared to be positively associated with the development of acute PTSS. Acute manic symptoms appeared to be protective. The data of the present study suggest the relevance of monitoring patients with BD exposed to the burden related to the COVID-19 outbreak for prompt assessment and treatment of PTSS

Chemical and enzymatic hydrolysis of waste wheat bran to sugars and their simultaneous biocatalytic conversion to valuable carotenoids and lipids

Defatted wheat bran, an industrial waste of the food chain, represents a strategic renewable material for modern biorefinery schemes. Through a combination of chemical and biological catalysis, a cascade process was developed to produce high-value fine chemicals, such as carotenoids and lipids, from polysaccharide fraction. Due to the low lignin content and suitable particle size of defatted wheat bran, pretreatment steps are unnecessary, allowing the direct enzymatic or chemical hydrolysis of polysaccharide components (glucan, xylan, and arabinan) to give fermentable sugars. Regarding the biocatalytic approach, the optimisation of the main reaction parameters, such as enzyme dosage (15, 30, 45, 60 FPU Cellic (R) CTec 3 HS/g glucan) and biomass loading (5, 10, 15, 20 wt%), was performed to improve the monosaccharide yield. Regarding the chemical route, a microwaveassisted FeCl3-catalysed approach was optimised in terms of catalyst amount (1.0, 1.3, 1.6 wt%) and reaction time (2.5, 5, 10 min) to maximise the sugar yield, minimizing the formation of furanic derivatives which are strong inhibitors for the subsequent fermentation step. The biological conversion of sugars obtained by both enzymatic and chemical routes into carotenoids and lipids was then performed by adopting the commercial yeast Rhodosporidium toruloides DSM 4444. The simultaneous production of carotenoids and lipids was optimised by investigating the effect of the C/N ratio in the fermentation medium. Under the optimised process conditions (C/ N 60), by fermenting hydrolysate obtained by chemical and enzymatic routes, carotenoid productions of 120 and 180 mg/L and lipids productions of 5.2 and 3.5 g/L were achieved, respectively. The highest carotenoids cell content achieved in this study (14.8 mg/g) is about 5 times higher than the maximum value reported in the literature to date for this yeast. Moreover, Rhodosporidium toruloides achieved the complete conversion of sugars into desired bioproducts for both the biomass hydrolysates demonstrating the effectiveness of the two different catalytic approaches adopted for biomass hydrolysis

Risk of Post-Traumatic Stress Disorder in 111 survivors the 2009 Viareggio (Italy) Rail Crash: The role of mood spectrum comorbidity

Objectives: To explore the presence of PTSD and the potential correlations between the risk of developing PTSD and the lifetime mood spectrum signs and symptoms, as assessed with the Mood Spectrum Questionnaire Lifetime Version (MOODS-SR), in a sample of survivors of a liquid gas train crash in Italy, in 2009. Methods: One hundred eleven subjects were assessed with the Structured Clinical Interview for Axis I Disorder (SCID-I), the Mood Spectrum Questionnaire (MOODS-SR) Lifetime version, the Impact of Event Scale-Revised (IES-R), and the Trauma and Loss Spectrum Questionnaire (TALS-SR). Results: Sixty-six subjects, of the 111 who completed the SCID-I (59.5%), met criteria for PTSD. PTSD patients showed higher comorbidity rates for Generalized Anxiety Disorder (GAD) (p < 0.001), and lifetime and current Major Depressive Disorder (MDD) (p < 0.001) than subjects who did not develop PTSD. Lifetime MOODS-SR 'Sociability/Extraversion' factor and the prevalence of lifetime MDD differentiated subjects with from those without PTSD, when a multiple logistic regression analysis was performed. Conclusions: Although further research is needed, our results show a significant correlation between the risk of developing PTSD and the mood spectrum comorbidity

Exploratory Study on the Associations between Lifetime Post-Traumatic Stress Spectrum, Sleep, and Circadian Rhythm Parameters in Patients with Bipolar Disorder

The present study aimed at exploring whether lifetime post-traumatic stress spectrum symptoms are associated with chronotype in patients with bipolar disorder (BD). Moreover, we explored whether the chronotype can moderate the potential associations between lifetime post-traumatic stress spectrum symptoms and rest–activity circadian and sleep-related parameters. A total of 74 BD patients were administered the Trauma and Loss Spectrum Self-Report (TALS-SR) lifetime version for lifetime post-traumatic stress spectrum symptoms, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and the Reduced Morningness–Eveningness Questionnaire (rMEQ) to discriminate evening chronotypes (ETs), neither chronotype (NT), and morning chronotype (MT). Actigraphic monitoring was used to objectively evaluate sleep and circadian parameters. Patients classified as ET reported significantly higher scores in the re-experiencing domain, as well as poorer sleep quality, lower sleep efficiency, increased wake after sleep onset, and delayed mid-sleep point compared with both NT and MT (p-value ≤ 0.05). Moreover, ET presented significantly higher scores in the TALS-SR maladaptive coping domain than NT and lower relative amplitude than MT (p-value ≤ 0.05). Moreover, higher TALS-SR total symptomatic domains scores were significantly correlated with poor self-reported sleep quality. Regression analyses showed that the PSQI score maintained the association with the TALS total symptomatic domains scores after adjusting for potentially confounding factors (age and sex) and that no interaction effect was observed between the chronotype and the PSQI. Conclusions: This exploratory study suggests that patients with BD classified as ET showed significantly higher lifetime post-traumatic stress spectrum symptoms and more disrupted sleep and circadian rhythmicity with respect to other chronotypes. Moreover, poorer self-reported sleep quality was significantly associated with lifetime post-traumatic stress spectrum symptoms. Further studies are required to confirm our results and to evaluate whether targeting sleep disturbances and eveningness can mitigate post-traumatic stress symptoms in BD

Reduction of nutrient run-off by the use of coated slow-release fertilizers on two container-grown nursery crops

The agricultural district of Pistoia (Tuscany, Italy) is one of the most important sites in Europe for the production of Hardy Ornamental Nursery Stock (HONS). One of the main problems of this sector is the environmental impact of the pot cultivation, mainly due to an incorrect irrigation scheduling that leads to high nitrogen and phosphorus losses. The aim of this research has been to compare the effects of the traditional fertigation versus new fertilization strategies, based on the use of controlled slow-release fertilizers (CRFs), on plant growth and on nitrogen and phosphorus run-off in two container HONS species (Photinia × fraseri and Prunus laurocerasus). Every week, plant height, cumulate irrigation and drainage volume were measured on four replicates for each treatment and species. Every four weeks two average samples of drainage water and irrigation water for each treatment and species were analysed, determining total nitrogen and phosphorus content, in order to draft a water and nutrient balance. The three different fertilization strategies did not produce any relevant effect on the final plant height and all plants were ranked in the top quality market category. The data confirmed that the use of CRFs could contribute to a huge reduction of nitrogen and phosphorus run-off in the environment and could be a winning strategy for the fertilization of HONS in nitrate vulnerable zones