Ansia di separazione nell'adulto: traduzione e validazione italiana della Adult Separation Anxiety Checklist (ASA-27)

L'obiettivo della tesi è la validazione della versione italiana dell'Adult Separation Anxiety Checklist (ASA-27). Il campione totale è di 234 soggetti ed è così composto: 115 pazienti afferenti all' ambulatorio della clinica psichiatrica dell'università di Pisa; 49 soggetti ad alto rischio di disturbo d'ansia di separazione e 64 controlli sani. Tutti i soggetti sono stati valutati mediante la SCID1 e l'ASA-CL. Lo strumento ha mostrato un buon livello di consistenza interna (Cronbach alpha .89) e un'ottima affidabilità test-retest (.96). Un cut-off di 25 è stato individuato come il punteggio in grado di garantire un equilibrio ottimale tra sensibilità (86%) e specificità (84%). Un ulteriore cut-off di 18 è stato individuato per l'utilizzo come strumento di screening (sensibilità 97% e specificità 62%)

Trajectories of Depressive and Anxiety Symptoms in an Italian Sample of Subjects suffering from Mental Disorders during the COVID-19 Pandemic.

Nonostante sia noto che le persone con malattie mentali rappresentano un gruppo potenzialmente vulnerabile all'impatto dannoso degli eventi stressanti, ad oggi sono disponibili dati limitati sull'effetto della pandemia COVID-19 sul decorso clinico delle patologie psichiatriche. I risultati degli studi condotti finora hanno evidenziato un rischio significativo di peggioramento delle condizioni psicopatologiche insieme a un alto tasso di sintomi di stress post-traumatico. Tuttavia, le evidenze emerse sinora sono ancora non conclusive e solo pochi studi hanno un disegno longitudinale. Il presente studio è uno studio multicentrico e naturalistico volto a esaminare le traiettorie dei sintomi depressivi e d'ansia in un campione nazionale di pazienti psichiatrici ambulatoriali con una vasta gamma di diagnosi e analizzarne i correlati clinici e socio-demografici durante un follow-up di tre mesi iniziato ad un anno dall'inizio dell'emergenza COVID-19. Although it is acknowledged that people with mental illness represent a potentially vulnerable cluster to detrimental impact of stressful events, to date limited data are available on the effect of COVID-19 pandemic on the clinical course of psychiatric illness. Results of studies conducted so far have reported a significant risk of worsening psychopathological conditions along with a high rate of post-traumatic stress symptoms.However, the evidence collected is still inconclusive, and only a few studies have a longitudinal design. The present study is a multicentric, naturalistic study aimed to examine the trajectories of depressive and anxiety symptoms in a national sample of psychiatric outpatients with a wide range of diagnoses and analyze clinical and socio-demographic correlates during a three-month follow-up starting one year after the onset of COVID-19 emergency

Suicidality and Illness Course Worsening in a Male Patient with Bipolar Disorder during Tamoxifen Treatment for ER+/HER2+ Breast Cancer

Purpose. Tamoxifen is a selective estrogenic receptor modulator (SERM) drug. In addition to its common use in breast cancer ER+, Tamoxifen has been object of growing interest in psychiatry as antimanic drug. At the same time, clinical concerns about Tamoxifen’s depressogenic effect have been repeatedly raised even without reaching univocal conclusions. We discuss the case of a 45-year-old-male with a diagnosis of Bipolar Disorder type II, treated with Tamoxifen as relapse prevention treatment after surgery for a ER+/HER2+ breast cancer. The patient required two psychiatric admissions in a few-month time span since he showed a progressive worsening of both depressive and anxiety symptoms, with the onset of delusional ideas of hopelessness and failure up to suicidal thoughts. The clinical picture showed poor response to treatment trials based on various associations of mood-stabilising, antidepressants, and antipsychotic drugs. During the second hospitalization, after a multidisciplinary evaluation, the oncologists agreed on Tamoxifen discontinuation upon the severity of the psychiatric condition. The patient underwent a close oncological and psychiatric follow-up during the following 12 months. Methods. Psychiatric assessments included the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Scale (HAM-D), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). All questionnaires were administered at the time of the second hospitalization and in a one-year follow-up. Results. Suicidal ideation fully remitted and depressive symptoms markedly and rapidly improved in the aftermath of Tamoxifen discontinuation. The symptomatological improvement remained stable across one-year follow-up. Conclusions. Male patients with a mood disorder history constitute a high-risk group as to Tamoxifen psychiatric side effects. The onset or worsening of depressive symptoms or suicidality should be carefully addressed and promptly treated, and clinicians should be encouraged to consider the possibility of discontinue or reduce Tamoxifen therapy after a multidisciplinary evaluation

Post-traumatic stress disorder, burnout and their impact on global functioning in Italian emergency healthcare workers

Post-Traumatic Stress Disorder (PTSD) and Burnout are severe and frequent conditions among emergency healthcare workers exposed to repeated workrelated traumatic experiences. The aim of the present study was to investigate PTSD, Burnout and global functioning in a sample of emergency healthcare workers (HCWs) of a major University Hospital of Italy, exploring possible correlations between the two constructs

Post-traumatic stress burden in a sample of hospitalized patients with Bipolar Disorder: Which impact on clinical correlates and suicidal risk?

Increasing evidence suggests Bipolar Disorder (BD) to be frequently associated to a history of traumatic experiences and Post-traumatic Stress Disorder (PTSD), with consequent greater symptoms severity, number of hospitalizations and worsening in quality of life. The aim of the present study was to investigate the lifetime exposure to traumatic events and PTSD rates in-patients with BD and to analyze the relationships between PTSD symptoms, clinical characteristics and severity of the mood disorder

Relationships Between Somatic Symptoms and Panic-Agoraphobic Spectrum Among Frequent Attenders of the General Practice in Italy

Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments

A longitudinal study of post-traumatic stress, depressive and anxiety symptoms trajectories in subjects with Bipolar Disorder during the COVID-19 pandemic

BACKGROUND: Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset. METHODS: A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points. RESULTS: We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one. CONCLUSIONS: Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population