Multimodal therapy in the management of MOH. a 3-year experience

The relationship between migraine and psychopathology has been clinically discussed in various studies. Medication-overuse headache (MOH) has been often found comorbid with emotional disturbances and disordered personality traits [1,2]

The relationship among the health-related quality of life, illness severity, personality and psychiatric symptoms in patients with psoriasis: an empirical investigation

Background: Psoriasis is a complex and chronic inflammatory skin disorder. The mechanisms underlying this immune-mediated disease are not clear, but some evidence indicates that specific personality features and symptom patterns may play an important role in the development and clinical presentation of the disorder and influence the quality of patients’ lives. This study aimed at evaluating the associations among the quality of life, illness severity, psychiatric symptoms and personality patterns in patients with psoriasis treated with biological or topical therapy. Methods: Fifty psoriatic patients were evaluated with self-report measures: the Symptom Checklist-90-R (SCL-90R) and the Psoriasis Index of Quality of Life (PSORIQoL). Their personality and psychological functioning were assessed by external raters using the Shedler-Westen Assessment Procedure (SWAP-200) applied to the Clinical Diagnostic Interviews (CDI). Finally, the severity and the area of psoriatic lesions were evaluated by dermatologists with the Psoriasis Area Severity Index (PASI). Results: Significant differences between the groups (biological vs topical therapy) were found in PASI scores: patients assigned to biological therapy showed lower levels of illness severity. No differences were found in PSORIQoL scores. The quality of life was negatively associated with various dimensions of SCL-90R and with borderline (r = .39; p< .01), dependent (r = .41; p< .01) and avoidant (r = .35; p< .05) personality styles/disorders; conversely, it did not relate to PASI. Conclusions: The results seem to suggest that the quality of life in psoriatic patients is more influenced by personality characteristics and psychiatric symptoms than by the severity of psoriatic lesions

ADHD symptoms and suicide attempts in adults with mood disorders: An observational naturalistic study

Abstract Background Although several studies explored the association between ADHD and suicidality in the pediatric population, there is a lack of studies focusing on adults. It is particularly unclear whether comorbid mood disorders confer an increased risk of suicidal ideation and attempt among individuals with high ADHD symptoms. Methods Participants were 111 inpatients admitted to the Department of Psychiatry of Sant'Andrea Hospital between July 2017 and July 2018. Data were collected using self-report questionnaires and semi-structured interviews. Lifetime and last-month suicidal ideation and attempts were rated with The Columbia-Suicide Severity Rating Scale (C-SSRS). Symptoms of ADHD were rated using The Adult ADHD Self-Report Scale Version 1.1 (ASRS-V1.1). Results Of the 111 participants, 40.6% had a history of suicide attempts. No associations were found between ADHD symptoms and suicide attempt/ideation as well as mood disorder diagnosis and suicide attempt, while an association between mood disorder diagnosis and suicidal ideation was found. ADHD symptoms were significantly associated with suicide attempt (lifetime and in the last 3 months) only among participants with mood disorders (lifetime, OR 2.30; 95% CI: 0.97–3.64; 3-months OR 2.34; 95% CI: 0.19–4.49) Limitations Given the cross-sectional nature of the study, the directions of the associations described are uncertain. Conclusions: ADHD symptoms were significantly associated with lifetime and recent suicide attempts, only when a mood disorder diagnosis was comorbid. The co-occurrence of ADHD symptoms and a mood disorders diagnosis might confer a higher risk of suicide attempt among adults

An MMPI-2 hopelessness scale: Construction, initial validation and implication for suicide risk

This study documents the development of a new MMPI-2 scale, Hopelessness (Hp), designed to identify suicide risk in examinees who, for whatever reason, may be reluctant to endorse items reflecting explicit suicide content. The psychometric and empirical validity characteristics were examined in a sample of 153 Italian psychiatric inpatients, all of whom were administered the MMPI-2, the Beck Hopelessness Scale (BHS), and the Mini International Neuropsychiatric Interview (MINI) shortly following admission.Item analysis suggested that the removal of one of the twelve original Hp items enhanced homogeneity of the scale and Bayesian confirmatory factor analysis (BCFA) indicated the fit of a unidimensional model (PPPs = 0.50 [PPC = -36.42/37.07]) for the 11-item version, with adequate reliability (ordinal alpha = 0.86). A regression analysis, with the MINI scores as criterion, and Hp and BHS scores as independent variables, indicated that only Hp scores (beta = 0.25, t = 2.32, p < 0.05) were independently associated with the MINI suicide risk. These findings indicate that the MMPI-2 Hp scale may be considered a valid and potentially useful measure of pessimistic attitudes toward the future and of potential suicide risk

Lifestyle Interventions and Prevention of Suicide

Over the past years, there has been a growing interest in the association between lifestyle psychosocial interventions, severe mental illness, and suicide risk. Patients with severe mental disorders have higher mortality rates, poor health states, and higher suicide risk compared to the general population. Lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. The current article provides a comprehensive review of the literature on lifestyle interventions, mental health, and suicide risk in the general population and in patients with psychiatric disorders. For this purpose, we investigated lifestyle behaviors and lifestyle interventions in three different age groups: adolescents, young adults, and the elderly. Several lifestyle behaviors including cigarette smoking, alcohol use, and sedentary lifestyle are associated with suicide risk in all age groups. In adolescents, growing attention has emerged on the association between suicide risk and internet addiction, cyberbullying and scholastic and family difficulties. In adults, psychiatric symptoms, substance and alcohol abuse, weight, and occupational difficulties seems to have a significant role in suicide risk. Finally, in the elderly, the presence of an organic disease and poor social support are associated with an increased risk of suicide attempt. Several factors may explain the association between lifestyle behaviors and suicide. First, many studies have reported that some lifestyle behaviors and its consequences (sedentary lifestyle, cigarette smoking underweight, obesity) are associated with cardiometabolic risk factors and with poor mental health. Second, several lifestyle behaviors may encourage social isolation, limiting the development of social networks, and remove individuals from social interactions; increasing their risk of mental health problems and suicide

Anxiety, Prenatal Attachment, and Depressive Symptoms in Women with Diabetes in Pregnancy

Abstract: The purpose of this study was to evaluate the relationship between anxiety, prenatal attachment, and depressive symptoms among women with diabetes in pregnancy. Participants were 131 consecutive pregnant women between the ages of 20 and 45 with a diagnosis of gestational or pregestational type 1 or type 2 diabetes. Data on previous psychiatric symptoms were obtained from the Anamnestic and Social Questionnaire and the Mini-International Neuropsychiatric Interview (MINI). Information on prenatal attachment was collected using The Prenatal Attachment Inventory (PAI), and The Edinburgh Postnatal Depression Scale (EPDS) assessed depressive symptoms in the third trimester of pregnancy (at a mean of 25 weeks). Results demonstrated that in women aected by diabetes in pregnancy, two facets of prenatal attachment (anticipation, interaction) were negatively correlated with depressive symptoms, and a history of anxiety, assessed with the MINI, moderated the relation between the prenatal attachment interaction factor and depressive symptoms during pregnancy

SUICIDE RISK IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Background: ADHD (Attention-deficit/hyperactivity disorder) is a common neurodevelopmental disorder that manifests itself during childhood with various combinations of symptoms, including inattention, hyperactivity and impulsivity. Research has shown that psychiatric comorbidities play an important role in the development of suicidal behavior and, recently, there has been a growing interest in a possible association between ADHD and suicide during both childhood and adulthood. Furthermore, some authors have shown a relationship between pharmacological treatments and suicide in patients affected by ADHD. Aims: We conducted a selective review of current literature to explore the factors which contribute to suicidal behavior and selfharm in those with ADHD. Methods: We performed a PubMed/MEDLINE, Scopus, PsycLit, and PsycINFO search to identify all articles and book chapters on the topic up to 2017. Results: Several studies have showed that ADHD may be correlated with an increased suicide ideation and attempts. Conclusions: Although differences in studies design and samples made the results difficult to compare and interpret, many studies indicate an association between ADHD and suicidal behavior. It remains controversial whether there is a direct relationship or whether the association depends on the increased prevalence of pre-existing comorbid conditions and individual and family dysfunctional factors

White matter hyperintensities and self-reported depression in a sample of patients with chronic headache

White matter hyperintensities (WMH) have been associated with mood disorders in psychiatric patients. In the present study, we aimed to assess whether WMHs are associated with depressive symptoms and different sensitivity of the behavioral inhibition (BIS), and activation (BAS) systems in patients with chronic headache. Participants were 85 adult outpatients (16 men and 69 women) with a diagnosis of chronic headache. All of the patients underwent brain magnetic resonance imaging (MRI) and were administered the BIS/BAS scales and the Center for Epidemiologic Studies Depression Scale. Above 40 % of patients had periventricular WMHs (PWMHs) and almost 98 % had deep WMHs (DWMHs). Patients with PWMHs reported fewer depressive symptoms than patients without PWMHs. Patients with more severe DWMHs (compared with patients with mild or without DWMH lesions) were older and reported lower scores on the drive dimension of the BIS/BAS scales. In multivariate analyses, patients with PWMHs were 1.06 times more likely to report fewer depressive symptoms than patients without PWMHs. WMH lesions in patients with chronic headache were associated with less depression severity

Mental turmoil, suicide risk, illness perception, and temperament, and their impact on quality of life in chronic daily headache

To evaluate the relationship among quality of life, temperament, illness perception, and mental turmoil in patients affected by chronic daily headache with concomitant medication overuse headache. Participants were 116 consecutive adult outpatients admitted to the Department of General Medicine of the Sant’Andrea Hospital in Rome, between January 2007 and December 2007 with a diagnosis of chronic daily headache (illness duration >5 years). Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), the Beck Hopelessness Scale (BHS), the Hamilton Rating Scale for Depression (HAM-D), the Mini-International Neuropsychiatric Interview (MINI), the Revised Illness Perception Questionnaire (IPQ), the Suicide Score Scale (SSS), and the Quality of Life Index (QL-Index). Twenty-eight percent of the patients evidenced moderate to severe depression, and 35% evidenced severe hopelessness. Analyses also indicated that quality of life, temperament, illness perception, and psychological turmoil are associated. However, a hierarchical multivariate regression analysis with quality of life as dependent variable indicated that only a model with mental turmoil variables may fit data; further, only the MINI suicidal intent resulted associated with quality of life (standardized regression coefficient = −0.55; t = −3.06; P < 0.01). Suicide risk may play a central role in affecting the quality of life of patients with chronic headache. The investigation of the interplay of factors that precipitate suicide risk should include assessment of chronic headache and its effects on wellbeing

Il debutto della psicosi Fallimento della funzione riflessiva nello sviluppo dei prodromi

Una linea di studio percorribile nel vastissimo panorama di ricerca relativa ai prodromi, riguarda l’adozione di una visione dimensionale e meramente psicodinamica degli eventi psichici e di quel rumore clinico antecedente l’imporsi della malattia. La relazione tra adolescenza e possibili sviluppi psicotici potrebbe essere articolata – più che su un elenco di fenomeni in grado di connotare quadri patologici differenti – lungo il vettore storico-evolutivo in grado di operare un ribaltamento della funzione diagnostica da un mero soppesare i sintomi trasversalmente presenti ad un processo in cui è possibile conoscere il senso di certe specifiche ricorrenze sintomatologiche a partire da narrative soggettive (Pazzagli & Rossi Monti, 1999). I modelli attuali di psicosi suggeriscono che fattori ambientali avversi, in particolare traumi interpersonali, svolgono un importante ruolo nello sviluppo e decorso della psicosi (ad esempio,van Winkelet al., 2013;Bentallet al., 2014). Dati di ricerca, infatti, hanno mostrato un’alta prevalenza di traumi nel campione ad alto rischio di psicosi, rilevando come il trauma sessuale, in particolare, sia predittivo di passaggio alla psicosi (Thompson et al., 2014). Scopo di questo lavoro è dunque, valutare, a partire dai racconti soggettivi, l’effetto di un mancato rispecchiamento – relazione di attaccamento traumatica – sull'esperienza affettiva precoce del bambino. Il punto di partenza dello sviluppo psicotico coincide, dunque, con una battuta d’arresto di fronte ad un debordare di tracce emotivo-affettive non mentalizzate – per effetto di un mancato contenimento di base da parte di un caregiver –che condurrebbe all'emergere di elementi confusi, carichi di angosce, simili a quelli che Bion definiva “elementi Beta” (Bion, 1963), fino alla completa rottura con il mondo esterno:la psicosi. In questa lotta contro “l’inermità, l’impotenza e la passività” (Correale, 2000) che caratterizza l’atmosfera prodromica, diviene interessante, dunque, porre l’accento sul ruolo del trauma e la sua riattualizzazione, intesa come riattivazione di memorie emotive implicite e sulla visione della dissociazionee depersonalizzazione come venir meno del principio ordinatore della coscienza e messa in atto di iniziali forme di distacco dal sé e dal mondo. Da un punto di vista clinico, l’alta prevalenza di fenomeni dissociativi in pazienti con psicosi, pone l’accento sulla necessità di ripensare alla psicosi e a quel rumore clinico che potrebbe precederla all'interno di una nosologia dimensionale, in cui le manifestazioni psicopatologiche divengono espressione della dissociazione abitualmente conseguente al trauma. A partire da un modello di disturbo derivante dalla disorganizzazione dell’attaccamento e mediato dai processi dissociativi prodotti dal trauma, obiettivo dello studio è, dunque, quello di esplorare il ruolo della mentalizzazione nello sviluppo dei prodromi della psicosi. Gli approfondimenti in tal senso risentono, principalmente, dell'approccio e della terminologia proposta da Fonagy e colleghi (Fonagy et al., 2003; Bateman&Fonagy, 2004)