PSYCHOPATHOLOGICAL CHARACTERISTICS OF PATIENTS WITH FIRST-EPISODE PSYCHOSIS AND CHRONIC SCHIZOPHRENIA: A DESCRIPTIVE COMPARISON

Only few studies have compared the psychopathological features in first episode psychosis (FEP) and chronic schizophrenia (CS) patients. The aim of our study was to compare sociodemographic and clinical aspects of FEP and CS inpatients using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) in order to better characterize FEP. We did not find significant socio-demographic differences between the two groups apart from age and nationality. About PANSS we found that conceptual disorganization, poor rapport and lack of insight items scores were significantly higher in patients with FEP. Related to BPRS the items of somatic concerns, grandiosity and motor hyperactivity were significantly higher in the CS group; uncooperativeness was significantly higher in FEP group. Our study offers a characterization of FEP patients that confirms evidence and adds some information from the current literature. FEP patients seem to be more uncooperative with a worse interpersonal empathy and insight into the illness than CS patients; this could reduce their compliance with the treatment

INVOLUNTARY HOSPITALIZATION AND VIOLENT BEHAVIORS: MEDICAL ACT OR SOCIAL CONTROL? A 3-year retrospective analysis

Background: The present retrospective study is aimed at assessing the clinical and psychopathological correlates of violent behaviors in a sample of acute involuntary committed inpatients. Subjects and methods: Involuntary inpatients were retrospectively assessed for the presence of violent behaviors. Patients with and without overt hetero-aggressive behaviors were compared according to socio-demographic, clinical and psychopathological features. A stepwise backward logistic regression was performed in order to assess the variables most associated with the perpetration of violent acts. The sample of violent patients was then divided in two subgroups on the basis of the presence/absence of a serious mental illness (SMI). Bivariate analyses were performed between SMI and non-SMI violent patients. Results: In the present sample of 160 inpatients, 88 (55%) perpetrated violent acts. Subjects who performed violence presented a higher rate of mood stabilizers prescription (p=0.038). The PANSS-excited component was positively associated with violent behaviors (p=0.027, Odds Ratio (OR)=1.14, Confidence Interval (CI) 1.01-1.28), whilst the PANSS-depressed/anxiety factor displayed a negative association (p=0.015, OR=0.78, CI 0.64-0.95). Violent inpatients diagnosed with SMI presented higher rehospitalization rate (p=0.009), longer length of stay (p=0.005), more frequent long-acting injectable antipsychotics prescription (p<0.001) and a higher positive symptoms severity as measured by the PANSS-positive factor (p=0.049). Conclusions: The clinical population of acute psychiatric inpatients performing violent behavior represents a specific and heterogeneous subgroup of patients for which prevention and treatment strategies should be addressed

CIRCADIAN RHYTHMS DISRUPTIONS AND EATING DISORDERS: CLINICAL IMPACT AND POSSIBLE PSYCHOPATHOLOGICAL CORRELATES

Background: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. Methods: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). Results: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. Conclusions: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities

DIFFERENTIAL GENDER SEVERITY EXPRESSION OF SYMPTOMS IN PATIENTS WITH DUAL DIAGNOSIS: AN IN-PATIENT OBSERVATIONAL STUDY

Background: The present retrospective study is aimed at exploring the impact of gender differences in a sample of inpatients with dual diagnosis. Subjects and methods: The study was carried out at the Psychiatric Service of the General Hospital/University of Perugia (Italy). Patients were recruited from January 2015 until December 2018. The sample consists of patients with dual diagnosis, divided into two subgroups based on gender; descriptive and bivariate statistics were performed (p<0.05). Male and females were compared according to socio-demographic, clinical and psychopathological features, measured by Clinical Global Impressions (CGI) and factor models of the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). Results: In our sample (n=157), no significant differences in socio-demographic features were found between male (n=108, 68.8%) and female subjects (n=49, 31.2%). Women displayed a higher frequency of involuntary hospitalizations (53.1% vs 32.4%, p=0.022) and a higher score on the general psychopathology scale of the Positive and Negative Syndrome Scale (PANSS) (41.86±8.96 vs 36.54±10.38, p=0.041). Conclusions: Our study confirms the prevalence of dual diagnosis in the male gender. Female sex appears more frequently connected to some indices of clinical severity. We expect to enlarge our sample to confirm these results and further clarify the knowledge on the subject

CIRCADIAN RHYTHMS DISRUPTIONS AND EATING DISORDERS: CLINICAL IMPACT AND POSSIBLE PSYCHOPATHOLOGICAL CORRELATES

Background: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. Methods: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). Results: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. Conclusions: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities

COVID-19, AIR POLLUTION AND MENTAL ILLNESS: HEADS OF THE SAME "BEAST"?

The Covid-19 outbreak are generating relevant consequences under several aspects. Covid-19 pandemic together with air pollution and a dysfunctional anthropization/urbanization might affect public and mental health with a synergistic effect. The current paper explore hypothesis about existing links among Covid-19, air pollution and mental illness

COVID-19, AIR POLLUTION AND MENTAL ILLNESS: HEADS OF THE SAME "BEAST"?

The Covid-19 outbreak are generating relevant consequences under several aspects. Covid-19 pandemic together with air pollution and a dysfunctional anthropization/urbanization might affect public and mental health with a synergistic effect. The current paper explore hypothesis about existing links among Covid-19, air pollution and mental illness

“REVOLVING DOOR” AND BIPOLAR DISORDERS: A RETROSPECTIVE STUDY IN AN ACUTE INPATIENT UNIT

Introduction: The present retrospective study investigated clinical correlates of the revolving door (RD) phenomenon in a population of subjects affected by Bipolar Disorders (BDs). Subjects and methods: Medical records of subjects with BDs admitted to a psychiatric inpatient unit over a 5-year period of time were retrospectively reviewed and clinical data were extracted into an electronic dataset. “Revolving Door Subjects” (RDS) were defined as those who presented three or more “Revolving Door Hospitalizations” (RDH) during twelve months. Features of RDH were compared with non-RDH in order to identify characteristics associated with RD phenomenon and possible risk factors for readmission. To explore predictors of RDH, a stepwise backword logistic regression model was built, including the variables that were significantly associated with RDH in the bivariate analyses. Results: In our sample of 176 subjects affected by BDs, 53 (19.9%) RDH were identified. In the RDH group, a higher prevalence of mixed episodes (p=0.029) and medical co-morbidities (p=0.004) was detected. Subjects with repeated hospitalizations were more often committed to psychiatric residential facilities at discharge (p=0.002). Treatment features related to RDH were represented by a higher prescription rate of atypical antipsychotics (p=0.030), benzodiazepines (p=0.001) and antidepressants (p=0.048). Conclusions: Findings from the present study suggest that the early identification and treatment of medical comorbidities and specific clinical features of BDs may help reducing the RD phenomenon in this population of subjects

INVOLUNTARY HOSPITALIZATION AND VIOLENT BEHAVIORS: MEDICAL ACT OR SOCIAL CONTROL? A 3-year retrospective analysis

Background: The present retrospective study is aimed at assessing the clinical and psychopathological correlates of violent behaviors in a sample of acute involuntary committed inpatients. Subjects and methods: Involuntary inpatients were retrospectively assessed for the presence of violent behaviors. Patients with and without overt hetero-aggressive behaviors were compared according to socio-demographic, clinical and psychopathological features. A stepwise backward logistic regression was performed in order to assess the variables most associated with the perpetration of violent acts. The sample of violent patients was then divided in two subgroups on the basis of the presence/absence of a serious mental illness (SMI). Bivariate analyses were performed between SMI and non-SMI violent patients. Results: In the present sample of 160 inpatients, 88 (55%) perpetrated violent acts. Subjects who performed violence presented a higher rate of mood stabilizers prescription (p=0.038). The PANSS-excited component was positively associated with violent behaviors (p=0.027, Odds Ratio (OR)=1.14, Confidence Interval (CI) 1.01-1.28), whilst the PANSS-depressed/anxiety factor displayed a negative association (p=0.015, OR=0.78, CI 0.64-0.95). Violent inpatients diagnosed with SMI presented higher rehospitalization rate (p=0.009), longer length of stay (p=0.005), more frequent long-acting injectable antipsychotics prescription (p<0.001) and a higher positive symptoms severity as measured by the PANSS-positive factor (p=0.049). Conclusions: The clinical population of acute psychiatric inpatients performing violent behavior represents a specific and heterogeneous subgroup of patients for which prevention and treatment strategies should be addressed

A DUAL THERAPEUTIC SETTING MODEL EXPERIENCE FOR SCHIZOTYPAL PERSONALITY DISORDER IN AN INPATIENT UNIT

G.B., 21-year-old patient of Albanian origin suffering from acute psychotic burning on schizotypal personality disorder induced by substance abuse, was admitted to the Psychiatric Service at Perugia’ General Hospital, Italy. On admission, antipsychotic therapy was set up which had the role to reduced delusional and hallucinatory symptoms but the suspiciousness, the presence of magical thought and the closure towards surrounding world that characterize it, combined with the presence of intrusive images, consequently increased the anxiety experiences and negatively affects the establishment of a therapeutic relationship with the operators. During the hospitalization, daily support interviews were carried out: G.B. showed clear difficulty in expressing his own thought contents in presence of more than two operators emerged jointly with the tendency to project different emotional experiences based on the gender of the operator. Following these observations, with the aim to carrying out an intervention that could integrate a psychological approach to the pharmacological therapy in place, a specific personalized support setting was set up, consisting of a female and a male operator. This setting was structured coherently with the therapeutic goals to be achieved: creation of a therapeutic alliance, the integration of the patient\u27s emotional experiences and containing the splitting through the transference analysis. By means of this setting, the patient has obtained a substantial improvement of the splitting framework allowing a better integration of his emotional experiences. At the end of the sessions, G.B. showed more confidence with the medical staff and showed himself to be more aware of his pathological and non-pathological mental states and consequently more adherent to taking drug therapy and to the continuation of post-discharge psychological therapy