Female vs Males inmates: Authors' reply and sample size calculation

Bruno and colleagues highlighted the relatively low absolute-percentage of psychiatric morbidity that we found in our sample, as compared to their male sample. They invited to the use of diagnostic tools, specific for personality disorders and suicidal risk factors, to better investigate these critical issues. In summary, our results showed high percentages of psychiatric morbidity (44%), especially anxiety and depression. Female inmates declared to be most stressed by the distance from family and loved ones, and they did not present any antisocial personality diagnosis. They also showed a resilient reaction to their situation, because more than a half of women requested a supportive psychological therapy during their detention (14/25= 56%), and 10 of them were those with a psychiatric disorder (10/11= 90.9%), thus a higher proportion than those reported in male detainees at the Messina jail (56%), by Zoccali and colleagues (Zoccali et al., 2008). As we have acknowledged, we could further explore other personality disorders and not merely the antisocial personality pathological traits, as we did in our study. In conclusion, we agree with them about the need to repeat the screening for mental health and a deeper ascertainment of specific suicidal risk factors, with an adequate sample. Nonetheless, we believe that our data were not biased, and likely represented the psychological asset of the ladies’ detainee with a final sentence at the Pagliarelli jail of Palermo

Opinions about people with schizophrenia among medical students: Findings from an Italian cross-sectional study

Background: Accumulating evidence suggests that stigmatisation toward people with schizophrenia (PWS) is common among healthcare professionals and represents a major barrier to care. Aim: The study aimed at comparing the opinions about PWS among Italian medical students at different stages of education. Methods: Study participants were 234 medical students, attending either the first three-years pre-clinical or the following three-years clinical stage. Participants read an unlabelled case-vignette of schizophrenia and completed the Opinions on Mental Illness Questionnaire. Results: A greater proportion of students at the clinical stage identified schizophrenia in the clinical description, compared to their younger colleagues They were also more optimist about the efficacy of drug and psychological treatments and sceptical regarding the possibility of PWS to establish their own family. Conclusion: This study suggests that medical training may benefit from providing information about recovery from schizophrenia and contact with PWS in the community

Borderline personality in patients with poly-diagnoses treated for a Bipolar Disorder

Some patients with dysphoria, explosive behaviour, or suicidal ideation, may receive a diagnosis of, and treatment for Bipolar Disorder (BD) and, not infrequently. The coexistence of these two diagnoses has been explained in different ways. Some authors include the BPD in the bipolar spectrum; others are sceptical about the existence of real comorbidity, suggesting a misdiagnosis. This study aimed to assess the personality of this group of poly-diagnosed patients (PolyD) and hypothesised they had a pathological borderline organisation. Via the administration of the Schedler Westen Assessment Procedure (SWAP-200), we compared PolyD patients with those suffering from BPD or BD only. We performed two different MANCOVAs to test PolyD, BPD and BD patients' differences in PD-factors, Q-traits and age. The sample comprised 45 patients (Mean age=43.3, SD=15.7; Females 57.7%, N=26). BD patients (N=15) did not present any personality disorder, they had a higher functioning and Obsessive Q-traits, and a lower Histrionic PD-factor than both PolyD (N=20) and BPD (N=10) patients. Compared to PolyD patients, BD had inferior PD-Borderline, PD-Antisocial factor and Dependent-Masochistic Q-traits, but there were no other differences with BPD patients. PolyD did not differ from BPD patients in any of the PD-factors and Q-traits. Our results suggest that PolyD patients are different from BD patients and propose to consider the pathological borderline personality as a central core of their disease

Break in volition: a virtual reality study in patients with obsessive-compulsive disorder

Research in obsessive-compulsive disorder (OCD) produced inconsistent results in demonstrating an association between patients' symptom severity and their cognitive impairments. The process involved in volition aspects of behavioral syndromes can be extensively analyzed using specific tests developed in virtual environments, more suitable to manipulate rules and possible breaks of the normal task execution with different, confusing or stopping instructions. The study involved thirty participants (15 OCD patients and 15 controls) during task execution and the relative interferences. At this purpose, the virtual version of Multiple Errands Test was used. Virtual reality setting, with a higher ecological validity respect to a classic neuropsychological battery, allowed us to take into account deficits of volition and the relative dysexecutive functions associated with OCD patients. The proposed paradigm also allows the development of innovative prototypes of coevolving technologies based on new theories and models and deeper understanding of human behavior

INCIDENCE OF PSYCHOTIC DISORDERS IN PALERMO: PRELIMINARY DATA

Background: The incidence of psychotic disorders varies in different geographical areas (McGrath 2004). Recent data suggest that the incidence is higher in males, migrant minorities and in urban areas. There aren\u2019t many available epidemiological data on the incidence of psychotic disorders in Italy. This is the first incidence study on psychotic disorders carried out in Palermo, the capital of Sicily. Methods: we screened all patients presenting with their first episode of psychosis to the mental health services of our catchment area (5 inpatient, 5 outpatient units and 3 private psychiatric hospitals) over a period of three years (2008-2011). The diagnosis of psychosis was defined using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN Wing, J. K., et al., 1990).The main socio-demographic data were collected using the MRC Social Data Schedule. When subjects were not available (did not consent) for interview, information was collected from clinical notes. The population at risk referred to the people aged from 18-65 who were resident in the same catchment area (Palermo Municipality) in the period considered, according to the data of the Statistic Office of Palermo Municipality). Results: we identified 216 patients affected by a first episode of psychosis (FEP): 135 M (62.5%) and 81 F (37.5%), mean age 31.42 years (SD: 11.44). 77.1% of FEP had a diagnosis of non affective psychosis, 12.8% of affective psychosis and 10.1% received a diagnosis of other psychosis. 204 subjects were Caucasian, 12 non Caucasian belonging to various ethnicities and they were all first generation migrants (4 Indian, 3 African, 2 Bangladeshi, and 3 Mixed). Population at risk is 425.194 people. The mean age of onset was lower in men than women M: 29.98 years (SD: 10.41) vs. F: 34.28 (SD:12.64) (p=0.013)The incidence of psychotic disorders in our catchment area is 16,9 per 100.000 person years. It was higher in men 21,9 per 100.000 than women 12,2 per 100.000. Discussion: Our study is the first epidemiological study in Sicily investigating the incidence of psychotic disorders. In our population men have a higher incidence of psychotic disorders than women and an earlier age of onset

The role of different game-genres in predicting internet gaming disorder (IGD)

Introduction: Internet gaming disorder (IGD) is a new diagnosis in DSM 5 worth of research. New potentially addictive features are emerging in pay- and free-to-play videogames, involving different at-risk populations of gamers. However, few studies have examined whether and how different game-genres can contribute to the risk of IGD. Objectives: This study aimed to investigate how game-genres can predict IGD, accounting for alexithymia scores, time-related play- ing habits, and other predictors. Methods: Participants were gamers joining online communities, surveyed about which games they played more than 20 hours in their lifetime, time-variables, other stressors and alexithymia scores. A six-steps linear regression with IGD scores and a post hoc logistic regression (outcome: IGD>=21) were performed. Results: 5,979 subjects (88.7% males, 14-18 years), playing at different games (Figure-1). The game-genre explained the 1% of variation only. WoW and similar MMORPGs confirmed their potentiality in promoting IGD, regardless of alexithymia features (B=0.50, p=0.005). However, time-variables completely absorbed the WoW effect (B=0.01, p=0.951). LoL resulted addictive, even if considering time-variables and alexithymia (B=0.88, p<0.001). Minecraft emerged when time-variables were inserted (B=0.359, p=0.041) and stayed significant if removing alexithymia scores (B=0.48, p=0.010). Playing at Diablo3 and similar RPG did not increase IGD (B=-0.99, p>0.001). None of the different game- genres was able to push the subject over the threshold of IGD, because other characteristics interacted as additive risk-factors. Conclusions: Alexithymia traits and time-related playing habits mostly moderated the effect of different games in increasing IGD risk. A videogame could engage people with specific characteristics that may, in turn, differentially predispose to IGD

Pathological gambling in adolescence: A narrative review

Pathological gambling is an emerging and increasing phenomenon in Western counties. This work is aimed at reviewing the existing literature on this topic, paying special attention to its development, course and outcome in adolescence. We will explore epidemiological data, the instruments for the diagnostic and clinical assessment, the course and the outcome of the disorder, the comorbidity with other psychiatric syndromes and disorders. The main risk factors will be described at individual, social and community level. We provide an overview of the available pharmacological and psychological treatments and we report a clinical vignette in order to describe the psychological and psychopathological features of pathological gambling in adolescence

Differences between female and male gamers and gender-specific risk-factors for internet gaming disorder (IGD)

Introduction: Videogames have become more popular across females, although their widespread diffusion among males. How- ever, few studies have examined differences between female and male gamers and gender-specific risk factors for Internet Gaming Disorder (IGD). Objectives: The study aimed to describe males and females’ differ- ences in a sample of gamers, and to identify gender-specific risk- factors for IGD, accounting for alexithymia, playing habits, and other perceived stressors. Methods: Participants were gamers joining online communities, tested by IGDS-SF9 and TAS-20 for alexithymia. To explore isk-factors for IGD (outcome: IGD>=21), we set a binary logistic regression stratified by gender. Results: 5,305 males and 674 females differed in most of the descrip- tive characteristics (Figure-1) and game-genres preferences (Figure- 2). Higher DIF scores increased the risk of IGD in both males (OR=1.8 95% C.I. 1.6, 2) and females (OR=1.3 95% C.I. 1.1, 1.7) while higher EOT in males only (OR=1.2 95% C.I. 1.1, 1.3). Having another hobby apart from gaming was protective for males (OR=0.5, 95% C.I. 0.4, 0.6). Having started playing before their ten-years was a risk factor for females (OR=2.3 95% C.I. 1.2, 4.6). Loneliness and boredom feelings predicted IGD in males (OR=1.7 95% C.I. 1.5, 2) and, even more, in females (OR=2.7 95% C.I. 1.8, 4.2). Playing more than six hours/per day increased IGD-risk up to seven times in males (OR=7.3 95% C.I. 5.1, 10.3) and of almost sixteen times in females (OR=15.9 95% C.I. 5.4, 46.7) (Figure-3). Conclusions: Female gamers presented specific characteristics and a greater vulnerability to the increased time spent playing as a risk- factor for IG

Efficacy of a functional therapy program for depression and c-reactive protein: A pilot study

Objective: Affecting more than 264 million people, depression is a systemic and multifactorial disorder that represents one of the leading causes of illness and disability worldwide. Several studies showed an inflammatory response in depressed patients, including the involvement of both chronic low-grade inflammatory response and activation of cell-mediated immunity. The present study aimed to verify the efficacy of a structured functional therapy program for patients with depressed mood, and to determine whether this program can significantly reduce levels of C-reactive protein. Method: 28 outpatients with depressed mood received 20 individual sessions of Functional therapy. Data about socio-demographic variables, depression, self-esteem, and quality of life were collected; moreover, blood specimens were collected before and after treatment, and CRP measurement was performed by immunoenzymatic method. All measures were administered at baseline, at the end of treatment (i.e., 3 months after baseline), and at follow‐up (i.e., 6 months after baseline). Results: A repeated measures ANOVA showed a significant difference after treatment on depression levels, levels of self‐esteem, and all dimensions of quality of life, such as physical, psychological, social relationships, and environment. Furthermore, a statistically significant difference on levels of CRP was found. Moreover, at follow‐up, improvements were maintained. Conclusions: The study revealed initial evidence of the efficacy of a functional therapy program on treating depression and its psychological and inflammation-related markers

Children and Families' mental health during the first COVID-19 lockdown in Italy

Background: This study aimed to screen a wide range of emotional and behavioural variables emerging during the first COVID-19 pandemic-lockdown in a sample of parents and children, residents in the southern part of Italy, and explore which variables could predict children's wellbeing. We hypothesised that difficulties in adapting routines to pandemic restrictions, parents' emotional wellbeing, and attitude towards the pandemic could influence the children's behavioural attitudes. Methods: 221 parents completed the survey and gave information about 246 children. Ad hoc questionnaires were created and then exploratory reduced in factors. Strengths and Difficulties Questionnaire (SDQ) for parents assessed positive and negative behavioural attitudes in children. Depression Anxiety Stress Scale (Italian DASS-21) scored depression, anxiety and stress in parents. Results: Children presented higher emotional distress (Mean difference (Mdiff)=0.6, 95% C.I. 0.2, 0.9, p=0.013) and better prosocial behaviour (Mdiff=0.5, 95% C.I. 0.1, 0.9, p=0.011) than the Italian normative sample. Parents were more depressed than expected in the general population (Mdiff=1.0, 95% C.I. 0.3, 1.6, p=0.005). Having developed a morbid attachment to an adult (B=0.37, 95% CI 0.05, 0.69, p=0.024), a higher parental depression (B=0.1, 95% CI 0.02, 0.18, p=0.014), and children's suffering from nightmares (B=0.35, 95% CI 0.03, 0.67, p=0.032) explained the 31.9% of the total variance in children's emotional distress. Children's anxiety was related to parents' fear of the pandemic effects (r=0.32, p=0.001) and avoiding communicative approach (r=0.24, p=0.011). Conclusion: The first lockdown determined emotional distress and regressive mechanisms in children in the contest of higher parental discomfort, fear of the infection and avoidant communication. Following parents' indications, it could be helpful to provide families with informative and age-appropriate support