Rational Suicide in Late Life: A Systematic Review of the Literature

Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians' and population's perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting "silent" suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the "rationality" of patients' decision to die should be avoided, the possibility of rational suicide cannot be precluded

Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature

Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients' ability to benefit from the adopted interventions. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted

Resilience and Quality of Life in Mood Disorders and Diabetes: Correlations with Personality Traits, Coping and Self-esteem

Introduction The topic of resilience is obtaining a growing interest in psychiatric research. Resilience refers to positive adaptation or ability to maintain or regain mental health despite experiencing adversity. It is a dynamic, context- and time-specific process, and may vary across all life domains. Pathways to resilience are multiple and reciprocally interacting, and include biological, psychological, social and dispositional attributes. These factors play an important role both in psychiatric and somatic chronic disorders. Aims Our aim is to evaluate and compare resilience in mood disorder patients and diabetic ones. We also mean to investigate personality features, coping abilities, self-esteem and quality of life, and their possible correlation with resilience in these two populations. Methods Mood disorder and diabetic patients will be recruited at the Psychiatry Institute (SC Psichiatria) and Endocrinology Ward (SC Endocrinologia), respectively. Socio-demographic data will be gathered and patients will be asked to fill the following self-administered scales: Resilience Scale for Adult (RSA), Coping Orientation to Problems Experienced Inventory \u2013 Brief (Brief Cope), Rosenberg Self-Esteem Scale (RSES), Paykel List Of Stressful Events, Temperamental and Character Inventory (TCI), Short Form 36 (SF-36). Results/Conclusions Data collection is ongoing. We expect that the findings from this research may allow to develop strategies to support patients with chronic diseases, both as far as outcome and subjective well-being are concerned, according to the World Health Organization definition of 'mental\u201d and 'physical\u201d health

A Case Report of a Woman Affected with Rapid Cycling Bipolar Disorder I and Methabolic Syndrome Improved with Aripiprazole Monotherapy

Introduction We present the case of a 51-years-old Caucasian woman with Bipolar Disorder I (BDI), treated for a long time with typical antipsychotics and mood stabilizers. She referred to our outpatient service because she wished to revise her precriptions, which had caused several side-effects, including metabolic syndrome, gain of body weight, sedation, cognitive impairments, and extrapiramidal symptoms. Moreover, treatment was poorly effective, the patient's compliance was lacking and she experienced frequent relapses. Aims We started treating the patient with aripiprazole at a daily dose of 15 mg. Our aim is to describe the substantial clinical and metabolic improvements of a patient who poorly responded to previous prescriptions. Methods Psychometric measures for the assessment of mood and social functioning were administered at baseline and at the follow-up interviews. Body Mass Index was monitored and blood tests were performed to evaluate the lipid profile (LDL, HDL, total cholesterol, triglycerides), blood glucose, and glycated haemoglobin. Results In the last two years the patient has regularly taken her therapies and attended to follow-up visits. Her social functioning and tolerance to stressful situations have improved, as well as her metabolic profile. Noteworthy, she had not needed further hospitalizations. Conclusions Our clinical observations support the efficacy of aripiprazole in the treatment of BDI. Switching to aripiprazole should be considered in cases similar to the one we have described, characterized by poor compliance, obesity or metabolic syndrome, sensitivity to manifest extrapiramidal syndrome (especially tardive dyskinesia) and other side effects such as sedation and cognitive impairments

Orthorexia and anorexia nervosa: Two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples

BACKGROUND: Orthorexia nervosa (ON) is defined as pathological healthful eating. The aim of this study was to investigate whether there is any difference in orthorexic behaviours between clinical and non-clinical groups, and in different cultural contexts. . METHODS: Recruitment involved both female patients with anorexia nervosa (AN) and healthy controls (HC) from Italy and Poland (N = 23 and N = 35 AN patients; and N = 39 and N = 39 HCs, in Italy and Poland, respectively). Assessment of orthorexic behaviours was performed with the ORTO-15 test. RESULTS: Statistically significant differences were found between Italian women in the AN and HC group, whereas no difference between Polish women in the AN and HC group was found. Both Italian groups scored significantly higher than the Polish ones on the ORTO-15. CONCLUSIONS: Differences have been found between the Italian and Polish samples, both in the percentage of individuals with orthorexic behaviours as suggested by an ORTO 15 score below the cutoff, and in the mean ORTO 15 scores in the AN and HC groups, suggesting cross-cultural differences in orthorexic behaviours, whose meaning is currently difficult to understand

Involuntary psychiatric admissions: A retrospective study of 460 cases

Introduction: We collected the data relating to involuntary hospital treatment (IHT) in the University Psychiatric Ward at Novara Hospital between 1991 and 2002, and compared them with those relating to Piedmont and the whole of Italy. Methods: The data were collected from the ward medical records. Results: IHT was much more frequent among young male schizophrenics living with their families of origin. Most of the subjects were not working at the time of admission. There was a statistically significant correlation between male gender and the risk of being admitted for a period of less than 12 days. The risk of being admitted for more than 12 days significantly correlated with the province of birth and residence, as well as with a diagnosis of schizophrenic psychosis. Conclusions: Schizophrenia is the diagnosis that is most frequently associated with IHT

The moderating effects of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women

The aim of the current study was to examine the moderating effect of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women. One hundred and eighty four overweight and obese adult women (BMI 30.12\u2009\ub1\u20093.77 kg/m2) were assessed with the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Three Factor Eating Questionnaire and the Mindful Eating Scale. Mindful eating significantly moderated several of the relationships between emotional functioning and eating styles. When mindful eating techniques are included as part of an intervention for overweight or obese individuals, it is even more important that those interventions should also include techniques to reduce emotion dysregulation and negative affect

The psychopathology of body image in orthorexia nervosa

The human body has a complex meaning and role in everybody\u2019s life and experience. Body image has two main components: body percept (the internal visual image of body shape and size) and body concept (the level of satisfaction with one\u2019s body), whose specific alterations may lead to different conditions, such as overestimation of one\u2019s own body dimensions, negative feelings and thoughts towards the body, body avoidance and body checking behavior. Moreover, body dissatisfaction can be associated with a variety of other mental health and psychosocial conditions, but only a few studies have explored the body image construct in orthorexia nervosa (ON). ON is a condition characterized by concern and fixation about healthy eating, with mixed results available in the literature about the presence of body image disorders. The aim of this manuscript is to present the main findings from the literature about the psychopathology of body image in ON. Summarizing, while theoretically the presence of body image disturbances should help clinicians to differentiate ON from eating disorders, further research is needed to confirm this finding. It is not clear whether the body image disorder in ON depends on an altered body percept or body concept, and the relationship between the disordered eating behavior and body image disorder still needs to be disentangled. Further studies regarding the relationship between ON and body image could be helpful to better understand the relevance of body image as a transdiagnostic factor and its potential value as target for treatment intervention

Consultation-liaison psychiatry: strategy for care, opportunity for training

The liaison psychiatry defines itself as way to comprehend the psychological aspects in any situation of care, and in particular in the context of somatic care. The identification of the psychic processes, which can influence the diagnosis and the outcome of a somatic disease, is essential to adequately and globally take care of the individual. At the same time, training in the Help relationship allows to identify the difficulties of nursing, which is very often source of exhaustion and burn-out

Schizophrenia spectrum disorders: Focus on social cognition and empathy

Background Schizophrenic patients show deficits in social cognition, functioning and in interpreting facial expressions. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian Network of Research on Psychosis headed by Prof. Maj and Prof. Galderisi (Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014:275\u201387. Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community. Schizophr Res 2014;159(1):144-50); collection in our centre went on also after the conclusion of the national project. Aims To identify the correlations among social inference, facial emotion identification and clinical history and therapies in schizophrenic patients. Material and methods We recruited patients with Schizophrenia referring to our Psychiatry Ward, AOU Maggiore della Carit\ue0, Novara, Italy. Socio-demographic characteristics were gathered; assessment of patients included The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test (FEIT), the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). Results Data collection is still ongoing. In a previous study we pointed out that schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. These features underlie poor and limited social relationships proper to schizophrenia. Our preliminary results revealed thatidentification of facial emotions is influenced by psychopathological symptoms especially by avolition, blunted affect and alogia. Implication will be discussed