The impact of COVID-19 lockdown and of the following "re-opening" period on specific and general psychopathology in people with Eating Disorders: the emergent role of internalizing symptoms

BACKGROUND: We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on specific Eating Disorder (ED) and general psychopathology in people with an ED diagnosis during the lockdown period and after the end of the related containment measures.METHODS: People with clinically defined diagnosis and undergoing treatment for an ED completed an online survey, which included adapted questions from standardized psychometric scales. Data relative to three different time periods (before, during and after the end of lockdown) were collected. Psychopathological changes over these periods were investigated and compared through one-way analysis of variance or covariance with repeated measures.RESULTS: Three hundred twelve people completed the survey (57.4% diagnosed with Anorexia Nervosa (AN) or atypical AN, 20.2% with Bulimia Nervosa, 15.4% with Binge Eating Disorder, 7.05% with Other Specified Feeding or Eating Disorders). The severity of both specific and general psychopathology increased during the lockdown and the rise of general symptoms persisted in the following re-opening phase, except for suicide ideation. Almost all of these findings were not affected by ED diagnosis, participants' age and illness duration.LIMITATIONS: The retrospective nature of data collection is the main limitation of the study.CONCLUSIONS: People with EDs showed a COVID-19 emergency-induced worsening of both general and specific psychopathology. The effect on general psychopathology persisted in the re-opening period. These findings suggest a high stress vulnerability of ED individuals with important effects on internalizing symptoms, which are worth of attention by clinicians

Does social cognition change? Evidence after 4 years from the Italian Network for Research on Psychoses

BackgroundDeficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up. MethodsThe reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up. ResultsIn 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery. ConclusionsThe RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery

The influence of autistic symptoms on social and non-social cognition and on real-life functioning in people with schizophrenia: Evidence from the Italian Network for Research on Psychoses multicenter study

BACKGROUND: Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals. AIMS: To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia. METHODS: The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures. RESULTS: Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p\ua0=\ua00.010), attention (p\ua0=\ua00.011), verbal memory (p\ua0=\ua00.035), and social cognition (p\ua0=\ua00.001) domains, and an overall lower global cognitive composite score (p\ua0=\ua00.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p\ua0=\ua00.004), real-world interpersonal relationships (p\ua0<\ua00.001), and participation in community-living activities (p\ua0<\ua00.001). CONCLUSIONS: These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD

Accuracy of self-assessment of real-life functioning in schizophrenia

A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n=618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients' reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin's concordance correlation, Somers' D, and Bland-Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients' self-evaluation of functioning was higher than caregivers' in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers' ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program

Review of Rural Development Instruments: DG Agri project 2006-G4-10. Final Report

The aim of the study was to review the policy instruments under the framework of the European Agricultural Fund for Rural Development (EAFRD), 2007-13, by: • reviewing intervention rationales and instruments and their use against the objectives, priorities and key actions in the EU Strategic Guidelines; • assessing whether and how RD rationales and instruments should be adapted to deliver these more effectively. The study involved 8 tasks, grouped into 3 themes of analysis: 1) the targeting of EU-27 rural development expenditure, 2000-13, including the development of databases of EU-27 rural area characteristics and ‘indicators of need’ for RD; 2) consideration of the adequacy of the current EAFRD framework, based upon an evaluation of instruments’ cost-effectiveness; the a priori development of a typology of RD interventions and catalogue of instruments; an analysis of delivery mechanisms; and assessment of instruments in ‘fiches’; 3) conclusions and recommendations. In the event, progress in finalising national and/or regional RDPs 2007-13 was delayed,over the study period. Thus, the approach was modified to incorporate more qualitative analysis and the expenditure analysis was made using incomplete figures (July 2007), so 4% of total EAFRD planned expenditure was missing

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

Correlation between angiogenic factors and perifollicular blood flow in patients undergoing in vitro fertilization

While primordial and primary follicles receive nutrients and oxygen by passive diffusion from stromal blood vessels, follicular growth is associated with the development of an individual capillary network and continued angiogenesis to nourish the rapidly expanding follicle. It seems, however, that age is negatively correlated with ovarian perifollicular blood flow even if this has been observed only very late in the follicular phase. Support to this finding is the observation of increased levels of Vascular Endothelial Growth Factor (VEGF) in the follicular fluid from aging women. Transcriptional upregulation of VEGF is involved in the cellular adaptation to hypoxia under control of Hypoxia-Inducible Factor 1 (HIF1), a transcription factor activated by low oxygen tension to prevent depletion of oxygen at anoxic levels and subsequent cell death. Various recent studies have discovered that the vascular and the nervous system share an overlapping repertoire of growth factors affecting the development and the homeostasis of both systems. These include members of the vascular endothelial growth factor (VEGF), and neurotrophin growth factor family, such as brain derived neurotrophic factor. It has been shown, in neural tissue, that BDNF activation of TrkB stimulates VEGF mRNA transcription via induction of HIF-1. Thus, in normal tissues, BDNF seems to act as a proangiogenic stimulus. In the ovary, both VEGF and BDNF, secreted by the granulosa cells, seem to play a role in folliculogenesis and oocyte maturation. We aimed at establishing whether there is a relationship between follicular fluid VEGF concentrations, BDNF concentrations and perifollicular blood flow (PFBF) in women undergoing IVF and whether age makes a difference. In a prospective observational study, we enrolled 30 consecutive patients all at their first IVF cycle. These were subdivided in two age groups (13 patients aged 30-34 years and 17 patients aged 35-39 years). At oocyte retrieval, the perifollicular vascularity of one follicle per ovary was estimated qualitatively through power Doppler blood flow, for a total of 60 follicles. The follicular fluid from each of the identified follicles was centrifuged and stored until VEGF and BDNF assay. In our study, we found VEGF levels to be significantly correlated with grade of PFBF only in the younger age group. BDNF did not directly correlate with PFBF in any of the patients. There was a significant positive correlation between VEGF and BDNF follicular fluid levels only in the younger patients. VEGF follicular fluid levels were significantly higher in the older age group than in the younger group (VEGF 955,4 vs 546,5 ng/ml);. BDNF levels were also significantly higher in the older versus younger women undergoing IVF (BDNF 603,3 pg/ml vs 401,1 pg/ml). The ability of a given follicle to express BDNF and VEGF and develop an adequate vascular network may be inter-related. An adequate blood supply is of fundamental importance in the regulation of intrafollicular oxygen levels and the determination of oocyte quality. Reproductive aging may be associated with relatively low levels of intrafollicular oxygen and with an attempt, on behalf of a given follicle, to increase its vascular supply by increasing the secretion of VEGF. The trigger for this phenomenon may be represented by BDNF, which is tightly correlated to VEGF levels in younger age women, and tends to increase in older women