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

Relationship between fatty liver and glucose metabolism: A cross-sectional study in 571 obese children

BACKGROUND AND AIMS: Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children. METHODS AND RESULTS: A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p</=0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD. CONCLUSION: NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function

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&gt;=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&lt;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&gt;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

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&gt;=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

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

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

Latent burnout profiles in a sample of frontline healthcare professionals after the peak of the Italian COVID-19 pandemic

Background: In Italy since February 2020, the unexpected massive afflux of COVID-19 patients exposed healthcare professionals to high work-related stress, high time pressure and increased the risk of being infected. This is the first study that aimed to investigate the psychological impact of COVID-pandemic at the end of the peak, by identifying latent burnout profiles in a sample of front-line healthcare professionals that worked in Italy during the peak of the pandemic. Methods: A total of 589 subjects filled in an online ad-hoc questionnaire and the Italian version of Maslach Burnout Inventory - Human Services Survey. Results: A higher presence of burnout profile in healthcare professionals who worked in frontline during the peak of the COVID-19 pandemic was highlighted. Furthermore, those professionals showed significantly higher perceived stress levels, increase of worries, and sleep problems, they were more likely to underline the importance of team spirit and to consider asking for psychological support. A multiple regression analysis revealed that age, managing COVID-19 patients, perceived stress levels, adequacy of training, and considering to ask for psychological support significantly predicted latent burnout profiles. Moreover, perceived stress levels mediate the relationship between those profiles and managing COVID-19 patients. Conclusions: These findings highlight how stressful and damaging the pandemic has been, especially for people directly involved in the care of patients tested positive for COVID-19. Furthermore, it provides evidence for the importance of investing in wellness for healthcare professionals, in order to avoid shortage due to burnout and to guarantee optimal standards of care to all patient

Working Memory, Jumping to Conclusions and Emotion Recognition: a Possible Link in First Episode Psychosis (Fep)

Introduction A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions - JTC). Aims To investigate a possible correlation between working memory, JTC and ER in FEP. Methods 41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task. Results According to the literature, cases had poorer performance in working memory tasks (Digit Span: \u3bc7,72 [ds=2,98] vs \u3bc10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: \u3bc5,36 [ds=2,43] vs \u3bc10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: \u3bc5,46 [ds=2,76] vs \u3bc8,74 [ds=3,24], U=865,50, p=0,00; Block Design: \u3bc4,82 [ds=2,72] vs \u3bc7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, \u3c72=10,27, p=0,001, \u3bc2,53 [ds=3,57] vs \u3bc4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: \u3bc21,62 [ds=7,43] vs \u3bc16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: rrho=0,276, p=0,003; Digit Symbol: rrho=0,275, p=0,002; Arithmetic: rrho=0,265, p=0,003; Block Design: rrho=0,292, p=0,001), but only Digit Span with ER (rrho=-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (rrho=-0,281; p=0,004). Conclusions Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients

Perceived public stigma towards schizophrenia among healthcare students: The relationship with diagnostic labelling and contact with people with schizophrenia

Objectives This study aimed at investigating the relationship between perceived public stigma towards people with schizophrenia (PWS) and their family members in a large sample of medical and psychology students. We hypothesised that: a) schizophrenia labelling would be related to greater perceived public stigma; b) contact with PWS would be related with lower perceived stigma; c) perceived public stigma would be similar between medical and psychology students and would be higher among students attending the clinical stage compared to their pre-clinical colleagues. Methods Participants were 592 students attending either the pre-clinical or clinical stage of coursework in Medicine and Psychology, at the University of Palermo (Italy) (Tab. I). Study measures included a short socio-demographic questionnaire, the Devaluation of Consumers Scale (DCS), and the Devaluation Consumers Families Scale (DCFS). Results Students who identified schizophrenia in an unlabelled clinical description expressed greater perceived public stigma towards PWS (t = -2.895, p = 0.004) and their family members (t = -2.389, p = 0.017). A trend-level association was found between previous contact with PWS and lower perceived public stigma (t = 1.903, p = 0.058), which became significant for those students who had a more extensive contact (Mann-Whitney z = 2.063, p = 0.039). Compared to medical students, psychology students perceived greater public stigma towards PWS. No difference was observed between students at different stages of their academic coursework (Tab. II). In a multivariate linear regression model, schizophrenia labelling and degree course predicted perceived public stigma towards severe mental disorders. Conclusions This study replicated previous findings on the relationship between public stigma towards PWS, schizophrenia labelling, and contact with PWS. Perception of public stigma was similar among pre-clinical and clinical students and greater among psychology students. The findings suggest the importance of promoting a critical awareness of negative stereotypes towards schizophrenia among healthcare students, since the beginning of their coursework. In addition to correct information about schizophrenia, anti-stigma intervention should include contact with PWS who live in the community

Cannabis consumption and the risk of psychosis

Summary Objectives: Cannabis is the most widely used illicit drug globally and its use has been linked to an increased risk for psychotic disorders. An association between cannabis consumption and psychotic symptoms was consistently reported by several studies. This case-control study aimed to widen the current findings about the impact of cannabis exposure on the risk of psychosis, by investigating the pattern of cannabis consumption in a sample of first-episode of psychosis (FEP) patients compared to healthy controls. Material and methods: 68 individuals who presented for the first time to mental health services of Palermo (Italy) with an ICD-10 diagnosis of psychotic disorders and 74 healthy were enrolled as part of the Sicilian Genetics and Psychosis study. Psychopathological assessment and diagnosis were carried out by the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Socio-demographic data were collected by the modified version of the Medical Research Council (MRC) socio-demographic scale. All participants were interviewed using the Cannabis Experience Questionnaire \u2013 Modified Version to obtain a detailed assessment of lifetime patterns of cannabis and other illicit drug consumption. Logistic regression was applied to investigate the relationships between various aspects of cannabis use (lifetime use, age at first use, duration, and frequency of use) and case-control status while controlling for potential confounders. Results: Patients started cannabis consumption about 3 years earlier than the control group (t = 3.1, p = 0.002) and were 8 times more likely to having started using cannabis before 15 years (adjusted OR = 8.0, 95% CI 2.4-27) than controls. Furthermore cases were more likely to smoke more frequently than controls (adjusted OR = 4.4, 95% CI 1.08-18). We did not find a difference in duration of cannabis use between cases and controls. Conclusions: The findings suggest that cannabis exposure, and especially daily cannabis consumption, is associated with the risk for psychosis; however, the retrospective study design does not allow drawing firm conclusions about causality