Il ruolo dello stress soggettivo e oggettivo nella variabilità fenomenologica dei sintomi di base. Studio di un campione di pazienti affetti da disturbi dello spettro della schizofrenia e del disturbo bipolare

Introduzione: Il modello della vulnerabilità allo stress, in accordo al quale i sintomi psichiatrici emergono quando il peso cumulativo degli stressor eccede la soglia di vulnerabilità individuale, sostiene che lo stress psicosociale sia implicato nello sviluppo dei sintomi psicotici. Un altro approccio interessante allo studio della vulnerabilità nello sviluppo della psicosi è rappresentato dal concetto dei sintomi di base. Obiettivo: Scopo del presente lavoro è quello di proporre una integrazione tra questi due modelli e investigare la possibile associazione tra sintomi psicotici, sintomi di base, stress percepito e eventi di vita in un campione di pazienti affetti da schizofrenia, disturbo schizoaffettivo e disturbo bipolare con e senza sintomi psicotici. Metodi: Sono stati arruolati 112 pazienti in due ospedali universitari e sono stati sottoposti ad una valutazione della sintomatologia psichiatrica (Positive and Negative Syndrome Scale, PANSS), sintomi di base (Frankfurt Complaint Questionnaire, FCQ), stress percepito (Stress-related Vulnerability Scale, SVS), e eventi di vita (scala di Paykel). Risultati: I pazienti affetti da disturbo bipolare (sia con che senza sintomi psicotici) hanno mostrato un maggiore numero di eventi di vita indipendenti (p<0.001) e tendevano a riportare con maggior frequenza almeno un evento di vita nei 6 mesi precedenti (p<0.001). Non sono emerse differenze significative tra i due gruppi rispetto allo stress percepito o ai sintomi di base. Nel campione totale, la regressione lineare multipla ha mostrato un’associazione dei livelli di stress percepito tanto con l’intensità delle esperienze soggettive disturbanti (p<0.001) che con la gravita della sintomatologia psichiatrica (p<0.05). Conclusioni: Nel presente campione, gli eventi di vita e i sintomi di base non hanno svolto un ruolo significativo nell’influenzare i sintomi psicotici, rispetto alla percezione soggettiva dello stress e la gravità della psicopatologia. Complessivamente, questi risultati possono essere informativi per le terapie riabilitative volte a migliorare la resilienza e le strategie di coping in questo gruppo vulnerabile di pazienti

Free will, neuroscience, and choice: towards a decisional capacity model for insanity defense evaluations

Il libero arbitrio è stato spesso considerato una tematica centrale nella dottrina della responsabilità criminale. Ciononostante, il concetto stesso di libero arbitrio presenta intrinseche problematiche nella sua definizione teorica e applicazione pratica in un contesto clinico/ forense ed è intensamente dibattuto. Nello specifico, l’esistenza stessa del libero arbitrio è stata recentemente posta in discussione anche sulla base di alcune evidenze sperimentali neuroscientifiche. Questo dibattito ha implicazioni significative in quei campi in cui l’associazione tra libertà di scelta è comportamento costituisce il focus di interesse, quali la psichiatria forense. Esiste inoltre una sorta di conflittualità tra la centralità e concezione teorica del libero arbitrio (free will) e il suo status e applicazione pratica. Questo problema ha bisogno di essere affrontato, specialmente all’interno della psichiatria forense, dal momento che risulta rilevante per l’effettiva valutazione dell’infermità di mente. Nel presente articolo cercheremo di rendere operativo il concetto del “libero arbitrio” utilizzando il modello a quattro dimensioni utilizzato per la capacità decisionale, che può essere impiegato nella valutazione forense dell’infermità di mente. Descriveremo i suoi vantaggi e applicazioni per guidare la valutazione dell’infermità di mente. Mentre il libero arbitrio è spesso considerato problematico dal punto di vista delle neuroscienze, questo modello, a nostro avviso, è compatibile con le neuroscienze; inoltre, le valutazioni che utilizzino questo modello possono anche essere arricchite e rafforzate dalle scoperte neuro scientifiche, per esempio riguardo il controllo inibitorioFree will has often been considered central to criminal responsibility. Yet, the concept of free will is also difficult to define and operationalize, and, moreover, it is intensely debated. In particular, the very existence of free will has been denied based on recent neuroscience findings. This debate has significant implications on those fields in which the link between free will and behaviour is the main focus of interest, such as forensic psychiatry. In fact, a tension is often experienced between the centrality of the notion of free will on the one hand, and its controversial status on the other. This tension needs to be addressed, especially in forensic psychiatry, since it is relevant for actual assessments of legal insanity. In the present paper we will try to operationalize “free will” using a fourpartite decision-making capacity model, which can be used in forensic assessment of insanity. We will describe its advantages and application to guide mental insanity assessments. Whereas free will is often considered problematic from a neuroscience perspective, this model, we argue, is compatible with neuroscience; moreover, evaluations using this model can also be informed and strengthened by neuroscientific findings, for example regarding inhibitory control

The admission experience survey italian version (I-AES). a factor analytic study on a sample of 156 acute psychiatric in-patients

Coercive treatments are often regarded as an inevitable and yet highly debated feature of psychiatric care. Perceived coercion is often reported by patients involuntarily committed as well as their voluntary counterparts. The Admission Experience Survey (AES) is a reliable tool for measuring perceived coercion in mental hospital admission. We developed the Italian AES (I-AES) through translation back-translation and administered it to 156 acutely hospitalized patients (48% women, 69% voluntarily committed) in two university hospitals in Rome (Policlinico Umberto I, Sant'Andrea Hospital). A principal component analysis (PCA) with equamax rotation was conducted. The I-AES showed good internal consistency (Cronbach's alpha = 0.90); Guttmann split-half relia- bility coefficient was 0.90. AES total score significantly differed between voluntary and involuntary committed patients (5.08 ± 4.1 vs. 8.1 ± 4.9, p < .05). PCA disclosed a three-factor solution explaining 59.3 of the variance. Some discrepancies were found between the factor structure of the I-AES and the original version. I- AES total score was positively associated with numbers of previous involuntarily hospitalization (r = 0.20, p < .05) and psychiatric symptoms' severity (r = 0.22, p < .02). I-AES and its proposed new factor structure proved to be reliable to assess perceived coercion in mental hospital admission. Consequently, it may represent a helpful instrument for the study and reduction of patients' levels of perceived coercion

The impact of machine learning in predicting risk of violence: a systematic review

Background: Inpatient violence in clinical and forensic settings is still an ongoing challenge to organizations and practitioners. Existing risk assessment instruments show only moderate benefits in clinical practice, are time consuming, and seem to scarcely generalize across different populations. In the last years, machine learning (ML) models have been applied in the study of risk factors for aggressive episodes. The objective of this systematic review is to investigate the potential of ML for identifying risk of violence in clinical and forensic populations.Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review on the use of ML techniques in predicting risk of violence of psychiatric patients in clinical and forensic settings was performed. A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Risk of bias and applicability assessment was performed using Prediction model Risk Of Bias ASsessment Tool (PROBAST).Results: We identified 182 potentially eligible studies from 2,259 records, and 8 papers were included in this systematic review. A wide variability in the experimental settings and characteristics of the enrolled samples emerged across studies, which probably represented the major cause for the absence of shared common predictors of violence found by the models learned. Nonetheless, a general trend toward a better performance of ML methods compared to structured violence risk assessment instruments in predicting risk of violent episodes emerged, with three out of eight studies with an AUC above 0.80. However, because of the varied experimental protocols, and heterogeneity in study populations, caution is needed when trying to quantitatively compare (e.g., in terms of AUC) and derive general conclusions from these approaches. Another limitation is represented by the overall quality of the included studies that suffer from objective limitations, difficult to overcome, such as the common use of retrospective data.Conclusion: Despite these limitations, ML models represent a promising approach in shedding light on predictive factors of violent episodes in clinical and forensic settings. Further research and more investments are required, preferably in large and prospective groups, to boost the application of ML models in clinical practice

Virtual reality interventions for victims of crime: A systematic review

In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost-effectiveness of these interventions compared to in-person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face-to-face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime

Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis.

ABSTRACTObjectives:To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer's disease (AD), and healthy comparisons (HCs).Design:A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.Setting:The United States, France, Japan, and China.Participants:Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.Measurements:The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).Results:We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.Conclusions:Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent

Correlations between cortical gyrification and schizophrenia symptoms with and without comorbid hostility symptoms

Introduction: Interest in identifying the clinical implications of the neuropathophysiological background of schizophrenia is rising, including changes in cortical gyrification that may be due to neurodevelopmental abnormalities. Inpatients with schizophrenia can show abnormal gyrification of cortical regions correlated with the symptom severity. Methods: Our study included 36 patients that suffered an acute episode of schizophrenia and have undergone structural magnetic resonance imaging (MRI) to calculate the local gyrification index (LGI). Results: In the whole sample, the severity of symptoms significantly correlated with higher LGI in different cortical areas, including bilateral frontal, cingulate, parietal, temporal cortices, and right occipital cortex. Among these areas, patients with low hostility symptoms (LHS) compared to patients with high hostility symptoms (HHS) showed significantly lower LGI related to the severity of symptoms in bilateral frontal and temporal lobes. Discussion: The severity of psychopathology correlated with higher LGI in large portions of the cerebral cortex, possibly expressing abnormal neural development in schizophrenia. These findings could pave the way for further studies and future tailored diagnostic and therapeutic strategies

Psychometric Properties of the Perinatal Anxiety Screening Scale Administered to Italian Women in the Perinatal Period

Literature stressed the importance of using valid, reliable measures to assess anxiety in the perinatal period, like the self-rated Perinatal Anxiety Screening Scale (PASS). We aimed to examine the psychometric properties of the Italian PASS version in a sample of Italian women undergoing mental health screening during their third trimester of pregnancy and its diagnostic accuracy in a control perinatal sample of psychiatric outpatients. Sample comprised 289 women aged 33.17 ± 5.08, range 19–46 years, undergoing fetal monitoring during their third trimester of pregnancy, with 49 of them retested 6 months postpartum. Controls were 60 antenatal or postnatal psychiatric outpatients aged 35.71 ± 5.02, range 22–50 years. Groups were assessed through identical self- and clinician-rating scales. Confirmatory Factor Analysis (CFA), Principal Component Analysis (PCA), Pearson's correlations and receiver operating characteristic were conducted for PASS. PCA and CPA confirmed four-factor structure with slight differences from the original version. Construct validity and test-retest reliability were supported. Cut-off was 26. The PASS correlated with principal anxiety scales. Despite small sample size, findings confirm reliability and validity of the Italian PASS version in assessing anxiety symptoms in the perinatal period. Its incorporation in perinatal care will improve future mother and child psychological health

“If You Dance Alone, You Cannot Be Healed”: Relational Ontologies and "Epistemes of Contagion" in Salento (Italy)

In this article I focus on neo-animist, relational ontologies that are active within and beyond contemporary Pagan communities in the Salento area of Italy. By addressing case-studies such as "spiritual neotarantismo," the querelle around the Xylella Fastidiosa epidemics that has been affecting olive trees, and NoTAP activism, I argue that many Salentinians today pursue health and well-being by embracing neo-animist attitudes that consider human and non-human persons alike as kin. By analyzing these neo-animist stances in conversation with the work of the philosopher Roberto Esposito, I will offer examples of ways of being in which "contact, relationality, and being in common" are not "liquidated" (Esposito, Welch, and Lemm 2021a),&nbsp;but fostered and put at the center of personal and collective practices of well-being and of political activism

We Are Witnesses, Not Victims. The Affective Politics of Representation in the Struggle against ‘femicide’ in Italy

In this dissertation I focus on the political mobilization of Italian—especially Salentine— feminists around gendered violence and ‘femicide’ (femminicidio). I explore their modes of representation, giving special emphasis to those modes that are inspired by performances and practices of dignity, understood as a privileged ‘battlefield’ in their struggle particularly against ordinary forms of gendered violence. My work contributes to the anthropological debates on the relations between politics and the senses, and to the ones in the Anthropology of Ethics. First, by engaging with the work of Rancière, I read the feminist representational struggle as a form of dissensus —i.e. of sensing and making sense differently. I read it as a political enterprise that aims at widening the available sensorium by changing the practices and performances of seeing and sensing around gendered violence and ‘femicide’ in Italy. Second, since this political activity of the reconfiguration of the sensible has not just aesthetic but also ethical implications, my ethnographic material adds to the current anthropological debates in the Anthropology of Ethics. I show some possible consequences of the quite explicit links between the practice of autopoiesis, the work of art, and political activism that emerged during my fieldwork in the Salento area of Italy. The performative dimensions of performance (Lowell Lewis 2013) are at the center of my ethnographic and anthropological analyses, and these concentrate not only on the illocutionary, but also on the perlocutionary aspects of representations in political activism. My analyses of their role in constructing audiences by affecting the latter’s practices and performances of seeing and sensing, in Rancièrian terms, are elements that could offer a contribution to the current debates in Performance Studies.Ph.D