We read with great interest the article by Ferraro et al. about the presence of current and lifetime psychiatric disorders among a sample of Italian female inmates. However, despite the strengths of the article, we have certain reservations on the methodology followed and conclusions drawn in the study that need to be elaborated for a better understanding of this very important research. Our correspondence thus, emphasizes the need for further explorations on this important area of research on mental health in inmates, in order to identify appropriate diagnostic and therapeutic strategies to be applied in this population

Antonio Bruno

Maria Rosaria Anna Muscatello

Nicola Pangallo

Rocco Antonio Zoccali

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 Article Commentary      A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali  1     Mediterranean Journal of Clinical Psychology  MJCP   ISSN: 2282-1619   VOL. 6, N.3  (2018)   Article Commentary    “Comment on: Psychopathology and female detention at the “Pagliarelli” jail of Palermo: preliminary results.”    By Ferraro, L., Nuzzo, M.C., Sideli, L., Maniaci, G., Caprì, C.A., La Barbera, D., & La Cascia, C.  In Mediterranean Journal of Clinical Psychology, vol 6, n 2.    We read with great interest the article by Ferraro et al. about the presence of current and lifetime psychiatric disorders among a sample of Italian female inmates. However, despite the strengths of the article, we have certain reservations on the methodology followed and conclusions drawn in the study that need to be elaborated for a better understanding of this very important research. Our correspondence thus, emphasizes the need for further explorations on this important area of research on mental health in inmates, in order to identify appropriate diagnostic and therapeutic strategies to be applied in this population. To the editor: We read with great interest the article by Ferraro et al. (2018) about the presence of current and lifetime psychiatric disorders among a sample of Italian female inmates.  Article Commentary      A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali  2    Mental disorders represent a serious health concern in prisoners populations, with prevalence rate up to 85% in Italian sample (Zoccali et al., 2008; Piselli, Elisei, Murgia, Quartesan, & Abram, 2009; Macciò et al., 2015). As a consequence, inmates must be considered a vulnerable group at elevated risk for anti-conservative acts, and suicide is one of the leading causes of death in jails (Winters et al, 2017). Thus, adequate psychopathological and neuropsychological evaluations (Martin, Hynes, Hatcher & Colman, 2016; Muscatello et al., 2014) and the ascertainment of further and specific suicidal risk factors represent a fundamental clinical moment in this special population. In their study, Authors reported a psychiatric disorders prevalence rate of 44%; furthermore, no personality disorders were diagnosed. These findings did not confirm the higher percentages obtained in previous Italian studies conducted on large male samples (Zoccali et al., 2008; Piselli, Elisei, Murgia, Quartesan, & Abram, 2009; Macciò et al., 2015); moreover, regarding personality disorders, other studies that have specifically investigated this aspect by different diagnostic tools (e.g. SCID II) showed the high prevalence of antisocial (60.3%) and borderline (19.5%) disorders, confirming that these disorders are markedly associated with criminal/deviant behaviours, impulsivity, and aggression (Zoccali et al., 2008). Despite the strengths of the article (the sample, although small, represents an entire inmate female population with a final judgment), we have certain reservations on the methodology followed and conclusions drawn in the study that need to be elaborated for a better understanding of this very important research. First, the discrepancy of the results can certainly be explained by the small sample size, as correctly stated by the Authors; further studies with adequate sample size are needed. Moreover, the use of a diagnostic tool like the Mini International Neuropsychiatric Interview (MINI) which evaluates only the Antisocial personality disorder can lead to an understatement (and, therefore, undertreatment) of the other personality disorders that represent a major  Article Commentary      A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali  3    mismatch factor to prison life; the use of diagnostic tools, including projective ones, specific for personality disorders would be desirable to better investigate this important clinical aspect.  Finally, it should be borne in mind that some inmate (malingering of symptoms or unwillingness/inability to disclose symptoms), staff (heuristics related cognitive errors, assessment and/or the methods used), and environmental (situational stressors, screening and assessment time) characteristics may contribute to the risk of diagnostic errors and that at least 10% to 15% of all inmates may be incorrectly classified in terms of the presence or absence of a mental illness (Martin, Hynes, Hatcher & Colman, 2016). Our correspondence thus, emphasizes the need for further explorations on this important area of research on mental health in inmates, in order to identify appropriate diagnostic and therapeutic strategies to be applied in this population.  References Ferraro, L., Nuzzo, M.C., Sideli, L., Maniaci, G., Caprì, C.A., La Barbera, D., & La Cascia, C. (2018). Psychopathology and female detention at the “Pagliarelli” jail of Palermo: preliminary results. Mediterranean Journal of Clinical Psychology, 6, 2. Macciò, A., Meloni, F. R., Sisti, D., Luigi Rocchi, M. B., Petretto, D. R., Masala, C., & Preti, A. (2015). Mental disorders in Italian prisoners: Results of the REDiMe study. Psychiatry Research, 225(3), 522–530.  Martin, M. S., Hynes, K., Hatcher, S., & Colman, I. (2016). Diagnostic error in correctional mental health: Prevalence, causes, and consequences. Journal of Correctional Health Care, 22(2), 109-117. Muscatello, M. R. A., Scimeca, G., Pandolfo, G., Micò, U., Romeo, V. M., Mallamace, D., ... & Bruno, A. (2014). Executive functions and basic symptoms in adolescent antisocial behavior: A cross-sectional study on an  Article Commentary      A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali  4    Italian sample of late-onset offenders. Comprehensive psychiatry, 55(3), 631-638. Piselli, M., Elisei, S., Murgia, N., Quartesan, R., & Abram, K. M. (2009). Co-occurring psychiatric and substance use disorders among male detainees in Italy. International Journal of Law and Psychiatry,32(2), 101–107.  Winters, G.M., Greene-Colozzi, E., & Jeglic, E.L. (2017). Preventing Suicide in Forensic Settings: Assessment and Intervention for Inmates With Serious Mental Illness. J Correct Health Care, 23(4), 383-397.  Zoccali, R., Muscatello, M. R. A., Bruno, A., Cambria, R., Cavallaro, L., D’Amico, G., … & Meduri, M. (2008). Mental disorders and request for psychiatric intervention in an Italian local jail. International Journal of Law and Psychiatry,31(5), 447–450.    Antonio Bruno, Maria Rosaria Anna Muscatello,  Nicola Pangallo, Rocco Antonio Zoccali      Department of Biomedical and Dental sciences and  Morphofunctional Imaging,  University of Messina, Italy                © 2014 by the Author(s); licensee Mediterranean Journal of Clinical Psychology, Messina, Italy. This article is an open access article, licensed under a Creative Commons Attribution 3.0 Unported License. Mediterranean Journal of Clinical Psychology, Vol. 6, No. 3, 2018.    Doi: 10.6092/2282-1619/2018.6.1937 

“Comment on: Psychopathology and female detention at the “Pagliarelli” jail of Palermo: preliminary results.”

 
We read with great interest the article by Ferraro et al. about the presence of current and lifetime psychiatric disorders among a sample of Italian female inmates. However, despite the strengths of the article, we have certain reservations on the methodology followed and conclusions drawn in the study that need to be elaborated for a better understanding of this very important research. Our correspondence thus, emphasizes the need for further explorations on this important area of research on mental health in inmates, in order to identify appropriate diagnostic and therapeutic strategies to be applied in this population.


Bruno, Antonio

Muscatello, Maria Rosaria Anna

Pangallo, Nicola

Zoccali, Rocco Antonio

Università degli Studi di Messina: Open Journals Messina

 Article Commentary     
 
A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali 
 
1  
  
 
Mediterranean Journal of Clinical Psychology  MJCP   
ISSN: 2282-1619   
VOL. 6, N.3  (2018)   
Article Commentary   
 
“Comment on: Psychopathology and female detention at the 
“Pagliarelli” jail of Palermo: preliminary results.” 
   
By Ferraro, L., Nuzzo, M.C., Sideli, L., Maniaci, G., Caprì, C.A., La 
Barbera, D., & La Cascia, C. 
 
In Mediterranean Journal of Clinical Psychology, vol 6, n 2. 
   
We read with great interest the article by Ferraro et al. about the presence of 
current and lifetime psychiatric disorders among a sample of Italian female 
inmates. However, despite the strengths of the article, we have certain 
reservations on the methodology followed and conclusions drawn in the study 
that need to be elaborated for a better understanding of this very important 
research. Our correspondence thus, emphasizes the need for further 
explorations on this important area of research on mental health in inmates, in 
order to identify appropriate diagnostic and therapeutic strategies to be applied 
in this population. 
To the editor: 
We read with great interest the article by Ferraro et al. (2018) about the 
presence of current and lifetime psychiatric disorders among a sample of Italian 
female inmates. 
 Article Commentary     
 
A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali 
 
2  
  
Mental disorders represent a serious health concern in prisoners populations, 
with prevalence rate up to 85% in Italian sample (Zoccali et al., 2008; Piselli, 
Elisei, Murgia, Quartesan, & Abram, 2009; Macciò et al., 2015). As a 
consequence, inmates must be considered a vulnerable group at elevated risk 
for anti-conservative acts, and suicide is one of the leading causes of death in 
jails (Winters et al, 2017). Thus, adequate psychopathological and 
neuropsychological evaluations (Martin, Hynes, Hatcher & Colman, 2016; 
Muscatello et al., 2014) and the ascertainment of further and specific suicidal 
risk factors represent a fundamental clinical moment in this special population. 
In their study, Authors reported a psychiatric disorders prevalence rate of 44%; 
furthermore, no personality disorders were diagnosed. These findings did not 
confirm the higher percentages obtained in previous Italian studies conducted 
on large male samples (Zoccali et al., 2008; Piselli, Elisei, Murgia, Quartesan, 
& Abram, 2009; Macciò et al., 2015); moreover, regarding personality 
disorders, other studies that have specifically investigated this aspect by 
different diagnostic tools (e.g. SCID II) showed the high prevalence of 
antisocial (60.3%) and borderline (19.5%) disorders, confirming that these 
disorders are markedly associated with criminal/deviant behaviours, 
impulsivity, and aggression (Zoccali et al., 2008). 
Despite the strengths of the article (the sample, although small, represents an 
entire inmate female population with a final judgment), we have certain 
reservations on the methodology followed and conclusions drawn in the study 
that need to be elaborated for a better understanding of this very important 
research. 
First, the discrepancy of the results can certainly be explained by the small 
sample size, as correctly stated by the Authors; further studies with adequate 
sample size are needed. Moreover, the use of a diagnostic tool like the Mini 
International Neuropsychiatric Interview (MINI) which evaluates only the 
Antisocial personality disorder can lead to an understatement (and, therefore, 
undertreatment) of the other personality disorders that represent a major 
 Article Commentary     
 
A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali 
 
3  
  
mismatch factor to prison life; the use of diagnostic tools, including projective 
ones, specific for personality disorders would be desirable to better investigate 
this important clinical aspect.  
Finally, it should be borne in mind that some inmate (malingering of symptoms 
or unwillingness/inability to disclose symptoms), staff (heuristics related 
cognitive errors, assessment and/or the methods used), and environmental 
(situational stressors, screening and assessment time) characteristics may 
contribute to the risk of diagnostic errors and that at least 10% to 15% of all 
inmates may be incorrectly classified in terms of the presence or absence of a 
mental illness (Martin, Hynes, Hatcher & Colman, 2016). 
Our correspondence thus, emphasizes the need for further explorations on this 
important area of research on mental health in inmates, in order to identify 
appropriate diagnostic and therapeutic strategies to be applied in this 
population. 
 
References 
Ferraro, L., Nuzzo, M.C., Sideli, L., Maniaci, G., Caprì, C.A., La Barbera, D., 
& La Cascia, C. (2018). Psychopathology and female detention at the 
“Pagliarelli” jail of Palermo: preliminary results. Mediterranean Journal of 
Clinical Psychology, 6, 2. 
Macciò, A., Meloni, F. R., Sisti, D., Luigi Rocchi, M. B., Petretto, D. R., 
Masala, C., & Preti, A. (2015). Mental disorders in Italian prisoners: Results of 
the REDiMe study. Psychiatry Research, 225(3), 522–530.  
Martin, M. S., Hynes, K., Hatcher, S., & Colman, I. (2016). Diagnostic error in 
correctional mental health: Prevalence, causes, and consequences. Journal of 
Correctional Health Care, 22(2), 109-117. 
Muscatello, M. R. A., Scimeca, G., Pandolfo, G., Micò, U., Romeo, V. M., 
Mallamace, D., ... & Bruno, A. (2014). Executive functions and basic 
symptoms in adolescent antisocial behavior: A cross-sectional study on an 
 Article Commentary     
 
A. Bruno, M. R. A. Muscatello, N. Pangallo, R. A. Zoccali 
 
4  
  
Italian sample of late-onset offenders. Comprehensive psychiatry, 55(3), 631-
638. 
Piselli, M., Elisei, S., Murgia, N., Quartesan, R., & Abram, K. M. (2009). Co-
occurring psychiatric and substance use disorders among male detainees in 
Italy. International Journal of Law and Psychiatry,32(2), 101–107.  
Winters, G.M., Greene-Colozzi, E., & Jeglic, E.L. (2017). Preventing Suicide 
in Forensic Settings: Assessment and Intervention for Inmates With Serious 
Mental Illness. J Correct Health Care, 23(4), 383-397.  
Zoccali, R., Muscatello, M. R. A., Bruno, A., Cambria, R., Cavallaro, L., 
D’Amico, G., … & Meduri, M. (2008). Mental disorders and request for 
psychiatric intervention in an Italian local jail. International Journal of Law 
and Psychiatry,31(5), 447–450. 
  
 
Antonio Bruno, Maria Rosaria Anna Muscatello,  
Nicola Pangallo, Rocco Antonio Zoccali  
  
  
Department of Biomedical and Dental sciences and  
Morphofunctional Imaging,  
University of Messina, Italy   
   
   
  
 
 
 
 
 © 2014 by the Author(s); licensee Mediterranean Journal of Clinical 
Psychology, Messina, Italy. This article is an open access article, licensed 
under a Creative Commons Attribution 3.0 Unported License. Mediterranean 
Journal of Clinical Psychology, Vol. 6, No. 3, 2018.    
Doi: 10.6092/2282-1619/2018.6.1937 


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“Comment on: Psychopathology and female detention at the “Pagliarelli” jail of Palermo: preliminary results.”

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