Publications by authors named "Giulia Menculini"

25 Publications

  • Page 1 of 1

What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study.

Brain Sci 2021 Sep 17;11(9). Epub 2021 Sep 17.

Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138 Naples, Italy.

The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% ( = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4-2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.
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http://dx.doi.org/10.3390/brainsci11091231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466446PMC
September 2021

COVID-19, Air Pollution and Mental Illness: Heads of the Same "Beast"?

Psychiatr Danub 2021 Sep;33(Suppl 9):172-173

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, Edificio Ellisse, 8 piano, Perugia, Italy,

The Covid-19 outbreak are generating relevant consequences under several aspects. Covid-19 pandemic together with air pollution and a dysfunctional anthropization/urbanization might affect public and mental health with a synergistic effect. The current paper explore hypothesis about existing links among Covid-19, air pollution and mental illness.
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September 2021

COVID-19, Air Pollution and Mental Illness: Heads of the Same "Beast"?

Psychiatr Danub 2021 Sep;33(Suppl 9):172-173

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, Edificio Ellisse, 8 piano, Perugia, Italy,

The Covid-19 outbreak are generating relevant consequences under several aspects. Covid-19 pandemic together with air pollution and a dysfunctional anthropization/urbanization might affect public and mental health with a synergistic effect. The current paper explore hypothesis about existing links among Covid-19, air pollution and mental illness.
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September 2021

Antepartum Distress during COVID-19 Pandemic: an Observational Study.

Psychiatr Danub 2021 Sep;33(Suppl 9):137-141

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia, Italy.

Background: The present study investigates the impact of the Coronavirus diseases 2019 (Covid-19) pandemic on the subjective experience of pregnant women, as well as the impact of the pandemic on this population in terms of psychopathological correlates.

Subjects And Methods: Pregnant women referring to the Section of Obstetrics and Gynecology of the General Hospital of Perugia, Italy, were recruited from 1 May, 2021 to 15 June, 2021. Socio-demographic and clinical data was collected, as well as information regarding the Covid-19 pandemic impact on the subjective experience of pregnancy. Psychopathology was evaluated by means of the State-Trait Anxiety Inventory Form Y (STAI-Y), the Symptom Checklist-90 (SCL-90) and the Prenatal Distress Measure (Pre-DM). Descriptive analyses were performed. Significant associations between distress symptoms and the collected sociodemographic and clinical variables were assessed by using the Pearson correlation (p<0.05).

Results: 25 women were included in the study. Among these, 18 (72%) reported that the Covid-19 pandemic negatively impacted their experience of pregnancy. Were detected an average Pre-DM total score of 7.28±4.33 and an average state anxiety scale value of 35.56±9.21 and an average trait anxiety scale value of 34.04±7.44 at the STAI-Y. A global severity index > 1 at SCL-90 was detected in 8.3% of the sample.

Conclusions: The identification of antepartum distress and the early treatment of perinatal psychopathology represent a priority during the Covid-19 pandemic era.
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September 2021

Psychiatric Comorbidity in Bariatric Surgery: A Retrospective Study in a General Hospital.

Psychiatr Danub 2021 Sep;33(Suppl 9):75-79

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia, Italy.

Background: Candidates for bariatric surgery undergo a multidisciplinary evaluation in the pre-operative phase, including a psychiatric visit aimed at the screening for psychiatric comorbidities, including feeding and eating disorders (FEDs), which are shortcomings to the intervention or predictors of worse prognosis. The presence of FEDs, such as Binge Eating Disorder (BED) and Bulimia Nervosa (BN), is associated with higher rates of other psychiatric disorders. Furthermore, there is evidence of the association between obesity and Depressive Disorders, as well as B and C Cluster Personality Disorders. The aim of this study was to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery.

Subjects And Methods: Subjects were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia after being referred by surgeons. Psychiatric comorbidities were investigated by means of the Structured Clinical Interview for DSM-5 Disorders. Subjects underwent specific assessment with scales for the evaluation of FEDs, namely Binge Eating Scale, Obesity Questionnaire, Bulimia Test-Revised and Body Shape Questionnaire.

Results: The sample consisted of 101 subjects: 43 (42.6%) were diagnosed with at least one psychiatric disorder, including FEDs. In particular, 30 subjects (29.7%) presented at least one FED, among which the most frequent were FED not otherwise specified (24.1%) and BED (6.8%). Moreover, 26 subjects (25.7%) were diagnosed with at least one psychiatric disorder other than FEDs, such as Personality Disorders (17.1%), with a higher prevalence of B and C Cluster Disorders. Depressive Disorders were detected in 5% of the sample.

Conclusions: Subjects undergoing bariatric surgery often display psychiatric comorbidities, more frequently one or more FEDs. The systematic screening of these conditions should be implemented in the clinical practice in order to provide early intervention strategies and adequate monitoring.
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September 2021

Does Post-Traumatic Spectrum Comorbidity Influence Symptom Severity in Bipolar Disorders? A Cross-Sectional Study in a Real-World Setting.

Psychiatr Danub 2021 Sep;33(Suppl 9):41-46

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia, Italy.

Background: The present cross-sectional study investigates the relationship between post-traumatic spectrum comorbidity and the severity of symptoms in subjects diagnosed with Bipolar Disorders (BD).

Subjects And Methods: In- and outpatients diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were consecutively recruited. Sociodemographic and clinical data were collected. Psychopathology was evaluated by means of the Hamilton Rating Scale for Depression (HAM-D), the Young Mania Rating Scale (YMRS), and the Positive and Negative Syndrome Scale (PANSS). Sociodemographic, clinical and psychopathological characteristics of BD subjects with and without sub-threshold PTSD were compared by means of bivariate analyses (p<0.05).

Results: BD subjects with post-traumatic spectrum comorbidity (n=24.49%) presented a significantly higher number of hospitalizations when compared to those who did not present the co-occurrence of the two conditions (2.67±2.3 versus 1.65±2.32, p=0.039). As for treatment features, subjects with subthreshold PTSD were more frequently prescribed benzodiazepines at the moment of evaluation or in the past (n=18, 100% versus n=22.55%, p=0.032). When assessing differences in terms of psychopathological characteristics, subjects with subthreshold PTSD showed higher HAM-D total score (16.22±9.06 versus 10.22±7.23, p=0.032) and higher PANSS negative symptom scale score (16.06±6.92 versus 11.41±4.68, p=0.017).

Conclusions: Findings from the present study suggest that subthreshold PTSD may underpin higher symptom severity and worse outcomes when occurring as a comorbid condition in BD.
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September 2021

Searching for factors associated with the "Revolving Door phenomenon" in the psychiatric inpatient unit: A 5-year retrospective cohort study.

Psychiatry Res 2021 Sep 30;303:114080. Epub 2021 Jun 30.

Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy. Electronic address:

The revolving door (RD) phenomenon refers to subjects who undergo frequent rehospitalizations in psychiatric units. The main aim of this study was to analyze clinical factors associated with RD in acute inpatient psychiatric ward. In a 5-year cohort study, subjects hospitalized three or more times in 12 months (revolving door subjects-RDS) were identified. A total of 1,324 subjects were hospitalized. RDS represented 6.3% (n = 84) of the entire sample with a total of 337 RD hospitalizations (revolving door hospitalizations-RDH) (16.7% of all admissions). RDS were younger, unmarried, with comorbid substance related disorders, with mood or psychotic disorders and affected by comorbid medical conditions. After controlling for age, sex and marital status, the most strongly associated variable with RDH was the comorbidity between mood and substance use disorders. Other associated factors were the presence of a comorbid medical condition and a longer length of stay. The commitment to community residential facilities and the treatment with a first generation long-acting antipsychotic were also associated with RDH. On the contrary, admissions to the psychiatric unit for manic/hypomanic episode or for self-directed harmful behavior were inversely associated with RDH. Attention should be given to these clinical variables in order to reduce RD.
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http://dx.doi.org/10.1016/j.psychres.2021.114080DOI Listing
September 2021

Comorbidities, Depression Severity, and Circadian Rhythms Disturbances as Clinical Correlates of Duration of Untreated Illness in Affective Disorders.

Medicina (Kaunas) 2021 May 8;57(5). Epub 2021 May 8.

Department of Psychiatry, University of Perugia, 06132 Perugia, Italy.

: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. : Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI ( < 0.05). : In our sample ( = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration ( = 0.022) and a higher rate of psychiatric ( = 0.048) and physical comorbidities ( = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression ( = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale ( = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total ( = 0.044) and social domain ( = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: = 0.029, 18b: = 0.047). : A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.
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http://dx.doi.org/10.3390/medicina57050459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150538PMC
May 2021

Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD.

Medicina (Kaunas) 2021 May 12;57(5). Epub 2021 May 12.

Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.

: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. : One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. : Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. : ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with "sunny" cyclothymic features might escape the attention of clinicians unless ADHD is present.
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http://dx.doi.org/10.3390/medicina57050489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151096PMC
May 2021

Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis.

Int J Mol Sci 2021 Apr 23;22(9). Epub 2021 Apr 23.

Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, 06132 Perugia, Italy.

Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer's disease, fronto-temporal dementia, Parkinson's disease, Huntington's disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.
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http://dx.doi.org/10.3390/ijms22094440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123079PMC
April 2021

The Influence of the Urban Environment on Mental Health during the COVID-19 Pandemic: Focus on Air Pollution and Migration-A Narrative Review.

Int J Environ Res Public Health 2021 04 8;18(8). Epub 2021 Apr 8.

Department of Psychiatry, University of Perugia, 06132 Perugia, Italy.

The coronavirus disease 2019 (COVID-19) pandemic caused a crisis worldwide, due to both its public health impact and socio-economic consequences. Mental health was consistently affected by the pandemic, with the emergence of newly diagnosed psychiatric disorders and the exacerbation of pre-existing ones. Urban areas were particularly affected by the virus spread. In this review, we analyze how the urban environment may influence mental health during the COVID-19 pandemic, considering two factors that profoundly characterize urbanization: air pollution and migration. Air pollution serves as a possibly risk factor for higher viral spread and infection severity in the context of urban areas and it has also been demonstrated to play a role in the development of serious mental illnesses and their relapses. The urban environment also represents a complex social context where minorities such as migrants may live in poor hygienic conditions and lack access to adequate mental health care. A global rethinking of the urban environment is thus required to reduce the impact of these factors on mental health. This should include actions aimed at reducing air pollution and combating climate change, promoting at the same time a more inclusive society in a sustainable development perspective.
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http://dx.doi.org/10.3390/ijerph18083920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068323PMC
April 2021

Endocannabinoid System as Therapeutic Target of PTSD: A Systematic Review.

Life (Basel) 2021 Mar 9;11(3). Epub 2021 Mar 9.

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132 Perugia, Italy.

Post-Traumatic Stress Disorder (PTSD) is a complex disorder involving dysregulation of stress-related hormones and neurotransmitter systems. Research focused on the endocannabinoid system (eCBS) for anxiety and stress regulation, cognitive and emotional responses modulation and aversive memories extinction, leading to the hypothesis that it could represent a possible alternative treatment target for PTSD. In this systematic review, we summarize evidence about the efficacy and safety of medicinal cannabidiol (CBD), Δ-tetrahydrocannabinol (Δ-THC), and nabilone in PTSD treatment. The PRISMA statement guidelines were followed. A systematic literature search was conducted in MEDLINE/PubMed, Scopus and Web of Science by two independent researchers, who also performed data extraction and quality assessment. Among the initial 495 papers, 234 were screened for eligibility and 10 were included. Studies suggested that different medicinal cannabinoids at distinct doses and formulations could represent promising treatment strategies for the improvement of overall PTSD symptomatology as well as specific symptom domains (e.g., sleep disorders, arousal disturbances, suicidal thoughts), also influencing quality of life, pain and social impact. Although there is a robust rationale for treatment with drugs that target the eCBS and the results are promising, further studies are needed to investigate the safety and efficacy profile of their prolonged use.
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http://dx.doi.org/10.3390/life11030214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000573PMC
March 2021

Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review.

Medicina (Kaunas) 2020 Dec 11;56(12). Epub 2020 Dec 11.

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, 06132 Perugia, Italy.

A deeper comprehension of the role that environmental risk factors play in the development of adolescent Bipolar Disorder (BD), as well as in the evolution of high-risk states for BD, may entangle further prevention and treatment advances. The present systematic review is aimed at critically summarizing evidence about the role that environmental risk factors play in the development of BD in adolescence and their interaction with BD high-risk states. MEDLINE/Pubmed, Scopus and Web of Science datasets were systematically searched until 4 September 2020. Original studies that reported information about the role of environmental risk factors in the development of BD during adolescence, or assessing their influence on the development of psychopathology in high-risk states for BD, were considered for inclusion. Two blind researchers performed title/abstract, full-text screening, and hand-screening of relevant references. The risk of bias was assessed by means of the Newcastle-Ottawa Scale. Fourteen studies were included in the review. Negative stressful life events, particularly sexual and physical abuse, but also emotional mistreatment, were associated with more severe psychopathology in adolescents with BD, as well as with higher risk for developing mood disorders in BD offspring. Similar findings were detected for familial environment-related features, such as parental rejection and low perceived care, while no univocal results were found when analyzing familial functioning. The present systematic review confirmed the relevant role that environmental risk factors, particularly negative stressful live events and family-related features, play in the development of BD psychopathology during adolescence. Future studies are expected to clarify possible further environmental factors that may be implicated in the development of BD during youth that may serve as target of prevention and early treatment strategies.
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http://dx.doi.org/10.3390/medicina56120689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763529PMC
December 2020

Cannabinoid-Induced Psychosis: A Cross-Sectional Gender Study.

Psychiatr Danub 2020 Sep;32(Suppl 1):200-206

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia (PG), Italy.

Background: Gender is a crucial factor in the development of mental illnesses, with an essential influence on clinical characteristics and not only on the prevalence of each disorder. Gender differences in cannabinoid-related disorders are highlighted by different research fields (preclinical, clinical, socio-demographic studies), but few studies focused on differential symptom expression in cannabinoid-induced psychosis. This study aims at investigating qualitative and quantitative gender differences in specific psychopathological domains in a clinical sample of subjects affected by cannabinoid-induced psychotic disorder, without psychiatric comorbidity.

Subjects And Methods: The study was carried out at the Psychiatric Inpatient Service of General Hospital of Perugia (Italy). In this cross-sectional gender study, 28 inpatients were enrolled, 14 males (M) and 14 females (F). Participants were administered a psychometric battery consisting of 7 tests (PANSS, NDS-I, YMRS, HAM-D, HAM-A, AQ, SSI) in order to investigate 7 psychopathological domains (Psychosis, Dysphoria, Mania, Depression, Anxiety, Aggressive Behaviour and Suicide Ideation). Scores obtained at each test were compared between male and females by using Mann-Whitney U test (p<0.05).

Results: In this study, we observed that males present higher severity of psychotic symptoms, with prominent scores in PANSS positive and general psychopathology scale (p<0.001), and an important expression of aggressive behavior (p<0.001) compared with females. Female sample, instead, shows a greater expression of dysphoria and depressive domains (p<0.001) and a lower, but statistically significant, prevalence in the anxiety domains expression (p=0.01). By these observations, we could assert that in male group thought disorders are prominent. On the other hand, in female group affective disorder are prominent.

Conclusions: This study confirmed how gender influences the phenomenic expression of psychiatric disorders. In line with the precision medicine paradigm, a further clarification of different clinical profiles based on gender would allow the choice of a personalized treatment plan with better efficacy and accuracy indices.
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September 2020

A Dual Therapeutic Setting Model Experience for Schizotypal Personality Disorder in an Inpatient Unit.

Psychiatr Danub 2020 Sep;32(Suppl 1):194-199

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia (PG), Italy.

G.B., 21-year-old patient of Albanian origin suffering from acute psychotic burning on schizotypal personality disorder induced by substance abuse, was admitted to the Psychiatric Service at Perugia' General Hospital, Italy. On admission, antipsychotic therapy was set up which had the role to reduced delusional and hallucinatory symptoms but the suspiciousness, the presence of magical thought and the closure towards surrounding world that characterize it, combined with the presence of intrusive images, consequently increased the anxiety experiences and negatively affects the establishment of a therapeutic relationship with the operators. During the hospitalization, daily support interviews were carried out: G.B. showed clear difficulty in expressing his own thought contents in presence of more than two operators emerged jointly with the tendency to project different emotional experiences based on the gender of the operator. Following these observations, with the aim to carrying out an intervention that could integrate a psychological approach to the pharmacological therapy in place, a specific personalized support setting was set up, consisting of a female and a male operator. This setting was structured coherently with the therapeutic goals to be achieved: creation of a therapeutic alliance, the integration of the patient's emotional experiences and containing the splitting through the transference analysis. By means of this setting, the patient has obtained a substantial improvement of the splitting framework allowing a better integration of his emotional experiences. At the end of the sessions, G.B. showed more confidence with the medical staff and showed himself to be more aware of his pathological and non-pathological mental states and consequently more adherent to taking drug therapy and to the continuation of post-discharge psychological therapy.
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September 2020

Differential Gender Severity Expression of Symptoms in Patients with Dual Diagnosis: An In-Patient Observational Study.

Psychiatr Danub 2020 Sep;32(Suppl 1):70-74

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1 - "Ellisse" Building, 8th Floor, 06132 Perugia, Italy,

Background: The present retrospective study is aimed at exploring the impact of gender differences in a sample of inpatients with dual diagnosis.

Subjects And Methods: The study was carried out at the Psychiatric Service of the General Hospital/University of Perugia (Italy). Patients were recruited from January 2015 until December 2018. The sample consists of patients with dual diagnosis, divided into two subgroups based on gender; descriptive and bivariate statistics were performed (p<0.05). Male and females were compared according to socio-demographic, clinical and psychopathological features, measured by Clinical Global Impressions (CGI) and factor models of the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS).

Results: In our sample (n=157), no significant differences in socio-demographic features were found between male (n=108, 68.8%) and female subjects (n=49, 31.2%). Women displayed a higher frequency of involuntary hospitalizations (53.1% vs 32.4%, p=0.022) and a higher score on the general psychopathology scale of the Positive and Negative Syndrome Scale (PANSS) (41.86±8.96 vs 36.54±10.38, p=0.041).

Conclusions: Our study confirms the prevalence of dual diagnosis in the male gender. Female sex appears more frequently connected to some indices of clinical severity. We expect to enlarge our sample to confirm these results and further clarify the knowledge on the subject.
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September 2020

"Revolving door" and Bipolar Disorders: a retrospective study in an acute inpatient unit.

Psychiatr Danub 2020 Sep;32(Suppl 1):58-63

Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia (PG), Italy.

Introduction: The present retrospective study investigated clinical correlates of the revolving door (RD) phenomenon in a population of subjects affected by Bipolar Disorders (BDs).

Subjects And Methods: Medical records of subjects with BDs admitted to a psychiatric inpatient unit over a 5-year period of time were retrospectively reviewed and clinical data were extracted into an electronic dataset. "Revolving Door Subjects" (RDS) were defined as those who presented three or more "Revolving Door Hospitalizations" (RDH) during twelve months. Features of RDH were compared with non-RDH in order to identify characteristics associated with RD phenomenon and possible risk factors for readmission. To explore predictors of RDH, a stepwise backword logistic regression model was built, including the variables that were significantly associated with RDH in the bivariate analyses.

Results: In our sample of 176 subjects affected by BDs, 53 (19.9%) RDH were identified. In the RDH group, a higher prevalence of mixed episodes (p=0.029) and medical co-morbidities (p=0.004) was detected. Subjects with repeated hospitalizations were more often committed to psychiatric residential facilities at discharge (p=0.002). Treatment features related to RDH were represented by a higher prescription rate of atypical antipsychotics (p=0.030), benzodiazepines (p=0.001) and antidepressants (p=0.048).

Conclusions: Findings from the present study suggest that the early identification and treatment of medical comorbidities and specific clinical features of BDs may help reducing the RD phenomenon in this population of subjects.
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September 2020

'Come share my world' of 'madness': a systematic review of clinical, diagnostic and therapeutic aspects of .

Int Rev Psychiatry 2020 Aug - Sep;32(5-6):412-423. Epub 2020 May 4.

Department of Psychiatry, University of Perugia, Perugia, Italy.

, also known as shared psychotic disorder, shows intrinsic differences when compared to other psychiatric disorders. Literature about this condition is scanty and findings about its clinical correlates are not univocal. The present systematic review aimed at critically summarizing the existing evidence about , also focussing on psychopathological, diagnostic and treatment features. The electronic databases PUBMED, Web of Science and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles reporting original data about socio-demographic, aetiological, clinical, diagnostic and treatment features of , providing information about both primaries and secondaries, were included. Risk of bias was evaluated using the Critical Appraisal Skills Programme (CASP) instruments. The initial search yielded 834 records. After the screening process only 9 papers were deemed eligible for inclusion in the review. emerged to be a heterogeneous condition with a complex etiopathogenesis. The clinical presentation of the disorder included a multi-facet aspect, going beyond the classical description mainly focussed on delusions and possibly explaining conflicting outcomes of different treatments. Diagnostic categories appear to be often reductive and the need for a dimensional approach capable of global reliability emerged.
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http://dx.doi.org/10.1080/09540261.2020.1756754DOI Listing
May 2020

Circadian rhythms disruptions and eating disorders: clinical impact and possible psychopathological correlates.

Psychiatr Danub 2019 Sep;31(Suppl 3):497-502

Division of Psychiatry, Department of Medicine, University of Perugia, Piazzale Lucio Severi, 1 - "Ellisse" Building, 8th Floor, 06132 Perugia, Italy.

Background: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients.

Methods: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder).

Results: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies.

Conclusions: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities.
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September 2019

Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis.

Eur Neuropsychopharmacol 2019 07 18;29(7):825-834. Epub 2019 Jun 18.

Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain. Electronic address:

Resistance and worsening of depression in response to antidepressants (ADs) are major clinical challenges. In a large international sample of patients with major depressive disorder (MDD), we aim to explore the possible associations between different patterns of response to ADs and bipolarity. A total of 2811 individuals with a major depressive episode (MDE) were enrolled in the BRIDGE-II-MIX study. This post-hoc analysis included only 1329 (47%) patients suffering from MDD. Patients with (TRD-MDD, n = 404) and without (NTRD-MDD, n = 925) history of resistance to AD treatment and with (n = 184) and without (n = 1145) previous AD-induced irritability and mood lability (AIM) were compared using Chi-square, t-Student's test and logistic regression models. TRD-MDD patients resulted significantly associated with higher rates of AIM, psychotic features, history of suicide attempts, emotional lability and impulsivity, comorbid borderline personality disorder and polipharmacological treatment, compared to NTRD-MDD group. In comparison to NAIM-MDD patients, subjects in the AIM-MDD group showed significantly higher rates of first-degree family history for BD, previous TRD, atypical features, mixed features, psychiatric comorbidities, lifetime suicide attempts and lower age at first psychiatric symptoms. In addition, patients with AIM presented more often almost all the hypomanic symptoms evaluated in this study. Among these latter symptoms, logistic regressions showed that distractibility, impulsivity and hypersexuality were significantly associated with AIM-MDD. In conclusion, in MDD patients, a lifetime history of resistance and/or irritability/mood lability in response to ADs was associated with the presence of mixed features and a possible underlying bipolar diathesis.
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http://dx.doi.org/10.1016/j.euroneuro.2019.06.001DOI Listing
July 2019

Sultans of Swing: A Reappraisal of the Intertwined Association Between Affective Lability and Mood Reactivity in a Post Hoc Analysis of the BRIDGE-II-MIX Study.

J Clin Psychiatry 2019 02 19;80(2). Epub 2019 Feb 19.

Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.

Objective: This post hoc analysis of the BRIDGE-II-MIX study is aimed at evaluating affective lability (AL) as a possible clinical feature of mixed depression and assessing the relationship with atypical depressive features, particularly mood reactivity (MR).

Methods: In the BRIDGE-II-MIX multicenter, cross-sectional study, 2,811 individuals suffering from a major depressive episode (MDE; DSM-IV-TR criteria), in the context of bipolar I or II disorder (BD-I, BD-II, respectively) or major depressive disorder, were enrolled between June 2009 and July 2010. Patients with (MDE-AL, n = 694) and without (MDE-noAL, n = 1,883) AL and with (MDE-MR, n = 1,035) or without (MDE-noMR, n = 1,542) MR were compared through χ² test or Student t test. Stepwise backward logistic regression models, respectively testing AL and MR as the dependent variable, were performed to differentiate the 2 clinical constructs.

Results: AL was positively associated with BD-I (P < .001) and BD-II (P < .001), with DSM-5 mixed (DSM-5-MXS) (P < .001) and atypical (DSM-5-AD) features (P < .001) and negatively associated with MDD (P < .001). In the logistic regression models, MR was the variable most significantly associated with AL and vice versa (P < .001 for both). AL was positively associated with severity of mania and DSM-5-MXS and negatively correlated with severity of depression, while MR was better predicted by atypical symptoms such as hyperphagia, hypersomnia, and leaden paralysis and correlated with both comorbid anxiety disorders and DSM-5-MXS.

Conclusions: Mixed and atypical depression may lie on the same continuum. MR and AL could represent the underlying matrix, bridging the gap between mixed and atypical depression.
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http://dx.doi.org/10.4088/JCP.17m12082DOI Listing
February 2019

Involuntary hospitalization and violent behaviors: medical act or social control? A 3-Year Retrospective Analysis.

Psychiatr Danub 2018 Nov;30(Suppl 7):488-494

Division of Psychiatry, Department of Medicine, University of Perugia, Piazzale Lucio Severi, 1, 06132, S. Andrea delle Fratte, Perugia (PG), Italy.

Background: The present retrospective study is aimed at assessing the clinical and psychopathological correlates of violent behaviors in a sample of acute involuntary committed inpatients.

Subjects And Methods: Involuntary inpatients were retrospectively assessed for the presence of violent behaviors. Patients with and without overt hetero-aggressive behaviors were compared according to socio-demographic, clinical and psychopathological features. A stepwise backward logistic regression was performed in order to assess the variables most associated with the perpetration of violent acts. The sample of violent patients was then divided in two subgroups on the basis of the presence/absence of a serious mental illness (SMI). Bivariate analyses were performed between SMI and non-SMI violent patients.

Results: In the present sample of 160 inpatients, 88 (55%) perpetrated violent acts. Subjects who performed violence presented a higher rate of mood stabilizers prescription (p=0.038). The PANSS-excited component was positively associated with violent behaviors (p=0.027, Odds Ratio (OR)=1.14, Confidence Interval (CI) 1.01-1.28), whilst the PANSS-depressed/anxiety factor displayed a negative association (p=0.015, OR=0.78, CI 0.64-0.95). Violent inpatients diagnosed with SMI presented higher rehospitalization rate (p=0.009), longer length of stay (p=0.005), more frequent long-acting injectable antipsychotics prescription (p<0.001) and a higher positive symptoms severity as measured by the PANSS-positive factor (p=0.049).

Conclusions: The clinical population of acute psychiatric inpatients performing violent behavior represents a specific and heterogeneous subgroup of patients for which prevention and treatment strategies should be addressed.
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November 2018

Depressive mood and circadian rhythms disturbances as outcomes of seasonal affective disorder treatment: A systematic review.

J Affect Disord 2018 12 15;241:608-626. Epub 2018 Aug 15.

Division of Psychiatry, Department of Medicine, University of Perugia, Italy.

Background: The present systematic review was aimed at critically summarizing the evidence about interventions focused on circadian rhythms and mood symptoms in seasonal affective disorder (SAD).

Methods: A systematic search of the electronic databases PUBMED, PsycINFO and Web of Science was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Original papers reporting data about the effects of treatments on both mood and circadian rhythms disturbances in SAD patients were considered for inclusion. The quality of the evidence provided by the eligible studies was assessed using the Revised Cochrane Risk of Bias Tool (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies of Interventions Tool (ROBINS-I).

Results: Forty papers were deemed eligible for the systematic review. The evidence of treatment outcomes referring to circadian disturbances was not robust. Despite this, bright light therapy (BLT) demonstrates to phase-advance delayed rhythms and to improve sleep-wake disorders. As for mood symptoms, both BLT and selective serotonin reuptake inhibitors (SSRIs) show evidence of efficacy. The possible connection between improvements of mood symptoms and changes in circadian outcomes seems controversial.

Limitations: The included studies presented considerable methodological heterogeneity, small sample sizes and non-optimal sample selection.

Conclusions: The effectiveness of BLT in depressive symptoms and circadian disturbances of SAD was outlined by the present systematic review. The evidence about other biological and pharmacological treatments, although promising, should be replicated. A multifactorial etiopathogenesis could explain the heterogeneous clinical presentations of SAD and the complex link between mood and circadian symptoms.
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http://dx.doi.org/10.1016/j.jad.2018.08.071DOI Listing
December 2018

Psychopathological characteristics of patients with first-episode psychosis and chronic schizophrenia: a descriptive comparison.

Psychiatr Danub 2016 Sep;28(Suppl-1):39-44

Sezione di Psichiatria, Università degli Studi di Perugia, Piazzale Lucio Severi, Edificio Ellisse, 8 piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy,

Only few studies have compared the psychopathological features in first episode psychosis (FEP) and chronic schizophrenia (CS) patients. The aim of our study was to compare sociodemographic and clinical aspects of FEP and CS inpatients using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) in order to better characterize FEP. We did not find significant socio-demographic differences between the two groups apart from age and nationality. About PANSS we found that conceptual disorganization, poor rapport and lack of insight items scores were significantly higher in patients with FEP. Related to BPRS the items of somatic concerns, grandiosity and motor hyperactivity were significantly higher in the CS group; uncooperativeness was significantly higher in FEP group. Our study offers a characterization of FEP patients that confirms evidence and adds some information from the current literature. FEP patients seem to be more uncooperative with a worse interpersonal empathy and insight into the illness than CS patients; this could reduce their compliance with the treatment.
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September 2016
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