Publications by authors named "Orsola Gambini"

80 Publications

Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis.

J Affect Disord 2021 Apr 5;284:136-142. Epub 2021 Feb 5.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Italy.

Background: Although depression has frequently been associated with Internet Gaming Disorder (IGD), its epidemiological impact on this emerging condition has not been systematically assessed. In this study, we aimed to synthesize the available evidence focusing on depression and depressive symptoms in individuals with IGD.

Methods: We searched PubMed, Embase, PsycINFO, GreyLit, OpenGrey, and ProQuest up to March 2020 for observational studies focusing on depression-related outcomes in IGD. We conducted random-effects meta-analyses on 1) rate of comorbid depression in IGD; 2) severity of depressive symptoms in IGD participants without depression.

Results: We identified 92 studies from 25 different countries including 15,148 participants. 21 studies (n = 5025 participants) provided data for the first analysis, resulting in a pooled event rate of depression of 0.32 (95% Confidence Interval 0.21-0.43). The pooled Beck Depression Inventory scores in individuals without depression were suggestive of mild severity (13 studies, n = 508; 10.3, 95% Confidence Interval 8.3-12.4).

Limitations: The considerable inconsistency of methods employed across studies limits the transferability of these findings to clinical practice.

Conclusions: The prevalence of depression in individuals with IGD varied considerably across studies, affecting approximately one out of three participants overall. Furthermore, a globally major severity of depressive symptoms was found in those without a clinical diagnosis of depression, compared to the general population. These findings confirm a relevant impact of mood disturbances in IGD.

Registration Detail: PROSPERO (CRD42018100823).
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http://dx.doi.org/10.1016/j.jad.2021.02.014DOI Listing
April 2021

The psychological impact of COVID-19-related lockdown measures among a sample of Italian patients with eating disorders: a preliminary longitudinal study.

Eat Weight Disord 2021 Feb 13. Epub 2021 Feb 13.

Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, ASST Santi Paolo E Carlo, Presidio San Paolo, via A. di Rudinì, 8, 20100, Milano, Italy.

Purpose: To explore the prevalence of symptoms of anxiety and depression, along with PTSD- and ED-related symptoms, across a sample of patients with Eating Disorders (EDs) compared to a group of healthy controls (HC) during the lockdown period in Italy; to assess whether patients' reported aforementioned psychiatric symptoms improved, remained stable or worsened with the easing of the lockdown measures.

Methods: t0 assessment (during lockdown): 59 ED patients and 43 HC completed an online survey, including the Depression, Anxiety and Stress Scale-21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and specific ad-hoc questions extracted from the Eating Disorder Examination-Questionnaire; t1 assessment (post-lockdown): 40 EDs patients, a subset of the t0 sample, completed the same assessment 2 months after t0.

Results: EDs patients scored higher than HC at the DASS-21, IES-R and PSS. At t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD), patients' reported level of psychological wellbeing and specific EDs symptomatology improved.

Discussion: During the lockdown, EDs patients presented significantly higher levels of stress, anxiety, depression, PTSD- and ED-related symptoms than HC. With the easing of the lockdown, PTSD- and ED-related symptoms improved, but high levels of stress, anxiety and depression persisted.

Level Of Evidence: Level I, experimental study.
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http://dx.doi.org/10.1007/s40519-021-01137-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882047PMC
February 2021

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy.

Front Public Health 2020;8:575029. Epub 2021 Jan 8.

Respiratory Medicine, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy.

In March 2020, northern Italy became the second country worldwide most affected by Covid-19 and the death toll overtook that in China. Hospital staff soon realized that Covid-19 was far more severe than expected from the few data available at that time. The Covid-19 pandemic forced hospitals to adjust to rapidly changing circumstances. We report our experience in a general teaching hospital in Milan, the capital of Lombardy, the most affected area in Italy. First, we briefly describe Lombardy's regional Covid-19-related health organizational changes as well as general hospital reorganization. We also provide a multidisciplinary report of the main clinical, radiological and pathological Covid-19 findings we observed in our patients.
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http://dx.doi.org/10.3389/fpubh.2020.575029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820812PMC
February 2021

COVID-19 and mental health: the other side of the coin.

J Affect Disord 2021 03 31;282:695-696. Epub 2020 Dec 31.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy.

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http://dx.doi.org/10.1016/j.jad.2020.12.189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831769PMC
March 2021

Early Psychiatric Impact of COVID-19 Pandemic on the General Population and Healthcare Workers in Italy: A Preliminary Study.

Front Psychiatry 2020 22;11:561345. Epub 2020 Dec 22.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.

Since February 2020, the outbreak of COVID-19 spread to several countries worldwide, including Italy. In this study, we aimed to assess the psychopathological impact of the pandemic across the general population of Lombardy, the most affected Italian region, and to compare the prevalence of psychiatric symptoms between the general public and healthcare workers. Four hundred and thirty-two participants completed an online survey including: the Depression, Anxiety and Stress Scale-21 items (DASS-21), the Impact of Event Scale-Revised (IES-R) and the Pittsburgh Sleep Quality Index (PQSI). Healthcare workers were also asked to complete the Maslach Burnout Inventory (MBI). At the DASS-21, 33.3% of the responders presented pathological levels of stress, 25.5% of anxiety, and 35.9% of depression. At the IES-R, 13.9% appeared at risk of developing Post-Traumatic Stress Disorder (PTSD). At the PSQI, 57.6% presented sleep disturbances. Female gender and younger age predicted higher scores of distress. Healthcare workers presented higher levels of psychiatric symptoms than the general public. Moreover, working in contact with COVID-19 patients predicted higher scores at the IES-R subscale Intrusion. Our results showed that about a third of our sample presented symptoms of stress, anxiety, and depression during the first month of the COVID-19 pandemic outbreak in Lombardy; more than half of the responders presented sleep disturbances, and 13% appeared at risk of PTSD. Italian authorities should develop specific strategies to guarantee psychological support to the population of Lombardy, with particular attention to women, young people, and healthcare workers exposed to COVID-19 patients.
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http://dx.doi.org/10.3389/fpsyt.2020.561345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783153PMC
December 2020

Assessment of nutritional risk in persons with mental health disorders admitted to the acute psychiatric inpatient unit: an Italian study.

Prof Inferm 2020 Jun-Sep;73(3):196-204

MD, PhD, Associate Professor of Psychiatry, Department of Biomedical Sciences for Health, University of Milan. 20142 Milan, Italy.

Background: Mental disorders can impact on several aspects of the person and therefore also on nutritional models; the literature shows that psychiatric persons are at risk of malnutrition, but the available studies are limited, particularly in Italy.

Aims: To investigate the prevalence of malnutrition by defect and metabolic syndrome in inpatients in an acute Psychiatric unit. To evaluate the characteristics and food habits of the sample.

Methods: Assessment of the risk of malnutrition (Mini Nutritional Assessment Scale) and Metabolic Syndrome (APTIII criteria) by administering a new scale to all persons aged 18+ at admission in two inpatient units of a major teaching hospital in Milan, Italy.

Findings: One Hundred one people were enrolled; 29.70% were malnourished or at risk of malnutrition by defect; Major Depressive Disorder, serum levels of albumin below range and low levels of appetite were significantly associated with malnutrition. 11.88% was suffering from Metabolic Syndrome, which was significantly associated with Psychotic Disorder, high levels of appetite and junk food consumption.

Conclusions: The results highlighted the relevance of malnutrition in the psychiatric population and suggest the need for a systematic evaluation, in every clinical context as well as the key role of nurses.
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http://dx.doi.org/10.7429/pi.2020.733196DOI Listing
December 2020

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology.

Eur J Neurol 2020 Dec 9. Epub 2020 Dec 9.

Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.

Background And Purpose: The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases ("comorbid FMDs"), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases ("pure FMDs").

Methods: For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables).

Results: Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non-neurological comorbidities, paroxysmal non-epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non-neurological comorbidities.

Conclusions: Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non-neurological diseases.
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http://dx.doi.org/10.1111/ene.14674DOI Listing
December 2020

Cerebrospinal fluid glutamate changes in functional movement disorders.

NPJ Parkinsons Dis 2020 Dec 4;6(1):37. Epub 2020 Dec 4.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.

The aim of this study was to assess cerebrospinal fluid (CSF) concentrations of specific amino acids using a high-performance liquid chromatography system in a sample of patients with functional movement disorders (FMDs) and in a sample of controls. CSF levels of glutamate were significantly lower in patients with FMD than in controls. This finding argues in favor of glutamatergic dysfunction in the pathophysiology of FMD.
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http://dx.doi.org/10.1038/s41531-020-00140-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718900PMC
December 2020

Psychiatric Disorders in Alzheimer Disease With the Presenilin-1 L226F Mutation.

Cogn Behav Neurol 2020 12;33(4):278-282

Aldo Ravelli Center for Neurotechnology and Experimental Neurotherapeutics, University of Milan, Milan, Italy.

The presenilin-1 (PSEN1) L226F mutation has been linked to very early onset of prominent behavioral and psychiatric disturbances followed by cognitive decline within a few years. We report a novel case of early-onset Alzheimer disease that was originally diagnosed as psychotic depression in a patient with this gene mutation. We also compare our patient's clinical data to those of other cases of this mutation that have been described in the literature. Because atypical behavioral and psychiatric disturbances in young (<40 years) individuals can herald Alzheimer disease, a tight collaboration between psychiatrists and neurologists is crucial for an early diagnosis.
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http://dx.doi.org/10.1097/WNN.0000000000000249DOI Listing
December 2020

Human induced pluripotent stem cells technology in treatment resistant depression: novel strategies and opportunities to unravel ketamine's fast-acting antidepressant mechanisms.

Ther Adv Psychopharmacol 2020 2;10:2045125320968331. Epub 2020 Nov 2.

Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy.

Approximately 30% of Major Depressive Disorder (MDD) patients develop treatment-resistant depression (TRD). Among the different causes that make TRD so challenging in both clinical and research contexts, major roles are played by the inadequate understanding of MDD pathophysiology and the limitations of current pharmacological treatments. Nevertheless, the field of psychiatry is facing exciting times. Combined with recent advances in genome editing techniques, human induced pluripotent stem cell (hiPSC) technology is offering novel and unique opportunities in both disease modelling and drug discovery. This technology has allowed innovative disease-relevant patient-specific models to be set up for many psychiatric disorders. Such models hold great potential in enhancing our understanding of MDD pathophysiology and overcoming many of the well-known practical limitations inherent to animal and post-mortem models. Moreover, the field is approaching the advent of (es)ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, claimed as one of the first and exemplary agents with rapid (in hours) antidepressant effects, even in TRD patients. Although ketamine seems poised to transform the treatment of depression, its exact mechanisms of action are still unclear but greatly demanded, as the resulting knowledge may provide a model to understand the mechanisms behind rapid-acting antidepressants, which may lead to the discovery of novel compounds for the treatment of depression. After reviewing insights into ketamine's mechanisms of action (derived from preclinical animal studies) and depicting the current state of the art of hiPSC technology below, we will consider the implementation of an hiPSC technology-based TRD model for the study of ketamine's fast acting antidepressant mechanisms of action.
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http://dx.doi.org/10.1177/2045125320968331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649879PMC
November 2020

Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study.

Mov Disord Clin Pract 2020 Nov 22;7(8):920-929. Epub 2020 Sep 22.

Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy.

Background: Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases.

Objective: The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables.

Methods: For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms.

Results: Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs.

Conclusions: Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
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http://dx.doi.org/10.1002/mdc3.13077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604660PMC
November 2020

The pathophysiology of functional movement disorders.

Neurosci Biobehav Rev 2021 01 4;120:387-400. Epub 2020 Nov 4.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; III Clinica Neurologica, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy. Electronic address:

Functional neurological disorder is characterized by neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. This review will critically discuss the literature on the pathophysiology of functional movement disorders (FMD), including functional neuroimaging studies, neurophysiological studies, studies on biomarkers and genetic studies. According to PRISMA guidelines for systematic reviews, we selected 39 studies. A complex scenario emerged, with the involvement of different areas of the brain in the pathophysiology of FMD. Our findings showed a hypoactivation of the contralateral primary motor cortex, a decreased activity in the parietal lobe, an aberrant activation of the amygdala, an increased temporo-parietal junction activity and a hyperactivation of insular regions in patients with FMD. Functional connectivity (FC) findings underlined aberrant connections between amygdala and motor areas, temporo-parietal junction and insula. We proposed amygdala hyperactivation as a possible biological marker for FMD and FC alterations between amygdala and other areas of the brain as consequent epiphenomena, accounting for the pathophysiological complexity of FMD. These conclusions might drive novel treatment hypotheses.
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http://dx.doi.org/10.1016/j.neubiorev.2020.10.019DOI Listing
January 2021

The Anticipation and Perception of Affective Touch in Women with and Recovered from Anorexia Nervosa.

Neuroscience 2020 Sep 13. Epub 2020 Sep 13.

Department of Clinical, Educational and Health Psychology, University College London, London, UK.

Disruptions in reward processing and anhedonia have long been observed in Anorexia Nervosa (AN). Interoceptive deficits have also been observed in AN, including reduced tactile pleasure. However, the extent to which this tactile anhedonia is specifically liked to an impairment in a specialised, interoceptive C-tactile system originating at the periphery, or a more top-down mechanism in the processing of tactile pleasantness remains debated. Here, we investigated differences between patients with and recovered from AN (RAN) and healthy controls (HC) in the perception of pleasantness of touch delivered in a CT-optimal versus a CT-non-optimal manner, and in their top-down, anticipatory beliefs about the perceived pleasantness of touch. To this end, we measured the anticipated pleasantness of various materials touching the skin and the perceived pleasantness of light, dynamic touch applied to the forearm of 27 women with AN, 24 women who have recovered and 30 HCs using C Tactile (CT) afferents-optimal (slow) and non-optimal (fast) velocities. Our results showed that both clinical groups anticipated tactile experiences and rated delivered tactile stimuli as less pleasant than HCs, but the latter difference was not related to the CT optimality of the stimulation. Instead, differences in the perception of CT-optimal touch were predicted by differences in top-down beliefs, alexithymia and interoceptive sensibility. Thus, tactile anhedonia in AN might persist as a trait even after otherwise successful recovery of AN and it is not linked to a bottom-up interoceptive deficit in the CT system, but rather to a learned, defective top-down anticipation of tactile pleasantness.
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http://dx.doi.org/10.1016/j.neuroscience.2020.09.013DOI Listing
September 2020

Dissociation during Mirror Gazing Test in psychogenic nonepileptic seizures and functional movement disorders.

Epilepsy Behav 2020 11 26;112:107368. Epub 2020 Aug 26.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy; Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy. Electronic address:

Introduction: Psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD) seem to represent the two ends of a continuum where different clinical phenotypes represent the manifestation of a common framework, involving dissociation. The aim of the present study was to assess dissociation and its subcomponents through the Mirror Gazing Test (MGT) in these functional neurological disorders (FNDs).

Materials And Methods: Eleven patients with PNES, 17 with FMD, and 18 healthy controls (HCs) underwent a 10-minute MGT and completed the Strange Face Questionnaire (SFQ), an ad-hoc questionnaire assessing the sensations and perceptions they had looking in the mirror, and a short version of the Clinician-Administered Dissociative States Scale (CADSS).

Results: Patients with PNES, FMD, and HCs did not differ at the total score of the SFQ. Patients with PNES scored higher than HCs at the SFQ-subscale Dissociative Identity/Compartmentalization, at the CADSS Total Score and at its subscale Dissociative Amnesia, while patients with FMD scored higher than HCs at the CADSS subscale Depersonalization.

Conclusions: Patients with FMD reported more sensations falling in the detachment facet of dissociation, while patients with PNES in the compartmentalization one. We hypothesized that both facets of dissociation might be important pathophysiological processes for PNES and FMD and that different instruments (self-report clinical scales vs experimental tasks) might be able to detect different facets in different populations because they assess, respectively, "trait" and "state" dissociation.
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http://dx.doi.org/10.1016/j.yebeh.2020.107368DOI Listing
November 2020

Brief Psychotic Disorder During the National Lockdown in Italy: An Emerging Clinical Phenomenon of the COVID-19 Pandemic.

Schizophr Bull 2021 01;47(1):15-22

Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy.

The impact of the COVID-19 pandemic on psychosis remains to be established. Here we report 6 cases (3 male and 3 female) of first-episode psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full-blown psychosis (the Brief Psychiatric Rating Scale [BPRS] = 75.8 ± 14.6). Blood tests, toxicological urine screening, and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (male, 73 years). All patients were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout their stay, but 3 presented the somatic delusion of being infected. Of note, all 6 cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53.3 ± 15.6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13.8 ± 6.9) with remission of symptoms (BPRS = 27.5 ± 3.1) and satisfactory insight were possible after relatively low-dose antipsychotic treatment (Olanzapine-equivalents = 10.1 ± 5.1 mg). Brief psychotic disorder/acute and transient psychotic disorder diagnoses were confirmed during follow-up visits in all 6 cases. The youngest patient (female, 23 years) also satisfied the available criteria for brief limited intermittent psychotic symptoms. Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.
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http://dx.doi.org/10.1093/schbul/sbaa112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454891PMC
January 2021

Pre/post comparison study of emergency mental health visits during the COVID-19 lockdown in Lombardy, Italy.

Psychiatry Clin Neurosci 2020 11 2;74(11):605-607. Epub 2020 Sep 2.

Department of Health Sciences, University of Milan, Milan, Italy.

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http://dx.doi.org/10.1111/pcn.13126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436868PMC
November 2020

Visual perception and dissociation during Mirror Gazing Test in patients with anorexia nervosa: a preliminary study.

Eat Weight Disord 2020 Aug 5. Epub 2020 Aug 5.

DISTUM, University of Urbino, Urbino, Italy.

Purpose: It has been widely shown that dissociative features might play a fundamental role in producing body image distortions in patients affected by eating disorders. Here, we hypothesize that the Mirror Gazing Test (MGT), a task consisting in mirror exposure in a condition of sensory deprivation, would elicit dissociative symptoms in a group of patients with anorexia nervosa (AN).

Methods: Fourteen patients with AN and fourteen healthy controls (HC) underwent a 10 min MGT and completed the Strange Face Questionnaire and a short version of the Clinician-Administered Dissociative States Scale, along with a psychological assessment for eating disorders psychopathology, anxiety and depression.

Results: AN patients reported a higher number of strange-face apparitions and dissociative sensations than HC during the MGT. Dissociative identity (compartmentalization of two or more identities) and depersonalization (detachment of bodily-self) were much higher in patients with AN than in HC. These findings were correlated with body dissatisfaction and disruption in interoceptive awareness.

Conclusion: Dissociation and body image dysfunction are strongly connected in the pathophysiology of anorexia nervosa. Future research should investigate the same aspects in other psychiatric conditions characterized by body image distortions, such as Body Dysmorphic Disorder.

Level Of Evidence: I, Experimental studies.
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http://dx.doi.org/10.1007/s40519-020-00977-6DOI Listing
August 2020

The psychological impact of COVID-19 among a sample of Italian patients with functional neurological disorders: A preliminary study.

Parkinsonism Relat Disord 2020 09 22;78:79-81. Epub 2020 Jul 22.

Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.parkreldis.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374122PMC
September 2020

Efficacy of Triple Chronotherapy in unipolar and bipolar depression: A systematic review of the available evidence.

J Affect Disord 2020 11 15;276:297-304. Epub 2020 Jul 15.

Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.

Background: Given the strong relationship between circadian rhythm disruption and mood regulation, combined chronotherapeutic approaches have been proposed for mood disorders. However, a comprehensive review of the available evidence on the efficacy of such interventions for depression is lacking.

Aim: To systematically review available literature on Triple Chronotherapy (Sleep Deprivation - Sleep Phase Advance - Bright Light Therapy) for depressive symptoms in Major Depression and Bipolar Depression.

Methods: We followed the PRISMA statement for systematic reviews to conduct a web-based search on PubMed, Scopus and Embase using a list of selected keywords relevant to depression and chronotherapy.

Results: After title and abstract screening of the 321 records retrieved, 25 potentially eligible studies were assessed at full-text screening. Nineteen studies were excluded for failure to match inclusion criteria. Six records of Triple Chronotherapy in addition to conventional treatment, published between 2009 and 2019, were included in the revision. All studies reported significant improvements on HAM-D scores at the end of treatment, with 50% to 84% response rates. Efficacy of treatment was confirmed on follow-up by three studies, with 58% to 61% response rates. Remission rates varied from 33,3% to 77%. Reported side effects were negligible across studies.

Limitations: Available trials are very few and only one included a control group treated with a daily exercise program.

Conclusions: The limited literature suggests that Triple chronotherapy might be a safe and effective addition to conventional antidepressant interventions, although well-designed, randomized controlled trials are needed.
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http://dx.doi.org/10.1016/j.jad.2020.07.026DOI Listing
November 2020

The effect of a single yoga class on interoceptive accuracy in patients affected by anorexia nervosa and in healthy controls: a pilot study.

Eat Weight Disord 2020 Jul 1. Epub 2020 Jul 1.

Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, A.O. San Paolo, via A. di Rudinì, 8, 20100, Milan, Italy.

Purpose: To evaluate interoceptive accuracy (Iac) before and after a single yoga class in a population of patients with anorexia nervosa (AN) and in a population of healthy controls (HC).

Methods: Fifteen patients with AN and twenty HC were included in the study. All individuals participated in a single yoga class. Before (T0) and after (T1) the yoga class, they underwent the heartbeat detection task for the evaluation of Iac. At T0, all participants also underwent a psychological assessment, including evaluation of depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders psychopathology.

Results: Patients with AN had lower Iac than HC at T0. A significant improvement of Iac at T1 was found in the HC group but not in the group of patients with AN.

Conclusion: We infer that our findings might be linked to the fact that patients with AN, differently from HC, did not properly attend to their bodies, despite the yoga class. This hypothesis is consistent with previous studies showing that patients with AN have decreased Iac during self-focused behavior because of body-related avoidance. Moreover, we surmise that HC might be keener to improve their perception of internal body signals even after a single yoga class because their emotional awareness system is not impaired. Patients with AN, on the contrary, may have an intrinsic impairment of their emotional awareness, making it harder for them to modulate their Iac.

Level Of Evidence: Level III, evidence obtained from well-designed cohort or case-control analytical studies.
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http://dx.doi.org/10.1007/s40519-020-00950-3DOI Listing
July 2020

Delirium and sleep disturbances in COVID-19: a possible role for melatonin in hospitalized patients?

Sleep Med 2020 06 17;70:111. Epub 2020 Apr 17.

Department of Health Sciences, Università Degli Studi di Milano, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.sleep.2020.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162748PMC
June 2020

Mental health services in Italy during the COVID-19 outbreak.

Lancet Psychiatry 2020 05;7(5):385-387

Department of Mental Health, ASST Santi Paolo e Carlo, Milan 20142, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.

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http://dx.doi.org/10.1016/S2215-0366(20)30133-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185925PMC
May 2020

The e-Psychonauts' 'Spiced' World; Assessment of the Synthetic Cannabinoids' Information Available Online.

Curr Neuropharmacol 2020 ;18(10):966-1051

Department of Mental Health, School of psychology, G. Marconi, Telematic University, Rome, Italy. ASL Roma 2, Rome, Italy.

Background: A wide range of novel psychoactive substances (NPS) is regularly searched and discussed online by web-based drug enthusiasts (i.e. the e-psychonauts). Among NPS, the range of synthetic cannabinoids (SC; 'Spice') currently represents a challenge for governments and clinicians.

Methods: Using a web crawler (i.e. the NPS.Finder®), the present study aimed at assessing psychonauts' fora/platforms to better understand the online mentions of SC.

Results: The open-web crawling/navigating software identified here some 1,103 synthetic cannabinoids. Of these, 863 molecules were not listed in either the international or the European NPS databases.

Conclusion: A web crawling approach helped here in identifying a large range of unknown SC likely to possess a misuse potential. Most of these novel/emerging molecules are still relatively unknown. This is a reason for concern; each of these analogues potentially presents different toxicodynamic profiles and there is a lack of docking, preclinical, and clinical observations. Strengthening multidisciplinary collaboration between clinicians and bioinformatics may prove useful in better assessing SC-associated public health risks.
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http://dx.doi.org/10.2174/1570159X18666200302125146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709145PMC
January 2020

The reMAP project: A retrospective, 15-year register study on inpatient care for youth with mental disorders.

Early Interv Psychiatry 2020 12 25;14(6):705-713. Epub 2019 Nov 25.

Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

Aim: We aimed to characterize youth hospitalization trends in a psychiatric inpatient unit from a large, public university hospital with a broad catchment area in Milan, Italy.

Methods: Hospitalization data of patients with an age at admission ≤ 35 were retrospectively retrieved over a time span of 15 years. The sample was comprised of 1982 admissions to a psychiatric ward, aggregated into ICD-10 diagnostic clusters and then analysed. We investigated the epidemiological trends with a focus on age at admission, gender, nationality and hospitalization rates, length of stay and "revolving door" readmissions within a year.

Results: Hospitalization rates increased for eating Disorders and decreased for non-affective psychotic disorders; median length of stay generally decreased; hospitalization rates for foreign youth increased, in particular for those diagnosed with non-affective psychotic disorders, personality disorders, and substance-related and addictive disorders. The revolving door phenomenon was also associated with non-affective psychoses and neurodevelopmental disorders, while found to increase for eating disorders.

Conclusions: Hospitalization patterns reflect the general increase of foreign youth in the suburban tissue of a large metropolitan area like Milan. However, our data might underestimate the constant growth of mental health problems in foreign youth due to a generally lower access to services. Novel pharmacological treatments and early intervention programs might explain the decrease of hospitalization duration and hospitalization rate for youth with non-affective psychoses. The observed increase in hospitalization for young patients with eating disorders sustains the development of adequate policies tailored towards specialty wards.
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http://dx.doi.org/10.1111/eip.12899DOI Listing
December 2020

Psychopharmacology of headache and its psychiatric comorbidities.

Handb Clin Neurol 2019 ;165:339-344

Department of Health Sciences, University of Milan, Milan, Italy; ASST Santi Paolo e Carlo, Milan, Italy.

The association between psychiatric disorders and headache is widely recognized, even though the explanation of likely mechanisms is yet speculative. The most common comorbid associated disorders are depressive (DD), anxiety (AD), and bipolar disorders (BD). Treatments options comprise pharmacologic therapies, psychologic therapies, other nonpharmacologic therapies, and combinations of them. To the best of our knowledge, no evidence-based guidelines exist regarding pharmacotherapy for DD, BD, and/or AD in patients with headache. When pharmacologic therapies are the choice for a psychiatric disorder comorbid with headache, an accurate psychiatric history is needed. Prescriptions of pharmacologic therapies for DD, BD, and AD need to take into account all the other therapies or psychoactive substances used by the subjects. The therapies for subjects with DD, AD, and BD can be very challenging and a strict collaboration among neurologists and psychiatrists is highly advisable.
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http://dx.doi.org/10.1016/B978-0-444-64012-3.00020-4DOI Listing
April 2020

A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder.

Mol Psychiatry 2019 Oct 29. Epub 2019 Oct 29.

KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium.

Deep brain stimulation (DBS) has been proposed for severe, chronic, treatment-refractory obsessive-compulsive disorder (OCD) patients. Although serious adverse events can occur, only a few studies report on the safety profile of DBS for psychiatric disorders. In a prospective, open-label, interventional multi-center study, we examined the safety and efficacy of electrical stimulation in 30 patients with DBS electrodes bilaterally implanted in the anterior limb of the internal capsule. Safety, efficacy, and functionality assessments were performed at 3, 6, and 12 months post implant. An independent Clinical Events Committee classified and coded all adverse events (AEs) according to EN ISO14155:2011. All patients experienced AEs (195 in total), with the majority of these being mild (52% of all AEs) or moderate (37%). Median time to resolution was 22 days for all AEs and the etiology with the highest AE incidence was 'programming/stimulation' (in 26 patients), followed by 'New illness, injury, condition' (13 patients) and 'pre-existing condition, worsening or exacerbation' (11 patients). Sixteen patients reported a total of 36 serious AEs (eight of them in one single patient), mainly transient anxiety and affective symptoms worsening (20 SAEs). Regarding efficacy measures, Y-BOCS reduction was 42% at 12 months and the responder rate was 60%. Improvements in GAF, CGI, and EuroQol-5D index scores were also observed. In sum, although some severe AEs occurred, most AEs were mild or moderate, transient and related to programming/stimulation and tended to resolve by adjustment of stimulation. In a severely treatment-resistant population, this open-label study supports that the potential benefits outweigh the potential risks of DBS.
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http://dx.doi.org/10.1038/s41380-019-0562-6DOI Listing
October 2019