Publications by authors named "Patrizia Moretti"

45 Publications

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

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

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

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

Psychiatr Danub 2020 Sep;32(Suppl 1):5-9

Psychiatric Studies Center (Cen.Stu.Psi.), Piazza Portici, 11 - 25050 Provaglio d'Iseo (BS), Italy,

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.
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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

FIMEC Test to Evaluate the Water Uptake of Coated and Uncoated CFRP Composites.

Materials (Basel) 2020 Mar 5;13(5). Epub 2020 Mar 5.

Dipartimento di Ingegneria dell'Impresa, Università degli Studi di Roma "Tor Vergata", via del Politecnico 1, 00133 Roma, Italy.

This study focuses on the application of the FIMEC (flat-top cylinder indenter for mechanical characterization) indentation test to evaluate the effect of water uptake on the mechanical properties of high-performance materials, in particular CFRP (carbon fibre reinforced polymer) composites. Coated and uncoated samples were analyzed. Silicon-based and siloxane coatings were formulated and applied to CFRP to reduce the moisture absorption of the material. The FIMEC test was adopted to study the reduction of the stiffness of CFRP plates for different ageing in water. The evolution of mechanical properties is reported as a function of the water uptake. IR analyses and weight variation measures were used as supporting data. Experimental results show that the FIMEC test is suitable to assess the stiffness reduction due to the aging in water and to identify coatings able to minimize the water uptake.
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http://dx.doi.org/10.3390/ma13051154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084978PMC
March 2020

Single-sided NMR: a non-invasive diagnostic tool for monitoring swelling effects in paint films subjected to solvent cleaning.

Anal Bioanal Chem 2020 Feb 21;412(5):1063-1075. Epub 2019 Dec 21.

Istituto CNR per le Scienze del Patrimonio Culturale (CNR-ISPC), Via Cardinale Guglielmo Sanfelice 8, 80134, Naples, Italy.

During solvent cleaning of a painted surface, the control of solvent diffusion into the painting matrix is a primary concern for conservators. In this work, a comparative systematic study of solvent ingress and of the ensuing swelling phenomenon in paint films due to cleaning treatments was tackled using single-sided NMR. Specifically, the effects of a TAC aqueous solution (triammonium citrate in deionized water) applied in both free and gelled forms (by Klucel G) on acrylic emulsion and vinyl-based model paints were evaluated. Notably, the NMR measurements (proton spin density depth profiles and transverse relaxation decays) collected before, during, and after these wet-cleaning tests proved that the use of the aqueous gel did not significantly minimize the penetration and the swelling action of water compared with the free solution. Furthermore, swelling effects associated with the use of an organic solvent (ligroin) were evaluated by NMR profilometry on varnished oil and egg-tempera paints. In this case, by comparing the depth profiles collected before and after the solvent treatments, a moderate paint swelling was observed followed by a width reduction of the paint films ascribable to the removed varnish layer.Overall, the reported NMR results reveal the analytical potentialities of the technique for a non-invasive assessment of the swelling effect of paint films subjected to cleaning (by water or an organic solvent), thereby providing an analytical method in support to the conservators' practice.
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http://dx.doi.org/10.1007/s00216-019-02331-xDOI Listing
February 2020

Dysphoria Dimensional Model for Feeding And Eating Disorders: a Preliminary Study.

Psychiatr Danub 2019 Sep;31(Suppl 3):512-516

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

Background: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are severe psychiatric illnesses which represent the main expression of Feeding and Eating Disorders (FED). Clinicians agree that emotional and behavioural dysregulation play a crucial role in FED. Dysphoria could help us to better understand these components. Indeed, we define dysphoria as a generic state of dissatisfaction and emotional instability, without any specific features. Among the multitude of symptoms, we find that irritability, discontent, interpersonal resentment and surrender prevail. These dimensions correspond to the four subscales of Neapean Dysphoria Scale - Italian version (NDS-I). Dysphoria role in FED has not yet been investigated. Using this test, we can characterize dysphoria both in quantitative and qualitative terms. Accordingly, domain evaluation could discriminate these disorders allowing us to assess possible differential phenomenological expressions.

Aims: The aim of this paper is to understand in which way the dimensional spectrum that composes dysphoria differs between Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorders through an observational comparative study.

Subjects And Methods: The enrolled sample (30 patients) is represented by patients with a history of FED (AN, BN or BED). Patients were males and females between the ages of 13 and 45 with a good knowledge of Italian language. Patients with severe cognitive impairment (MMSE <19) and civil incapacitation were excluded. Patients were recruited from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), and other residential and semi residential structures specialized in FED treatment (FED specialized center at Palazzo Francisci in Todi (PG), Nido delle Rondini in Todi (PG), BED (Binge Eating Disorders) center in Città della Pieve (PG) and ambulatory services for FED in Umbertide (PG)). We administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender). For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05.

Conclusions: This study allowed us to better understand and characterize the most common Eating Disorders. Beyond that, despite the small sample size, we found in our analysis statistically significant difference in the expression of various dysphoria dimension spectrum inside our 3 groups.
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September 2019

Eating Disorders: the Role of Childhood Trauma and the Emotion Dysregulation.

Psychiatr Danub 2019 Sep;31(Suppl 3):509-511

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 case-control study is aimed at evaluating the presence of childhood traumatic factors and the difficulty in regulating emotions, within a sample of patients with eating disorders compared to the group of healthy controls.

Subjects And Methods: We included 65 people assessed for eating disorders, 40 patients and 25 healthy controls, who were given two tests: the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to investigate the presence of traumatic events and the Difficulties in Emotion Regulation Scale (DERS) to assess the emotional regulation.

Results: People with eating disorders showed higher average scores, and therefore greater severity than the control group, in all the domains explored, both considering traumatic experiences and emotional dysregulation. The domain emotional neglect showed the closest correlation with eating disorders (average scoring 15.9 vs 9.9 of healthy controls), followed by emotional abuse (12.2 vs 7.8), physical neglect (8.2 vs 6.6), physical abuse (8.3 vs 6.6) and sexual abuse (7.2 vs 5.6). In the same way, the emotional dysregulation was greater among people with eating disorder than healty controls, concerning every items explored by DERS, as clarity (average scoring 14.8 vs 11.4), awareness (17.1 vs 11.7), goals (16.3 vs 12.9), strategy (22.0 vs 14.7), non acceptance (17.4 vs 12.1) and impulse (16.5 vs 11.4).

Conclusions: Childhood traumatic experiences and emotional dysregulation result significantly higher in people with eating disorders than healthy controls.
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September 2019

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

Dysphoria Dimensions: a Preliminary Inpatients Study to Diffrentiate Borderline Personality and Bipolar Disorder Spectrum.

Psychiatr Danub 2019 Sep;31(Suppl 3):490-496

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

Background: Differentiating Borderline Personality Disorder (BPD) from Bipolar Disorder (BD) represents a very difficult challenge for clinicians. Dysphoria could be a possible key to differentiate these disorders. We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them irritability, discontent, interpersonal resentment and surrender prevail. These dimensions can be detected using the Neapen Dysphoria Scale - Italian version (NDS-I). Dysphoria role in BPD has been highlighted by the recent theorization of the Interpersonal Dysphoria Model, according to which dysphoria could represent the "psychopathological organizer" of the BPD. On the other side, dysphoria role in BD has not yet been established. This is simply considered as an aspect, and not fundamental, of the symptomatology characterizing BD, especially in mixed states patients. The phenomenological analysis of the dimensional spectrum of dysphoria within BPD and DB could provide a valuable aid in the differential diagnosis between BPD and BD.

Aims: The aim of this paper is to verify if the dimensional spectrum of dysphoria differs between Borderline Personality Disorder (BPD) and Bipolar Disorder Spectrum (BD) through an observational comparative study SUBJECTS AND METHODS: In this study, 65 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1 2018 to April 30 2019. We have formed 2 groups. A BPD group composed of 33 patients (19 female patients, representing approximately 57.6% of the sample) and a BD group composed of 32 patients (18 Female patients, representing approximately 56.2% of the sample). Patient's comorbid with BD and BPD have been excluded from the study. After a preliminary assessment to exclude organic and psychiatric comorbidity, and after at least 72 hours from hospitalization, we administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and their NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender); For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05.

Conclusions: This study allowed us to explore and analyze dysphoria dimensions expressions in BPD and BD. Despite the small sample analyzed, the results show a significant different dimensional spectrum expression of the dysphoria between the two disorders. In particular, Irritability and Interpersonal Resentment dimensions show greater interest in BPD than BD spectrum. Further studies with a larger and stratified sample are needed to confirm these results.
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September 2019

Obstetric and psychosocial risk factors associated with maternity blues.

J Matern Fetal Neonatal Med 2021 Apr 24;34(8):1227-1232. Epub 2019 Jun 24.

Department of Obstetrics and Gynecology, Univerisity of Perugia, Perugia, Italy.

Aim: To identify risk factors for maternity blues (MB) and to evaluate the impact of obstetric factors on MB prevalence.

Materials And Methods: 194 mothers have completed the Edinburgh Postnatal Depression Scale (EPDS) 2 days after delivery. Bivariate and multivariate logistic regression models were used to identify the predictors of MB.

Results: 57 women (29.4%) were positive at screening. Comparing the two groups, no statistically significant difference was found in age ( = .536), nationality ( = .065) and BMI before pregnancy ( = .224). Interestingly, no significant differences were highlighted in terms of assisted reproduction technology or spontaneous pregnancies and the presence of labor analgesia, while MB was significantly more frequent in case of cesarean section (CS) ( = .035). Statistical differences have been found in previous CS ( = .022), previous voluntary interruption of pregnancy ( = .021), number of previous pregnancies ( = .007), Apgar 5' ( = .026), lower level of education ( = .009), and previous postpartum depression (PPD) ( = .026). A logistic regression analysis was realized according to a multivariate model incorporating all the variables with a -value ≤.25 in bivariate analysis. In the final model vaginal delivery (OR 0.451, 95% CI [0.224-0.911],  = .026) resulted to be MB protective factor, while a lower level of education (OR 3.657, 95% CI [1.482-9.023],  = .005) as well as previous PPD (OR 4.714, 95% CI [1.273-17.458],  = .020) were identified as independent risk factors.

Conclusion: This study showed that a lower education level and a previous PPD resulted to be important risk factors for MB development, while natural delivery was revealed as a protective factor. These results could be used to develop a better and more accurate prevention program after delivery.
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http://dx.doi.org/10.1080/14767058.2019.1630818DOI Listing
April 2021

Dysphoria as a psychiatric syndrome: a preliminary study for a new transnosographic dimensional approach.

Psychiatr Danub 2018 Nov;30(Suppl 7):582-587

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

Background: We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them prevail irritability, discontent, interpersonal resentment and surrender. Dysphoria, in line with the most recent Interpersonal Dysphoria Model, could represent a "psychopathological organizer" of the Borderline Personality Disorder. We would like to extend this theoretical concept to other psychiatric disorders in order to consider dysphoria as a possible psychopathological nucleus, a syndrome on its own. This syndromic vision may open up the possibility of new paths both in the differential diagnosis and in the therapeutic approach to the various disorders.

Aims: The goal of this paper is to understand if the dimensional spectrum that composes dysphoria differs from the different psychiatric disorders. Specifically, we would like to assess if the phenomenological expression of dysphoria differs in patients with Borderline Personality Disorder (BPD), Mixed State Bipolar Disorder (BDM) and Major Depressive Disorder (MDD) through an observational comparative study.

Subjects And Methods: In this study, 30 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1 to June 30, 2018. The aim was to form 3 groups each one composed of 10 individuals affected respectively with Borderline Personality Disorder (BPD), with Bipolar Disorder, Mixed State (BPM) and Major Depression Disorder (MDD). After a preliminary assessment to exclude organic and psychiatric comorbidity, we administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have obtained graphs showing the comparison between disorders groups selected and NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender). Finally, a comparison was made, taking two groups at a time, between the means of single groups for total scores and for single subscales considered into the NDS-I test. We made it using the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level α=0.05.

Conclusions: This study, through a transnosographic-dimensional approach, allowed us to explore dysphoria and its expressions in different psychopathological groups, despite analyzing a small sample. Differences between means of values obtained through NDS-I subscales were statistically significant in patients with BPD, BDM and MDD (p<0.05). Among the latter, the group of BPD patients has greater pervasiveness and severity of dysphoria symptoms.
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November 2018

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

Cannabis Use, Psychotic Like Experiences and Aberrant Salience in a Sample of Belgian Students.

J Nerv Ment Dis 2018 07;206(7):493-500

Department of Psychiatry, Erasme Hospital, Université Libre de Bruxelles (ULB), Anderlecht, Belgium.

The main goal of our study was to investigate the association between psychotic-like experiences, aberrant salience, and cannabis use in a nonclinical sample of Belgian students. The participants were asked to complete a self-report questionnaire on cannabis use. The Community Assessment of Psychic Experiences and the Aberrant Salience Inventory were used to assess psychotic-like experiences and aberrant salience. The final sample was of 257 students. Cannabis users showed significantly higher Aberrant Salience Inventory score and, concerning the Community Assessment of Psychic Experiences, higher total, positive, and negative dimension scores. Years of cannabis use and frequency of use showed a positive correlation with Aberrant Salience Inventory score. Our results support the evidence that cannabis use is associated with an increased rate of psychotic experiences in individuals without a clinical form of psychosis. Future studies are required to better investigate the meaning of the association between cannabis use, psychotic-like experiences, and aberrant salience.
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http://dx.doi.org/10.1097/NMD.0000000000000849DOI Listing
July 2018

Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York.

Community Ment Health J 2018 07 17;54(5):562-570. Epub 2017 Nov 17.

Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA.

The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.
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http://dx.doi.org/10.1007/s10597-017-0196-6DOI Listing
July 2018

Oral versus long-acting injectable antipsychotics: hospitalisation rate of psychotic patients discharged from an Italian Psychiatric Unit.

Psychiatr Danub 2017 Sep;29(Suppl 3):333-340

Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Ellisse Building, 8th Floor, Sant' Andreadelle Fratte, 06132, Perugia, Italy.

Objective: The primary aim is to verify the efficacy of long-acting injectable (LAI) and oral antipsychotics (AP) in terms of re-hospitalisation rate of patients with psychotic disorders. The second aim is to evaluate socio-demographic and clinical differences in patients that were re-hospitalised after the index discharge compared to patients that were not re-hospitalised. Finally, socio-demographic and clinical differences of re-hospitalised patients that were prescribed at discharge with oral or LAI AP were analysed.

Methods: A retrospective observational study including all patients discharged with diagnosis of psychotic disorders from July 2011 to July 2013 was conducted. Patients discharged with LAI or with oral AP were included. Re-hospitalisations occurred during a follow-up period of 24 months after the index discharge were considered. Chi-square test or Student's t-test were used for comparisons. Odds ratios (OR) and 95% confidence intervals (CI) for the incidence of re-hospitalisation for LAI or oral AP were provided.

Results: No significant differences between LAI and oral AP in terms of re-hospitalisation rate in a 24-month period were found. Clinical and socio-demographic characteristics did not significantly differ between the groups.

Conclusions: LAI seemed to be similar to oral AP in terms of prevention of re-hospitalisation in psychotic patients.
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September 2017

Personality disorders features in a sample of women with perinatal depression in Perugia, Italy.

Psychiatr Danub 2017 Sep;29(Suppl 3):323-332

Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Ellisse Edificio A Piano 8, Loc. Sant'Andrea delle Fratte, 06156 Perugia, Italy,

Background: Antepartum depression (APD) and postpartum depression (PPD) are a significant public health problem. Aim of the study was to determine which personality disorders features could be found in women with APD and PPD compared to women without perinatal depression.

Subjects And Methods: The Edinburgh Postnatal Depression Scale and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were administered during peripartum to a sample of 54 women recruited at the Obstetrics and Gynaecology Unit, Perugia (Italy).

Results: Results were grouped according to the EPDS ranges 0-8 and ≥9, and to the MMPI-2 scores on each clinical scale. Women with APD had high scores on the MMPI-2 Hypomania, Cynicism, and Antisocial Practices scales; women with early onset PPD (detected in the first week after childbirth) had high scores on the Paranoia and Low Self-Esteem scales; women with late onset PPD (detected up to three months after childbirth), had high scores on the Fears, Obsessiveness, and Depression scales.

Conclusions: Based on the high scores of specific MMPI-2 scales, our study would suggest that: cluster B personality features may represent a vulnerability factor for APD; passive-aggressive personality features may be a vulnerability factor for early onset PPD; cluster C personality features may act as a vulnerability factor for late onset PPD.
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September 2017

Delusional sharing: a history focus-on and case report of folie à deux.

Riv Psichiatr 2017 Jul-Aug;52(4):168-171

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

Folie à deux (FAD) is a clinical condition that was first described by Lasègue and Falret in 19th century. They reported a rare condition where two or more people shared delusional ideas from a person to another. Nowadays a trace of this historical diagnosis and its theoretical framework, could be found on ICD-10 where FAD is translated in “Shared Psychotic Disorder”. Given the lack of literature and a well-defined set of symptoms it is hard to detect the clinical limits of FAD. Furthermore, the complex of comorbidities could lead to a misdiagnosis. In this paper we report a peculiar case of FAD with an historical focus trying to give a wider point of view and tools to recognize this unconventional psychiatric diagnosis.
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http://dx.doi.org/10.1708/2737.27910DOI Listing
June 2018
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