Search

Abstract Background The aim of this study was to assess barriers and facilitators in the pathways toward specialist care for eating disorders (EDs). Methods Eleven ED services located in seven European countries recruited patients with an ED. Clinicians administered an adapted version of the World Health Organization “Encounter Form,” a standardized tool to assess the pathways to care. The unadjusted overall time needed to access the ED unit was described using the Kaplan–Meier curve. Results Four-hundred-nine patients were recruited. The median time between the onset of the current ED episode and the access to a specialized ED care was 2 years. Most of the participants did not directly access the specialist ED unit: primary “points of access” to care were mental health professionals and general practitioners. The involvement of different health professionals in the pathway, seeking help for general psychiatric symptoms, and lack of support from family members were associated with delayed access to ED units. Conclusions Educational programs aiming to promote early diagnosis and treatment for EDs should pay particular attention to general practitioners, in addition to mental health professionals, and family members to increase awareness of these illnesses and of their treatment initiation process.

Introduction There is a known association between the core psychopathological features of anorexia nervosa (AN) and sexual dysfunctions, to the point that the recovery of healthy sexuality could be considered a marker of recovery. However, no studies have evaluated the role of insecure attachment in moderating this recovery during treatment. Objectives To evaluate the role of insecure attachment as a possible moderator of the recovery of healthy sexuality in patients with AN treated with Enhanced Cognitive Behaviour Therapy (CBT-E). Methods A total of 65 patients with anorexia nervosa were treated with CBT-E in a multidisciplinary environment, after filling out self-administered questionnaires for the evaluation of general (SCL-90-R) and ED-specific psychopathology (EDE-Q), female sexuality (FSFI) and adult attachment style (ECR). The assessment was repeated after one (T1) and two years (T2). Results At baseline, all domains of sexual dysfunction were significantly predicted by avoidant attachment. A significant amelioration of both general and eating disorder-specific psychopathology and sexual dysfunctions was observed at all follow-up evaluations with respect to baseline levels. However, only 45% of remitted patients also showed a complete recovery of healthy sexuality: this subgroup reported significantly lower avoidance scores when compared to patients who only recovered from AN. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment. Conclusions This study highlighted the crucial role of avoidant attachment in the relationship between AN and sexual dysfunctions, underlining the importance of assessing adult attachment for a better characterization and treatment. Attachment-focused interventions may be beneficial for a full recovery. Disclosure No significant relationships.

Introduction Theory of Mind (ToM) is defined as the ability to understand mental states of other people. Recent studies explored its role in various psychopathological disorders, but evidence lacks on the relationship existing between specific psychopathological domains and ToM. Objectives We aimed to investigate the relationship between psychopathology of Anxiety Disorders (AD) and Theory of Mind. Methods We enrolled 35 patients admitted to the Psychiatric Unit of Careggi Hospital in Florence with diagnosis of AD. We administered them: Zung Anxiety Scale (ZSAS), Metacognition Questionnaire-30 (MCQ-30), and Reading the Mind in the Eyes (RMET). Pearson’s correlation was used to assess relationships between variables. Results A significant positive correlation was detected between RMET scores and ZSAS total scores (r=0.385, p=0.022), MCQ-30 Negative Beliefs about Uncontrollability and Danger subscale (MCQ-30-Neg, r=0.407, p=0.015), and MCQ-30 Cognitive Self-Consciousness subscale (MCQ-30-CSC, r=0.349, p=0.040). Correlations between the variables in the study and Reading the mind in the eyes total scores are shown. RMET total score r p MCQ-30-Neg 0.407 0.015 MCQ-30-CSC 0.349 0.040 MCQ-30 Positive beliefs about Worry 0.073 0.667 MCQ-30 Lack of Cognitive Confidence -0.245 0.155 MCQ-30 Need to Control Thoughts 0.311 0.069 ZSAS total scores 0.385 0.022 Conclusions Such preliminary data suggest a relationship between Theory of Mind and AD psychopathology. In particular, some dimensions of AD psychopathology seem to predict higher Theory of Mind levels. Disclosure No significant relationships.

Introduction It is proven that high levels of disgust contribute to implementing protective behaviors. Investigators also discovered that the emotion of disgust plays a central role in determining anxiety related to the contraction of COVID-19. Few data are available about the role of the contamination disgust, a specific disgust domain, in this relationship. Objectives The effect of contamination disgust on COVID-19-related anxiety was investigated. Methods 295 healthy subjects were enrolled through an online survey. They completed Disgust Scale-Revised (DS-R) and were asked to estimate their levels of Covid-19-related anxiety in 12 proposed situations. A total score was then calculated. An ANOVA model having Covid-19-related anxiety total score as dependent variable, and DS-R contamination disgust, age, and sex as predictors was estimated. Results The overall model was significant (F(3,291)=6.402, p

Introduction The high technical barrier to entry in the field of neuroimaging can hinder early insight from promising results and the development of evidence-based clinical practice. Objectives The working group focused on published literature in order to develop a new methodology in the analysis, visualization, and representation of fMRI data in the psychiatric setting. Methods Three valid and established measures were chosen, in order to achieve dimensionality reduction, stability and explainability of results, namely Regional-Homogeneity; fractional Amplitude of Low-Frequency Fluctuations; Eigenvector-Centrality. Each measure was color coded and individual images per subject compiled, averaging results by functional networks as described the FIND lab of the University of Stanford. 272 individual scans were processed (130 neurotypicals, 50 patients with Schizophrenia, 49 with Bipolar Disorder, 43 with ADHD). Results The discriminative power between clinical groups of the novel method was significant both by human eye, and later confirmation by statistical tests, and by computer vision algorithms (Convolutional Neural Networks). The precision-recall Area Under the Curve, dividing by 80/20 proportion between train and test sets, was >84.5% for each group. The group of patients with Bipolar Disorder showed a partial overlap with the group of patients suffering from Schizophrenia – by a dominance of Eigenvector-Centrality and Regional-Homogeneity, as well as a lower prevalence of fractional Amplitude of Low-Frequency Fluctuations, for both in comparison to controls. Conclusions The present study offers preliminary evidence for the adoption of i-ECO (integrated-Explainability through Color Coding) in fMRI analyses during rest in the Psychiatric field. Disclosure No significant relationships.

Introduction Theory of Mind is defined as the ability to understand mental states of other people, and is notoriously impaired in patients with Autism Spectrum Disorder. A growing body of evidence suggests an impairment of Theory of Mind in several other psychopathological disorders. However, only few studies have assessed Theory of Mind in patients with Anxiety Disorders (AD), addressing only patients with Social Anxiety Disorder. Objectives We aimed to investigate the differences in Theory of Mind between patients with AD and Healthy Controls (HC). Methods We enrolled 35 patients admitted in the Psychiatric Unit of Careggi with diagnosis of AD and 31 HC. We administered them: Zung Anxiety Scale (ZSAS), Empathy Quotient (EQ), Reading the Mind in the Eyes (RMET), and Faux Pas test (FP). A t-test for independent samples was performed to assess between-group differences. Results Zung total scores proved to be significantly higher in patients (t(60)=4.375, p

Abstract Background Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered. Methods 2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk. Results More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments. Conclusions Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.

Introduction The comorbidity between anxiety disorders (AD) and eating disorders (ED) has already been well discovered, and because of the link between disgust, food choice and rejection (which appear to be key factors of eating psychopathology), it can be suggested that these three aspects may be related. Accordingly, it can be hypothesized that individuals who express heightened levels of both disgust and eating concerns are at a higher risk to develop an AD. By contrast, disgust, as a negative emotion, influences ED symptoms through a greater level of anxiety. Objectives We aimed to investigate the psychopathological role of disgust and eating disorder symptoms in the development and maintenance of anxiety symptoms in patients with AD. Methods We enrolled 84 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders. We administered them: Zung Anxiety Scale (ZSAS), Disgust Propensity and Sensibility Scale-revised (DPSS-r) and Eating Disorders Examination Questionnaire (EDE-Q). Results A multiple regression model having ZSAS total as dependent variable, and EDE-Q total and DPSS disgust sensitivity subscale as independent variables explained 29% of ZSAS total variance (R²=0.290). The effect of EDE-Q total was positive, significant (β=0.331, t=2.631, p=0.011) and explained 11.9% of ZSAS total variance (pr²=0.119). The effect of DPSS disgust sensitivity was positive, significant (β=0.326, t=2.595, p=0.012) and explained 11.6% of ZSAS total variance (pr²=0.116) (Fig.1). Conclusions Such preliminary data suggest a possible role of feelings of disgust and eating disorder symptoms in development and maintenance of anxiety symptoms in patients with AD, making them a potential target for psychotherapy. Disclosure No significant relationships.

Introduction Several studies demonstrate that disgust, defined as a revulsion response aimed at distancing an individual from a potentially harmful or noxious stimulus, is linked to post-traumatic stress following sexual trauma even when accounting for associated fear and anxiety. One of the suggested mechanisms implicated in this association is a feeling of mental contamination. Recent neuroimaging studies demonstrated that exposure to contamination activates the insular cortex. In addition, disgust sensitivity correlates with the activation of the insular cortex. Objectives We aimed to investigate the psychopathological role of the emotion of disgust in the developement of anxiety symptoms in patient with an history of abuse. Methods We enrolled 84 patients admitted in Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders. We administered to them: Zung Anxiety Scale (ZSAS), Childhood Trauma Questionnaire (CTQ), Disgust Propensity and Sensitivity Scale-revised (DPSS-r). Results Results showed a significant mediation of the association between CTQ emotional abuse scores and total ZSAS scores via DPSS disgust sensitivity scores in patients with anxiety disorders (p=0.022). Total effect and indirect effect of emotional abuse on severity of anxiety symptoms were significant (total effect = 0.494; p=0.051, indirect effect: 0.256, p=0.022), while there was no significant direct effect from emotional abuse to anxiety symptoms in the total model (direct effect: 0.237, p=0.356). The model explained 18% of variance in anxiety symptomatology (R2=0.18). Conclusions Such preliminary data suggest a possible mediating role of disgust in development and maintenance of childhood abuse-related anxiety, making it a potential target for psychotherapy. Disclosure No significant relationships.

Introduction Amenorrhea is one of the most frequent and serious consequences of Anorexia Nervosa (AN). Resumption of menses (ROM) is considered an important goal and is associated with a better outcome. Objectives To investigate the role of age, Body Mass Index (BMI), diagnostic subtype (restrictive vs binge-purging), history of childhood abuse, duration of illness, psychopathology and sex hormones on ROM in AN. Methods 52 patients with AN and amenorrhea were enrolled at the start of treatment. Clinical parameters of interest were collected, and questionnaires were administered for the assessment of general (SCL-90-R) and specific (EDE-Q) psychopathology. Blood samples were taken to assess FSH, LH and estradiol levels. All patients were monitored regularly through psychiatric checkups until ROM, for up to four years. Results A total of 30 (57.7%) subjects recovered their menstrual cycle in the follow-up period (mean time: 18.7 ± 14.8 months). Recovery was more frequent in the binge-purging subtype than in the restrictive subtype (82.4% vs 48.6%, p=0.019), and was significantly associated with diagnostic crossover (odds ratio=10.0, p=0.032). Multivariate Cox regression showed an increased likelihood of menstrual recovery for binge-purging subtype (p=0.005) and for those reporting a history of childhood abuse (p=0.025). Early ROM was also associated with baseline SCL-90-R scores (p=0.002) and FSH (p=0.011), while a longer duration of illness (p=0.003) and EDE-Q scores (p=0.009) predicted a later recovery. Conclusions This study highlights the role of duration of illness, childhood abuse history and psychopathological characteristics in subjects with AN at the start of treatment in predicting ROM. Disclosure No significant relationships.

Transgender people represent a broad spectrum of individuals that transiently or persistently identify with a gender different from the one assigned at birth (APA, 2013). Transgender healthcare issues have become an increased matter of interest over the last years, as shown by the growth of publications on the subject and by the increase of referrals reported worldwide in all age groups. However, transgender people report encountering numerous obstacles in accessing and receiving appropriate health care with professionals being described as not properly trained on specific gender issues. Considering the diversity and complexity of the gender spectrum in the different age groups and in light of the recent changes in the formal psychiatric classification, mental health providers play a critical role in meeting the needs of gender non-conforming children, adolescents and adults, according to individualized paths. This course has the following aims: (1) learn the principles of assessment of gender incongruence in childhood, adolescence and adulthood; (2) address co-occurring psychopathology (if present); (3) identify different treatment paths according to age and individualized psychological and/or medical needs; (4) work in a multidisciplinary team in line with an integrated model.

Introduction Sexual dysfunction is common in eating disorders (EDs), but its relevance is often overlooked. Objectives To describe different ED clinical subgroups in terms of psychopathology, putative biological correlates, and consequences of dysregulated sexuality, focusing on the role of childhood trauma. Methods Healthy controls (n=60), binge-purging (n=38), and restricting patients (n=24) were compared (age- and BMI-adjusted ANOVA; Bonferroni post-hoc tests), using total scores of Eating Disorder Examination Questionnaire (EDE-Q), Emotional Eating Scale (EES), SCL-90-R Global Severity Index (GSI), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), Female Sexual Functioning Index (FSFI), Hypersexual Behaviour Inventory (HBI), and patients’ hormonal profiles (gonadal and pituitary hormones, ghrelin). Self-reported voluntary termination of pregnancy (VTP) and promiscuous sexual activity were recorded. For ED patients (N=62), regression analyses between significant variables and HBI were carried, applying moderation models for different CTQ scores. Results Table 1 outlines significant between-group comparisons (°: different from controls; *: different from restricting patients; p

Introduction The COVID-19 epidemic that spread in Italy in the early 2020, together with the general lockdown, are high-risk events for vulnerable populations who need high levels of assistance, such as patients with eating disorders (EDs). Objectives To evaluate the impact of the COVID-19 epidemic and lockdown on subjects suffering from EDs, considering previous vulnerabilities. Methods 74 patients with anorexia nervosa (AN) or bulimia nervosa (BN) already on treatment and 97 healthy controls were evaluated between November 2019/January 2020 (T1), and again in April 2020, 6 weeks after the start of lockdown (T2). Patients were also evaluated at baseline (T0). At each assessment, general and ED psychopathology (SCL-90-R and EDE-Q) were assessed. Childhood abuse experiences (CTQ) and adult attachment (ECR-R) were investigated at T1, and post-traumatic stress symptoms (IES-R) at T2. Results Patients reported a significant increase in compensatory exercise; in addition, patients with BN and those who achieved remission at T1 showed a significant exacerbation of binge-eating. The longitudinal trend (T1-T2) of psychopathology was not different between patients and controls, however the expected benefit from treatment on ED psychopathology was significant only for AN, while no changes were noted in BN. Patients with BN reported more severe post-traumatic stress symptoms than AN and controls, and these symptoms correlated positively with prior traumatic experiences and an insecure attachment style. Conclusions The COVID-19 epidemic and lockdown had a significant impact on subjects with eating disorders, both by interfering with the treatment process and in terms of post-traumatic stress symptoms. Disclosure No significant relationships.

Introduction The coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measures, such as “lockdown” and “social distancing”, have had important consequences on people’s mental and physical health. Objectives We aimed to study the effect of social isolation and subsequent re- exposure and eventual changes in general and ED-specific psychopathology in people with Eating Disorders (EDs). Methods Three-hundred twelve Italian people with EDs (179 Anorexia Nervosa, 83 Bulimia Nervosa, 48 Binge Eating Disorder and 22 Other Specific Feeding Eating Disorder) were asked to fill-in an online survey to explore several dimensions such as: anxiety, depression, panic, insomnia, suicide ideation, stress, post-traumatic stress and obsessive-compulsive symptoms. Differences in ED specific and general symptoms among the 3 investigated time periods (before, during and after the end of lockdown) were assessed with a one-way ANOVA with repeated measures. Subsequently, ED diagnosis was introduced as covariate in the analysis in order to investigate the possible contribution on psychopathological changes. Results ED core symptoms increased during the lockdown but most of them returned to pre-COVID19 levels at re-opening. The severity of general psychopathology also increased during the lockdown and persisted high in the following phase, except for depression and suicide ideation. None of this symptoms was affected by ED diagnosis, participants’age and illness duration. Conclusions People with EDs showed worsening of both general and specific psychopathology; moreover, changes in general psychopathology persisted in the re-opening period suggesting a higher stress vulnerability in this kind of patients. Disclosure No significant relationships. Keyword COVID19 and Eating Disorders

Introduction In the first months of 2020 the COVID-19 epidemic spread in Italy, and the Italian government implemented a general lockdown. These events are at high risk for psychiatric symptoms in the general population, including anxiety/depression and post-traumatic stress symptoms (PTSS). Objectives To characterize the psychopathological correlates of the spread of COVID-19 and lockdown in a sample of subjects from the Italian population, with a before-after follow-up. Methods Six weeks after the lockdown, 671 subjects aged 18-60 years completed the Brief Symptom Inventory and Impact of Event Scale-Revised, for the evaluation of psychopathology and PTSS respectively. Environmental factors and subjectively-perceived deteriorations related to COVID-19 were also investigated. Pre-COVID-19 data on psychopathology, collected in December 2019/January 2020, were available for 130 subjects and were used for longitudinal analyses. Results With respect to males, female subjects more frequently reported deteriorations of relations (21.5% vs 10.9%), household arguments (26.0% vs 12.6%), sleep quality (47.6% vs 26.6%), episodes of overeating (22.5% vs 12.5%), worries for oneself (19% vs 8.9%) and for loved ones (55.7% vs 36.5%). These changes were associated with increased psychopathology, PTSS, and numerous environmental conditions, including significant economic damage from COVID-19/lockdown. Longitudinal analyses showed an increase in phobic anxiety in the whole sample, and in depression for female subjects only, following the spread of COVID-19. Pre-existing psychopathology was a significant predictor of PTSS. Conclusions COVID-19 epidemic and lockdown have a high impact on psychopathology and PTSS. Female subjects and those with pre-existing psychopathology were found to be more vulnerable and may need additional support. Disclosure No significant relationships.

Introduction There is a growing literature suggesting disgust plays a major role in religiosity. Asceticism is a personality trait characterized by abstinence from sensual pleasures, often for the purpose of pursuing spiritual goals. Since few studies suggested that higher disgust levels may lead to greater fear of sin, contamination disgust may serve as effective mechanisms for inflated scrupulosity. Objectives We aimed to investigate the role of contamination disgust on a specific religious belief in two clinical groups: eating disorders and anxiety disorders. Methods We enrolled 84 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders (AD) and Eating Disorders (ED). We administered them: Disgust Scale Revised (DS-R) and Eating Disorders Inventory 2 (EDI-2) Results A t-test for independent samples between AD patients and ED patients showed no difference in DS-R contamination disgust subscale (t=1.437, p=0.153), while significantly higher EDI-2 asceticism scores were detected in ED patients (t=2.452, p=0.010). An ANCOVA model having EDI2 Asceticism subscale as dependent variable, and DS contamination disgust subscale, diagnosis, and interaction between contamination disgust and diagnosis was estimated. The overall model was significant (F(1,136)=4.854, p=0.003) and accounted for 9.7% of variance of EDI2 Asceticism subscale (R2=0.097). The effect of contamination disgust was positive and significant (β=0.302, t=2.781, p=0.006), and accounted for 5.4% of variance of EDI2 Asceticism (partial η2=0.054). No effect was detected for diagnosis (F(1,136)=0.012, p=0.912) or interaction between contamination disgust and diagnosis (F(1,136)=1.346, p=0.248). Conclusions Contamination disgust may have a trans-diagnostic effect on asceticism and may be a possible driver for specific religious behaviors. Disclosure No significant relationships.