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Gender identity disorder is a rare disorder of uncertain etiology (1:30,000 M to F; 1:100,000 F to M). The emphasis of body shape in this disorder suggests that there may be an association with anorexia nervosa. Previous research suggests that eating disorders are related to homosexuality in men although links with female sexual orientation is less clear. This report describes the case of an adolescent 19-year-old biological female transgender patient presented to a Mental Health Center in Trieste. Diagnostically, this patients presents with prominent restricting, purging anorexia that was wed by the desire to obtain and then maintain an idealized prototypal masculine shape. The failure of the realization of this project involves in a self-distructive conduct. The case offers an important opportunity to explore the comorbidity about eating disorders and gender identity disorder. The patient completed this measures: a background measure of his sexual orientation, the Millon Clinical Multiaxial Inventory III (MCMI-III), the Minnesota multiphasic personality inventory (MMPI-2), the Bem Sex Role Inventory, the Eating Disorder Inventory and the Eating Attitude test. This report suggests that the divergence of body image psychopathology may be impacted by gender role orientation, which is consistent with a developing body of research. [ABSTRACT FROM AUTHOR]

Introduction From Charcot studies on Hysteria to recent analysis of the World Health Organization (WHO), mental illness seems to be a matter in which sex and gender play a non-negligible role. In the WHO data on neuropsychiatric disorders, women are prevalent in almost all types of disorder. Objective Primary prevention can only refer to the recognition of social, educational, relational, environmental factors. Few studies have been conducted on the socio-demographic characteristics of the female population relating to psychiatric services. Aims The aims of our research are to evaluate both the demographic and clinical characteristics of women related to mental health services in Trieste and their adherence to rehabilitation programs. Methods The study was conducted by collecting the personal data of clinical users women from the four mental health centers in Trieste and the psychiatric service for diagnosis and treatment (SPDC). In the year 2014, the user attending the mental health department are 4952. Results Data analysis showed that women in charge at the Department of Mental Health is 2731, representing 55% of all users. The predominant age group is between 46 and 65 years (between 17% and 23% for each CSM). The number of women taking part at rehabilitation activities is of 1332 (49%). Conclusions It is considered necessary that the services for mental health sponsor prevention, treatment and rehabilitation around the specific needs of women. [ABSTRACT FROM AUTHOR]

Introduction The rate of non fatal self-injurious behaviour in young people has increase in recent years. Non fatal self-injurious behaviour such as cutting oneself and abuse of substance is often performed without suicidal intent to cope with emotional distress although it is well known to have a close association with future suicidal behaviour. Objectives Evaluating people under 29's suicidal behaviours' rates. Aims Monitoring developments in not lethal self injurious behaviour in the population of adolescents and young adults in Trieste to identify strategies that will guide the prevention of suicidal behaviour in this age group. Methods Retrospective study based on verbal access to emergency, extracts under the headings “self-harm” and “poisoning” during period 2000-2007. We considered as variables the calculation of rates for the age groups 15-19 and 20-29 years, mode of self-injurious act coded according to the parameters of the ICD-10. Results The average rate for the age group 15-19 years was found to be 0.5 cases per 100,000 inhabitants, while for ages 20-29 was found to be 1.3 cases per 100,000 inhabitants. There wasn't a significant difference between the two genders. The methods most frequently adopted were found to be voluntary intoxication and cutting. Conclusions To counter the fragility and risk of self-harm and suicide in adolescents and young adults, our Local Health Company launched in 2014 a dedicated website. The site provides information on the types of conditions that may affect the target population and the self-destructive behaviors. [ABSTRACT FROM AUTHOR]

Introduction A review of the literature shows that the self-injurious behaviours are more common among females, and suicides among male subjects. A significant difference between the two genders is also reflected in the choice of means used to commit the act of self-injuring, considering the male gender predilection for more violent means. Some recent studies indicate trends that deviate from the above data in the literature or indicate a tendency to an attenuation of these differences. Objectives Reasons for engaging in self-harm behaviours include to regulate emotion and to elicit attention. Correlates of these practices include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Aims: the aim of this study is to evaluate the gender difference in self-injurious behaviour. Methods Our retrospective study was conducted making a comparison between a period of time before and after the start of an articulated program of prevention of suicidal behaviors in Trieste, from 1983 to 2007. Results In the '80, the self-injurious behavior were more common among males; after 2000 years this difference has continuously attenuated. This trend is in contrast with findings in the international literature. Even the repeated acts of self-harm were more common among males. Regarding the data on suicides, they were more frequent in male subjects, and this fact has remained stable over time, in accordance with international data. Conclusions More studies are necessary to evaluate gender difference in self-injurious behaviour. [ABSTRACT FROM AUTHOR]

Introduction The suicidal behaviours constitute a significant problem in terms of public health, thus a major goal of the WHO is to reduce these behaviours. In the '80s suicide rates and suicide attempts in the Trieste were the highest in Italy, comparable with those of Central Europe. Since the '90s a project was launched to prevent suicidal behaviour and suicide rates and non-lethal self-harm gestures have plummeted. Objectives We study the sociodemographic variables of this phenomenon. Aims The aim of our study is to monitor the performance of non-lethal self-harm over time and identify evidences to implement prevention strategies Methods We conducted retrospective study in the period 01.01.2000- 31.12.2007. We analyzed the records of hospital emergency rooms in Trieste, screened according to the keywords that indicate the diagnosis of access “self-harm” and “voluntary intoxication”. Socio-demographic variables were stratified by age and gender. Outcome variables were evaluated. Data were compared with those of a study conducted from 1993 to 1990. Results The study showed a mean of 85/100,000 inhabitants. The methods most frequently used were drug intoxication and cutting. There was a reduction in hospitalisations rates and an increased number of appointments in the Mental Health Department by the subjects with a suicide attempt history. Conclusions The rates of non-lethal self-harm in the period considered decreased compared to the '80s, while the average age of those who commit the act increased. These data can be used to enhance the primary and secondary prevention strategies. [ABSTRACT FROM AUTHOR]

Purpose: This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods., Methods: Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs., Results: Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome., Conclusions: SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI., Level of Evidence: III, well-designed cohort., (© 2022. The Author(s).)

This study explored views of mental health services (MHS) professionals regarding positive changes in service practices and organizations, and staff-user relationships after one year of COVID-19 in Italy. Professionals from a community-oriented MHS completed online the Questionnaire on MHS Transformations during the COVID-19 pandemic, a 30-item tool developed by a participatory approach and validated. Of the 184 participants, 91.8% felt it was "true/definitely true" that during the pandemic they had informed users on procedures to reduce contagion risks, and 82.1% stated that they had increased telephone contact with users. Sixty-nine percent of professionals reported that staff revised treatment plans according to new needs of care and 78.6% stated that they had been able to mediate between user needs and safe working procedures. Moreover, 79.4% of respondents stated that they had rediscovered the importance of gestures and habits, and 65% that they had gained strength among colleagues to face fear. Fifty-four percent of participants admitted that they had discovered unexpected personal resources in users. Overall, 59.6% of participants stated that they found some positives in the COVID-19 experience. Perceived positive changes was greater among professionals from community facilities vs. those from hospital and residential facilities. In community-oriented MHS, the pandemic offered an opportunity to change practices and rethink the meaning of relationships between people. This data may be useful in generating a more balanced understanding of COVID-19's impact on MHS and for MHS planning in the pandemic era., Competing Interests: Conflicts of interestNone., (© The Author(s) 2022.)

Background: Few studies have investigated how physical, mental and sexual function are associated with each other in operated transgender women (oTW)., Aim: To provide information on the physical, mental and sexual health of oTW in comparison with a group of cisgender women (cisW)., Methods: An age-matched control study was carried out, recruiting 125 oTW in 7 national referral centers and 80 volunteer women. Beck Depression Inventory Primary Care (BDI-PC), General Health Survey (SF-36), Female Sexual Function Index (FSFI) and operated Male to Female Sexual Function Index (oMtFSI) questionnaires were web-based administered. Data included: age, area of origin, educational level, sexual orientation, years since surgery and hormone therapy., Outcomes: T-test was applied to inspect mean score differences between oTW and cisW, in mental, sexual and physical health; simple correlations and multiple regression analysis revealed how mental, sexual and physical health were concurrently associated in the two groups RESULTS: Response rate 60% (52% oTW, 71% cisW). oTW mean age 38.5 years (SD = 9.3), cisW 37.7 years (SD = 11.5). Both cisW and oTW reported average values in the range of mental, physical and sexual health. Statistical comparisons revealed no significant group differences in mental and physical health. oTW who referred a worse sexual function also reported worse overall mental well-being and higher levels of depressive symptoms. FSFI scores were negatively associated with years since surgery, but not with age. Multiple regression analysis showed that FSFI Pain accounted for a significant unique variance proportion of risk of depression in oTW. FSFI Sexual Pain was the strongest estimator of inter-individual differences in BDI-PC among oTW (P < .01)., Clinical Implications: No significant differences in the levels of depressive symptoms, physical and mental well- being were found in oTW and cis-W. The relation between depressive symptoms and sexual function in oTW is stronger than in cisW, and sexual pain substantially predicts risk of depression in oTW., Strengths & Limitations: The evaluation of outcomes using validated questionnaires and the relatively large sample size. The convenience control group reported mental, physical and sexual health levels within the range of Italian normative data. Since this is a cross-sectional study, we must be careful in drawing conclusions from our results., Conclusions: Sexual pain and lubrication difficulties are the main causes of worse sexual function in oTW, highlighting the importance of perioperative counseling to make surgical expectations realistic and to educate to a proper neovagina management. Vedovo F, Di Blas L, Aretusi F, et al. Physical, Mental and Sexual Health Among Transgender Women. A comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network. J Sex Med Rev 2021;18:982-989., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Individual Health Budget (IHB) is an intervention for recovery in mental health services, providing personalized care for subjects with severe disorders and complex needs. Little is known on its effectiveness and on the criteria for its delivery., Methods: A total of 67 IHB beneficiaries and 61 comparators were recruited among service users of the Mental Health Department of the Trieste Healthcare Agency, Italy. Data included sociodemographic and clinical variables, type of IHB, and Health of the Nation Outcome Scale (HoNOS) scores., Results: A comparison between groups showed significant differences in several socioeconomic and clinical characteristics. Multivariate logistic regression showed that IHB was positively associated to the 20-49 age group, single status, unemployment, low family support, cohabitation with relatives or friends, diagnosis of personality disorder, and a higher number of hospitalizations. The IHB group was at a higher risk of severe problems related to aggressive or agitated behaviors (OR = 1.4), hallucinations and delusions (OR = 1.5), and impairment in everyday life activities (OR = 2.1)., Conclusions: IHB was used in patients with severe clinical and social problems. More resources, however, may be aimed at the working and social axes. More research is needed to better assess clinical and social outcomes of IHB and to adjust their intensity in a longitudinal perspective in order to enhance cost-effectiveness.

Introduction: The aim of this study was to carry out a 2-year follow-up of refugees in a camp in Burkina Faso who had been interviewed previously. We also aimed to verify whether the general conditions in which they lived (e.g., protection by international organizations and the conclusion of negotiations and new hope of returning to Mali and reunification with surviving family members) would affect their mental health state., Methods: This is a cross-sectional study repeated over time on a cohort of refugees. People living in the Subgandé camp who had participated in the first survey in 2012 were identified using informational chains and approached for follow-up. Those who agreed were interviewed using the Short Screening Scale for post-traumatic stress disorder (PTSD) and the K6 scale, French versions, to measure general psychopathology and the level of impairment., Results: The second survey shows a dramatic decrease in psychopathological symptoms (positivity at K6 scale). Improvement was also conspicuous in the frequency of people with stress symptoms (positivity at Short Screening Scale for PTSD and simultaneous positivity to K6 scale). The frequency of people screened positive at the Short Screening Scale for PTSD had also decreased, but the level of improvement was not pronounced., Conclusion: Our findings confirm that when physical conditions improve, psychological symptoms can also improve. Although in the studied sample psychological factors, such as the hope of returning to their own land and thus the possibility of maintaining ethnic cohesion, may have played a role, future research carried out with a proper methodology and sufficient resources to identify protective factors is needed.

Purpose: Although community mental health services aim to support patients' autonomy and independence, they have repeatedly been criticised for making patients dependent. Yet, it remains often unclear what exactly is meant with dependency in this context. This review aimed to identify the meaning of the term dependency on community services in the literature., Methods: A systematic search and conceptual review of papers where dependency is used in the context of community mental health services. Narrative synthesis was used to identify thematic concepts linked to dependency in these settings., Results: Fifteen papers met the inclusion criteria. The analysis identified five different concepts of dependency on community mental health services: dislocation from the outside world; inflexibility and lack of freedom; obligation as resentment or appreciation; living with or without meaningful activities; and security., Conclusions: The findings suggest that, distinct from the exclusively negative connotation of the term dependency in a conventional medical context, dependency on community mental health services contains both negative and positive aspects. The different aspects might guide the future evaluation of the care provided in such services.

Background: Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders., Methods: Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003-2013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders., Results: The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003-2013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death., Conclusions: Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not show a significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: The use of synthetic cannabimimetics (SC; "spice" drugs) is increasing, especially among teenagers and young adults. In parallel with this, the number of studies describing intoxication episodes associated with psychotic symptoms in SC users is growing. We present both a systematic review of the related literature and a case report, which seems to highlight the existence of a possible association between SC use and psychosis., Methods: Some 223 relevant studies were here identified and reviewed. Out of these, 120 full text articles were assessed for eligibility, and 41 were finally included in the systematic review., Results: According to the available data from the studies here identified, SC's average age of users was 22.97 years, and the male/female ratio was 3.16:1. SC compounds most often reported in studies using biological specimen analysis were JWH-018, JWH-073, JWH-122, CP-47,497, and JWH-250. Mounting evidence seemed to suggest that psychotic symptoms such as hallucinations and delusions may occur in acute/chronic SC users., Conclusions: Although a clear causal link may not be here identified, the available evidence suggests that SC can trigger the onset of acute psychosis in vulnerable individuals and/or the exacerbation of psychotic episodes in those with a previous psychiatric history., (Copyright © 2013 John Wiley & Sons, Ltd.)

The primary aim of this study was to assess the level of satisfaction with 3 types of formal care systems of the elderly: (1) a day care center, (2) a nursing home, and (3) telecare service in a group of oldest frail elderly, and to describe the characteristics of the population using the services. The study involved a population of 162 oldest elderly using 3 different types of formal care services. Study participants were asked to complete a questionnaire, investigating socio-demographic characteristics and degree of overall satisfaction with the service, as well as eliciting possible suggestions for improvement. In our study, nearly all subjects using the telecare service were satisfied or very satisfied (98.5%), as compared to 75.3% of those residing in a nursing home, and 76.5% of those attending the day care center. This result confirms the findings of previous studies on elderly subjects satisfaction with telecare services. Telecare, therefore, seems to be the service achieving the greatest levels of satisfaction, a service that can also be used by low-income subjects, by whom it is also perceived as a source of social support.

Background: The lack of compliance is associated with an increased risk of hospitalization and switching or augmentation of therapy when compared with being compliant. A synergy of drug therapy and psychosocial interventions can give more benefits in treatment., Methods: A perspective study was conducted on 150 patients with schizophrenia over 15 centers in Italy. The experimental group was treated with drug therapy, traditional psychosocial and psychoeducation for the patients and their families, while the control group received traditional psychosocial and drug intervention over 1 year., Results: The experimental group showed a significant statistical improvement (p < 0,05) in almost all the scales that have been assessed (BPRS, SAPS, SANS, SIMPSON-ANGUS SCALE, LANCASHIRE QL SCALE). Significant was the reduction of the number of hospitalizations and of days of hospital stay., Conclusion: As it is shown in international literature, psychoeducational intervention with schizophrenic patients and their families can reduce the occurrence of relapse.