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Il litio è considerato il gold standard nel trattamento del disturbo bipolare (DB) e viene utilizzato come terapia di prima linea nella profilassi e nel trattamento della mania acuta e della depressione. Tuttavia, nonostante il litio sia universalmente accettato come standard di riferimento nel trattamento del DB, la sua diffusione nella pratica clinica risulta ancora limitata. Al fine di testare la consapevolezza sulle indicazioni di impiego del litio, sulle sue modalità di utilizzo clinico e sul monitoraggio dei principali effetti collaterali, è stata effettuata una survey tra gli psichiatri italiani con età inferiore a 40 anni. A tale survey è seguito un expert meeting nel corso del quale si è presa visione dei risultati della rilevazione, al fine di identificare le principali criticità riguardanti la gestione del farmaco e le possibili soluzioni. Nel presente lavoro si evidenzia come i giovani psichiatri italiani hanno presentato una buona consapevolezza riguardo all’impiego del litio nella pratica clinica. In particolare, è adeguata la conoscenza delle linee-guida riguardanti la sicurezza e l’attenzione verso strategie che possano migliorare l’aderenza a lungo termine.

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Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and - as for the previous versions - several criticisms raised. In particular, the persistence of the categorical approach to mental disorders represents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between "normality" and "pathology" is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient's psychopathological experiences.

Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and – as for the previous versions – several criticisms raised. In particular, the persistence of the categorical approach to mental disorders rep- resents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between “normality” and “pathology” is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient’s psychopathological experiences.

The discovery of benzodiazepines has represented a milestone in the history of pharmacological treatments and in relation to the management of anxiety, sleep and other psychiatric disorders. After several decades, these agents still represent one of the largest and most widely prescribed groups of medications, not only in the psychiatric clinical practice, but also in the whole medical field. Over the last decade, however, multiple concerns have been raised on the risks related to the prescription of benzodiazepines, for their addictive potential and for cognitive side-effects. Therefore, benzodiazepines are today considered as a double-edge sword, which should be carefully handled and preferentially prescribed by specialists (or at least under their supervision), after an adequate training. Unfortunately, this is not the case in many situations, and the need to improve training on benzodiazepines management has been recently emphasized.

Aim: the aim of the study is to evaluate the socio-demographic and clinical features with prognostic value in predicting evolution in severe OCD. Materials and methods: patients with a main diagnosis of OCD were recruited according to DSM-IV criteria. Socio-demographic and clinical features were assessed by mean of a semistructured interview and clinical rating scales (Y-BOCS, HAM-A, HAM-D and SCID-II). Two subgroups were compared according to the severity of symptoms (severe vs mild-moderate). Results: the total sample was made up of 450 OCD subjects aged 34.5±12.1, with a mean age of onset 22.3±9.1; 215 subjects (47.8%) were females. Patients with severe OCD (Y-BOCS ≥ 32) showed a more insidious onset and a more chronic course compared to patients with mildmoderate symptoms. Other predictors of increased OCD severity were washing and hoarding compulsions. Lastly, the severity of the obsessive-compulsive condition was higher when it was associated either with mood disorders or with Axis II disorders (particularly Cluster A). Discussion: our study shows a correlation between severe OCD and severity predictors such as functional impairment and mood disorders. Furthermore washing and hoarding symptoms, lifetime comorbity with mood disorders and Cluster A personality disorders seem to predict OCD severity

Today, it is well-known that the ‘pure’ forms of bipolar disorder (BD), e.g. those characterized only by alternating depressive and manic episodes, are quite rare, and that BD is more often associated with other psychiatric disorders or manifestations, among which anxiety disorders/symptoms. In patients with BD, symptoms and/or dis- turbances of anxiety have a primary role for both epidemiological and clinical aspects. Particular aspects of the relationship between anxiety symptoms/disorders and BD, some of which observed by classical authors in the last century, allow for a broader reading of this link, which goes beyond the simple comorbidity: anxiety disorders are the most frequent comorbid disorders for bipolar patients; anxiety symptoms/disorders tend to persist and assume a chronic course in bipolar patients; anxiety symptoms/dis- orders are early precursors of BD in offspring of BD subjects. Evidences exist, then, suggesting that anxiety is a core component or epiphenomenon of bipolar disorders. Moreover, comorbid anxiety disorders have a significant impact on the clinical presentation and prognosis of BD. The aim of this study was to explore the correlation be- tween anxiety and BD through a critical review of the recent literature, treating both conceptual and clinical questions.

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Serotonin reuptake inhibitors (SRIs) and/or cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). The study discuss whether: a) combining both treatments ab initio is more effective than either monotherapy alone; and b) a sequential treatment is effective both in responder and non responder patients.Have been carried out a search on Medline/PubMed database, selecting clinical randomized controlled studies in English. Have been examined 9 randomized controlled studies where combined treatment ab initio was compared to CBT alone, and 6 where combination treatment was compared to SRI alone. No controlled studies were found for sequential treatments in OCD. Have been then examined naturalistic studies, 2 including responder patients and 7 including non responder patients.Of the 9 studies, 7 didn't find any additional benefit of combining treatments as compared to CBT alone; in 1 study the combination strategy resulted more effective than CBT alone in children and adolescents, and in another in severely depressed adult patients with OCD. As compared to SRIs alone, combining treatments was not more effective in 4 studies, while in 2 studies it was more effective. All studies concerning sequential treatments found evidence of efficacy of this strategy.Combining ab initio CBT and SRI has not been found to be clearly superior of either therapy alone, except for patients with severe depression and for children and adolescents. On the contrary, a sequential strategy may be used successfully both to treat residual symptoms in responders and to determine clinical response in resistant patients.

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2002/2003 XV Ciclo 1969 Versione digitalizzata della tesi di dottorato cartacea.