Search

Background and Aim: International guidelines indicate pharmacological therapy and cognitive-behavioral therapy (CBT) as gold standard treatments for obsessive-compulsive disorder (OCD). However, up to 40% patients do not fully respond to CBT, thus manifesting persistent symptomatology. Empirical research reported brief strategic therapy (BST) as a potential treatment for OCD. The aim of the present study is to evaluate the efficacy of BST in treating OCD and to identify the clinical characteristics associated to response., Methods: BST protocol was administered to patients with OCD. During a 24-weeks observational phase, the following scales have been administered at the baseline and every 4 weeks: Yale Brown Obsessive-Compulsive scale (Y-BOCS), Clinical Global Impression, Global Assessment of Functioning, Quality of Life Index, Medical Outcomes Study Short Form 12-item, Clinical Outcomes in Routine Evaluation-Outcome Measure, Generalized Anxiety Disorder Scale, Patient Health Questionnaire - 9 and Somatic Symptom Scale-8., Results: eight patients completed the treatment and a subgroup of five patients obtained clinical remission, defined as Y-BOCS total score < 25. The repeated measures ANOVA performed showed a significant decreased of the Y-BOCS total scores (p<.001). Comparisons between the two subgroups (remitters vs. non-remitters) highlighted some potential baseline characteristics associated with remission: i.e., higher mean level of anxiety, quality of life, physical health, and lower mean level of somatic symptoms and lower prevalence of personality disorders comorbidity., Conclusions: BST could be a useful therapeutic strategy in treating OCD patients. Further studies with larger samples and with long-term follow-up are needed to assess the post-treatment maintenance of clinical effects.

Background: The new 2019 coronavirus disease (COVID-19) outbreak forced mental health providers to overcome their general reluctance about telematic assistance, shifting from a face-to-face approach to online therapy to promote continuity of care for psychiatric patients., Methods: An ad-hoc web-based survey questionnaire assessing the impact of the COVID-19 pandemic on therapeutic setting in Mental Health Services was sent via email from March 15, 2021 to June 15, 2021 to mental health providers in Genova, Italy. The survey was anonymous and a free Google Forms® software was used., Results: Two hundred nineteen mental health providers completed the survey, and the overall response rate (ORR) was 65%. During the COVID-19 pandemic period, the continuity of care was mainly guaranteed using electronic devices. Psychologists reported a higher availability of video call assistance service to guarantee continuity of care for psychiatric patients compared to psychiatrists and psychotherapists (p<0,001). Psychiatrists reported the lowest degree of satisfaction about this new telematic approach (p<0,01), while psychologists and to a lesser extent psychotherapists speculated to use it even in non-pandemic times (p=0,02)., Conclusions: COVID-19 pandemic creates an opportunity to overcome normative, technological and cultural barriers to the use of online psychotherapy, showing the importance of adapting the therapeutic setting to both collective and individual needs. Despite initial concerns about its effectiveness and efficacy, a general degree of satisfaction was expressed by the majority of the mental health providers. Further efforts will be needed to enhance this new way of working and to train therapists with particular regard to those employed in the public health system.

The direct and indirect stressful effects of COVID-19 lockdown measures adopted to restrict population movements to help curb the epidemic impacted on people's daily lives. Biella is a small Northern Italy province, historically characterized by the presence of an important and once flourishing textile industry. For decades this province has had suicide rates higher than the Piedmonts and Italian average. In two most recent decades a positive correlation between financial stressors, 2008 economic crisis related, and suicide has been found. As the current economic crisis COVID-19 related is expected to exacerbate again the vulnerability to suicide of this province, during the first lockdown the Crisis Center for Suicide Prevention of Biella set up a telephone counselling service. We aimed to evaluate whether it represented a suitable and useful tool for suicidal crisis prevention. Each phone intervention consisted of four phases: (i) psychoeducation, (ii) emotional stabilization, (iii) personal resources identification/reinforcement, (iv) session ending. This service provided a rapid therapeutic response to urgent requests for care, psychological support, and reassurance. It was able to mitigate stress and reinforce resilience in particularly vulnerable populations. The most innovative element of this project was that it proposed interventions for the emotional stabilization, something that is usually used in face-to-face sessions. Using the right protocols, it proved to offer continuity care and reduce pressure on hospital emergency departments while delivering good outcomes and patient satisfaction. Therefore, the COVID-19 pandemic provided an opportunity to overcome normative, technological, and cultural barriers regarding the use of remote healthcare services.

Suicide risk and resilience strategies during the different phases of the COVID-19 pandemic are of great interest to researchers. At the pandemic onset, a dramatic suicides exacerbation was feared. Some authoritative authors warned the scientific and clinical community about this risk by pointing out that especially psychiatric, psychological, and social factors could interact with each other to create a vicious cycle. While worldwide case-reports and studies conducted at emergency departments did indeed find an increase in suicidal behavior, recent systematic reviews, meta-analyses, and time-series analyses could not confirm this for the first COVID-19 wave. Instead, it appears that the increased suicide risk outlasted the acute phase of the pandemic and thus affected people more during the pandemic following phases. One possible reason for this phenomenon may be a persistent state of insecurity regarding the economic crisis evolution with serious financial stressors in terms of income decrease, unemployment, repaying debts difficulty, home loss, one's social status derive, social hierarchy drop, and poverty. During the COVID-19 first wave, with particular regard to vulnerable populations, one of the postulated theories unifying different risk factors under a single frame was the "Interpersonal Theory of Suicide". Conversely, the "Interpersonal Trust" theory emerged as a protective factor even during an economic crisis. In a possible mirroring of the two theories, it seems to be feasible to find common themes between them and, above all, to gain relevant insights to devise effective prevention and supportive strategies for dealing with suicide risk challenges that COVID-19 will continue to pose in the foreseeable future. (www.actabiomedica.it).

A well-known insidious obstacle for patients with mental illness is stigma, linked to feelings of incomprehensibility, incurability, and dangerousness. The COVID-19 pandemic represented a relevant additional barrier for these patients, which contributed to their marginalization, quality of life reduction and diminished treatments feasibility. As part of a cross-sectional multidisciplinary project conducted in the psychiatric service of Biella, a northern Italy province, preliminary data were collected by frontline clinicians during the COVID-19 first wave regarding the vicious cycle that may have been created between stigma and psychiatric patients in COVID-19 time. Therefore, we tried to frame the observed changes not in the dual literature paradigms stigma-mental illness or stigma-social consequences in COVID-19 time, but in the mental illness-stigma-COVID-19 three-way paradigm. The protection of this vulnerable segment of population, including a rapid access to COVID-19 vaccination, needs to be recognized as a real public health priority. The role of mental health services in providing information and activating supportive interventions for patients with mental illness is also crucial. Particularly, a multidisciplinary therapeutic team including mental health providers, general practitioners, hospital physicians, and social services would be needed to ensure adequate networks and cares continuity. Actions to contrast stigma can be arduous and exhausting because they must counteract the gravitational pull of customs, prejudices, and ingrained cultural beliefs, and may therefore appear to be moving in an "unnatural" direction, like the water in Escher's lithograph entitled "Waterfall". Nevertheless, there is no less strenuous way to go against the grain.

In the last two decades the awareness of depression as a public health issue has increased and the literature has flourished towards its primary and secondary prevention. Whereas timely targeting of depression risk factors is a frontier towards reducing the incidence of the disorder, nowadays the early diagnosis is of primary importance. Screening depressive disorders is paramount, since there are several types of depression. Besides, early diagnosis would improve the outcome of treatment, reduce the frequency of relapses and generally lead to higher levels of quality of life. We highlight the feasibility of depression screening in primary care and the need of a comprehensive public health approach.

In March 2020, when the Government imposed nation-wide lockdown measures to contrast the COVID-19 outbreak, the life of Italians suddenly changed. In order to evaluate the impact of lockdown on lifestyle habits and behavioral risk factors of the general adult population in Italy, we set up the Lost in Italy (LOckdown and lifeSTyles IN ITALY) project. Within this project, the online panel of Doxa was used to conduct a web-based cross-sectional study during the first phase of the lockdown, on a large representative sample of adults aged 18-74 years (N=6003). The self-administered questionnaire included information on lifestyle habits and perceived physical and mental health, through the use of validated scales. As we are working within the Lost in Italy project, we got two additional grants to further research on the medium-term impact of lockdown, a topic of great interest and with anticipated large socio-economic and public health implications. In details: we obtained by the AXA Research Fund support to evaluate the impact of COVID-19 lockdown on physical, mental, and social wellbeing of elderly and fragile populations in the Lombardy region, the area most heavily hit by the pandemic in the country. Moreover, as a fruitful integration, we obtained support by the Directorate General for Welfare of the region to assess health services delivery and access to healthcare in the same study population, combining an analysis of administrative databases with an economic analysis. We are confident that the solid background of our partners, the multi-disciplinary competencies they bring, together with appropriate funding and access to rich data sources will allow us to fulfill our research objectives.

Background and Aim of the Work: To reflect on content, trends and quality of scientific publishing on COVID-19. In particular, to report on the systematic screening, quantitative assessment and critical appraisal of the first 10,000 scientific papers published on COVID-19 and to compare how scientific outputs matched identified research priorities and public health needs., Methods: A comprehensive research strategy was developed to systematically retrieve on a daily basis all studies published on COVID-19. From included studies we extracted: bibliometric parameters, country of studies' implementation and study design. We assigned papers to 25 a priori defined COVID-19-related topics and we described scientific outputs in relation to countries' academic publishing ranking, as well as COVID-19 burden., Results: 10,000 scientific articles were published on COVID-19 between 20th January and 7th May 2020,  accounting for 2.3% of total scientific production over the study period. One third (33%) focused on COVID-19 clinical management, with little adherence to identified research priorities.   Over sixty per cent of papers were opinion pieces not reporting original data. Papers were published on 1881 different journals but with half of scientific production included in 8% of journals. The US accounted for one fourth of total scientific production, followed by China (22.2%) and Italy (9%)., Conclusions: Never before in the history of academic publishing such a great volume of research focused on a single topic, this being likely to introduce major changes in the way science is produced and communicated, at the risk of  bringing it far from its ultimate aim: informing clinical and public health practice and decision making.

Background: Since the World Health Organization declared the new 2019 coronavirus disease (Covid-19) outbreak first a Public Health Emergency of International Concern and then a pandemic, Italy held more than 195.350 cases and 26.380 deaths. Working in the frontline with suspected Covid-19 infection patients, general practitioners (GPs) are daily under both physical and psychological pressure.  Methods: A web-based cross-sectional survey was carried out on italian GPs working in Genoa (Italy), to assess the impact of Covid-19 pandemic on mental health. The survey was anonymous and a free Google Forms® software was used., Results: One hundred thirty-one GPs completed the survey. Compared to GPs with absent or mild depressive symptoms (PHQ-9 < 10), GPs reporting moderate to severe depressive symptoms (N=30, 22.9%; PHQ-9 ≥ 10) reported more helplessness (96.7% vs. 79.2%, p=.025), spent more than three hours searching for COVID-19 information (43.3% vs. 19.8%, p=.024), perceived less adequate personal protective equipment (PPE) (6.7% vs. 23.8%, p=.049) and visited more COVID-19 infected patients (16.63 ± 27.30 vs. 9.52 ± 11.75, p=.041). Moreover, PHQ-9 ≥ 10 GPs reported a significant higher severity for both anxiety and insomnia (13.43 ± 4.96 vs. 4.88 ± 3.53 and 11.60 ± 5.53 vs. 4.84 ± 3.81, respectively; p<.001), and a worse quality of life in both mental (34.60 ± 7.45 vs. 46.01 ± 7.83, p<.001) and physical (43.50 ± 9.37 vs. 52.94 ± 4.78, p<.001) component summary., Conclusions: Our results give early insight into the urgent need to provide continuity of care for patients at the community-level, adequate PPE to GPs and a clear guidance from public health institutions. A precarious healthcare system both at a national and regional level might have triggered negative mental health outcomes in Italian GPs.

Background and Aim of the Work: Suicide is a worldwide phenomenon, with a relevant number of victims. Moreover, repercussions of suicidality-across its entire spectrum-involve not only the individual but also survivors and communities, in a profound and lasting way. As such, suicidality represents a crucial public mental health concern, in which risk/protection factors' study represent a key issue. However, research primarily focused on suicidality risk factors. This study, moving from Frankl's first observations on "Meaning in Life" (MiL) as protective against suicidality, aimed to identify the main themes that suicidal patients identified as MiL carriers, or potential carriers, in their existences., Methods: Qualitative study on 144 patients admitted to the Geneva University Hospital's emergency department for suicidal ideation (SI) and suicide attempt (SA).  Results: Interpersonal/affective relationships constituted the main theme (71.53%), with emphasis on family (39.80%), children/grandchildren (36.89%). Profession/education, intellectual/non-intellectual pleasures, and transcendental dimension also emerged., Conclusions: These aspects could be considered among a public health agenda's points for suicide prevention programs taking into account also protective factors promotion/support, including community's mental health resources. Reconnecting to introduction's historical part, our findings are consistent with Frankl's observations. Even if exposed to "absurd" and reluctant to deliberate on this, he seems approach Camus conceptualization who, confronted to the necessity of predictable and conform to recognizable personal patterns transcending chaos for a sense-giving perspective, invited to imagine that a meaning, even a "non-absolute meaning", may lie in apparent smallest things and that Sisyphus can have "the possibility to revolt by trying to be happy".

Background: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressantsare the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined., Methods: Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants., Results: In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressantand improvement of affective and obsessive-compulsivesymptoms with mood stabilizers and atypical antipsychotics., Conclusions: Osler's view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasible.