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Background: Chronic obstructive pulmonary disease (COPD) is characterized by a burden of comorbid conditions, including depression, that has been related with an increased risk of exacerbations, low adherence to pharmacological treatments and behavioral interventions, and overall mortality rates. The aim of the present review was to explore the comorbidity between depression and COPD by examining epidemiological and etiopathogenetic perspectives, along with shared risk factors including the potential role of hypoxia, systemic inflammation, and drugs for COPD treatment. Methods: the aim of this work was to review studies published in the last eleven years, using Medline/PubMed, Scopus, and Google Scholar as search engines and the following terms “Mood Disorders", "Hypoxia "Pulmonary Disease, Chronic Obstructive", “Chronic obstructive pulmonary disease”, linked by the Boolean operator “AND”. Articles were included in the review if written in English and containing quantitative and qualitative information on Depression, Chronic Obstructive Pulmonary Disease, and Hypoxia. Exclusion criteria were studies in languages other than English, irrelevant articles to the examined topic reviews, case reports, case series, and articles on animal models. Results: The present review has confirmed the increased risk of depression onset in COPD patients, suggesting a strong multifactorial and bidirectional correlation between the two conditions. Hypoxia has been emphasized as a key mechanism in both diseases, whereas evidence on shared inflammatory and molecular pathways is still limited. Conclusions: The multifactorial nature of the bidirectional correlation between COPD and depression is far from being entirely understood. Comorbid depression negatively affects COPD course and severity, along with patients’ functioning, psychological well-being and quality of life. Well-designed pre-clinical and clinical studies on the genetic, molecular, and neurobiological pathways which underlie the comorbidity between COPD and depression are needed for addressing the clinical implications and treatment options. needs more research efforts to be clarified. Further studies are mandatory to improve our knowledge on the co-presence of these two widespread diseases.

Background: according to the DSM-5, somatic symptom disorder (SSD) is characterized by physical symptoms that cause a disruption in patient functioning and by excessive preoccupation about symptoms. There is a high prevalence of SSD in the general population, with a range going from 5 to 7% and with a relevant cost burden for healthcare system. So, it appears useful to know what the state of art regarding this significant problem is. Methods: the aim of this work is to review studies published in the last twenty years, using Pubmed, Scopus, Cochrane and PsichInfo, as search engines and the following terms: “somatic symptom disorder”, “somatization”, “somatoform disorder”, “medically unexplained symptoms”, “bodily distress syndrome” and “psychosomatic medicine”, linked by the Boolean operator “OR”. Exclusion criteria are studies in languages other than English and French, studies about pediatric population and animals, type of publication other than journal articles. Results: etiology of SSD is multifactorial, involving internal and external factors. Neuroanatomical studies show the presence of abnormalities in CNS of SSD patients. Assessment still results a problematic field, due to uncertainty of nosography. The therapeutic approach toward SSD can be pharmacological, but also the psychotherapy in its different approaches. Conclusions: the issue of SSD is complex and needs further investigations. To correctly analyze this phenomenon, it is necessary to consider both psychological and organic factors, being on the base of this disorder. It is worth to develop this research because an improvement of the state of art about this matter could lead to improve the approach to SSD, resulting in better quality of patients’ life.

Background: Alexithymia is a psychological construct characterized by inability to express emotions, poor imagination and operational thinking. It is well known its association with several chronic disease such as Diabetes type 2, little is known about diabetes type 1. We examined the association of alexithymia with clinical and psychological outcomes in subjects with type 1 diabetes. Methods: The study was conducted in a single diabetes center. The patients fully completed a protocol composed of the following instruments: the Toronto Alexithymia Scale-20 (TAS-20), the State-Trait Anger Expression Inventory-2 (STAXI-2), the State-Trait Anxiety Inventory form Y (STAI-Y), and the Hamilton Rating Scale for Depression (HAMD). TAS-20 scores were subdivided into tertiles, Correlations and two linear regression analyses, adjusted for only clinical and clinical plus psychological characteristics, were performed. Overall, 75 patients were enrolled (mean age 41.0±11.4 years, diabetes duration 19.9±11.9 years, 49.3% males, 30.7% treated with CSII). Results: People with diabetes of the upper TAS-20 tertile had the greatest rate of depression (with the highest degree of severity) and the higher levels of anger and anxiety. There was a significant correlation between TAS-20 scores with BMI (r=0.26; p=0.03), HAMD (r=0.38; p=0.001), STAXI-2 (r=0.34; p=0.003) and STAI-Y (r=0.48; p0.0001). Further regression analysis showed TAS-20 scores were associated with BMI (beta=0.29; p=0.02). The association with BMI was confirmed (beta=0.28; p=0.007) when psychological variables are considered; furthermore, a strong association with STAI-2 (beta=0.48; p0.0001) was detected, while the analysis did reveal any significant correlation between alexithymia and HbA1c levels. Conclusions: Alexithymia is strongly associated both with clinical and psychological characteristics, notably with BMI and anxiety traits. People with diabetes type 1 should be assessed for alexithymia. Future studies on the current topic are therefore required in order to elucidate the role of alexithymia in diabetes type 1. We believe that patients with diabetes and alexithymia could take advantage of psychological counseling.

Aim: Grief is a common reaction to loss and it is considered a physiological and instinctive response. The "normal" grief evolves into an "integrated" phase within one year from death, and it is a non-pathological condition, that does not require specific therapeutic interventions. When this “integrated phase” does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) was proposed as a new category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. PCBD is a new clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness. Method: We examined reviews and studies of different researches done in the last twenty years, concerning the issues of loss, "normal" and "complicated" mourning that led to the diagnostic category of PCBD. For this review we based our consideration starting from those pathological conditions that preceded PCBD, as “pathological”, “complicated” and “traumatic” grief. Results: PCBD results a new important clinical category showing specific symptoms, diagnostic criteria and treatment. It presents many differences with other pathologies, that goes into differencial diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches. Conclusions: Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis. Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.

We read with great interest the article by Ferraro et al. about the presence of current and lifetime psychiatric disorders among a sample of Italian female inmates. However, despite the strengths of the article, we have certain reservations on the methodology followed and conclusions drawn in the study that need to be elaborated for a better understanding of this very important research. Our correspondence thus, emphasizes the need for further explorations on this important area of research on mental health in inmates, in order to identify appropriate diagnostic and therapeutic strategies to be applied in this population.

There are conflicting data on peculiar negative emotional patterns in Irritable Bowel Syndrome subtypes. Our study was aimed to determine possible differences in depression, anxiety and anger in patients suffering from Irritable Bowel Syndromeconstipation, diarrhoea and mixed subtypes. The sample underwent a psychometric examination for the assessment of depression (Hamilton Rating Scale Depression), anxiety (Hamilton Rating Scale Anxiety), and anger (State-Trait Anger Expression Scale 2). Differences among groups were assessed using the Analysis of variance with Bonferroni post hoc comparisons, or the χ²-test if requested. 111 subjects (diarrhoea subtype =37; constipation subtype=34; mixed subtype=40) were included in the study. The severity of depressive symptoms was “moderate” in patients with constipationsubtype and “mild” in patients with diarrhoea and mixed subtypes (17.15±6.7 vs 14.24±6.6 vs 12.50±4.9); no statistically significant differences were documented among subtypes. Severity of anxiety symptoms was “mild to moderate” in patients with constipation subtype (mean = 18.53 ± 7.7), and mild in patients with diarrhoea (mean = 13.35 ± 7.1) and mixed subtypes (mean = 13.25 ± 4.7); statistically significant differences among subgroups were found (Constipation vs Diarrhoea: p=0.004; Constipation vs Mixed: p=0.003). Regarding anger, significant differences among subgroups emerged at State Anger Feeling Angry and Anger In variables, both higher in constipation subtype group than in mixedsubtype group (State Anger Feeling Angry: p=0.002; Anger In: p=0.001). Patients with constipation subtypeconstitute a subgroup characterized by a discrete burden of negative emotions, mainly anxiety and anger.

The term dependency is increasingly being used also to explain symptoms resulting from the repetition of a behavior or legalized and socially accepted activities that do not involve substance assumption. These activities, although considered normal habits of daily life can become real addictions that may affect and disrupt socio-relational and working functioning. Growing evidence suggests to consider behavioral addictions similar to drug dependence for their common symptoms, the high frequency of poly-dependence conditions, and the correlation in risk (impulsivity, sensation seeking, early exposure, familiarity) and protective (parental control, adequate metacognitive skills) factors. The aim of this paper is to describe addiction in its general aspects, highlighting the underlying neurobiological and psychopathological mechanisms.

Authors postulate that the difference between suppression and repression, highlighted in particular by the Societè Psychanalitique de Paris, enables the development of a quantitative instrument, since suppression is a defense accessible to consciousness and therefore quantifiable like scales and questionnaires. The idea of constructing a questionnaire, included the identification of thirty variables having somehow a plausible relationship with this mechanism. The factor exploratory analysis were identified three factors, named respectly “repressive function”, “regression to the ego service” and “rationalization”, the first of which is the closest to the theoretical construct postulated.

Autism is a pervasive developmental disorder characterized by deficits in the areas of communication, socialization and behavior. Current diagnostic criteria have been modified in a restrictive sense, thus the possibility that individuals with milder impairments may not reach the diagnostic threshold is concrete. Furthermore, heterogeneity in phenotypic expression and the high rate of comorbidity with other psychiatric disorders would make even more difficult the diagnostic classification in individuals with autism spectrum disorder (ASD). The present study was a Rorschach investigation aimed to identify specific psychopathological elements to properly orient the diagnosis of ASD in adulthood. Results have shown that the examined subjects were characterized by pragmatism, documented by the presence of details and little details, falls in formal thinking, thought inflexibility, lack of answers with human content, and the prevalence of particular phenomena (denial, perseveration). Data obtained in the study showed a specific pattern of psychopathological signs in adults with ASD, thus suggesting the importance of projective methods for a better understanding of the clinical features of avoidance behaviors and relationships.

The aim of this paper is to explore the state of the art about the connection between anger and sexual behavior in eterosexual couples. After a description of anger in psychiatric and psychological literature, the Authors review the available studies about anger-sexuality relationship from theorethical, clinical and experimental point of view. They conclude that there is, till now, a significant confusion about the question. Therefore, Authors suggest a new approach to this problem, due to the possible relevance of the topic in clinical practice. Despite the complexity of this research area, there is a need of clarification regarding methodological trends and clinical perspectives. Authors suggest the relevance of such a research for the understanding of sexual behavior, sexual couples problems and the finding of treatment strategies for anger problems connected to sexual behavior.