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Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Clinicaltrials.gov ID: NCT03080103

Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) (P

Molte persone a rischio suicidario non ricevono assistenza professionale per problemi economici, per il desiderio di risolvere il problema in autonomia o per via dello stigma. Gli Interventi Internet- e Mobile-based (o Internet and Mobile-based Interventions - IMI) sono in grado di superare molti di questi ostacoli, offrendo interventi flessibili e facilmente accessibili. Abbiamo condotto una revisione narrativa della letteratura riguardo le caratteristiche degli IMI rivolti al rischio suicidario, la loro efficacia e alcuni esempi di applicazioni e siti utilizzati per prevenire e trattare il rischio suicidario. Metodo. La ricerca della letteratura è stata condotta sui database PubMed e PsycINFO. Risultati. Gli IMI rappresentano una valida alternativa ai tradizionali trattamenti e diverse ricerche ne dimostrano l’efficacia nel ridurre l’ideazione e i comportamenti suicidari. La maggior parte degli IMI si basa sulla terapia cognitivo-comportamentale, un trattamento molto strutturato e facilmente trasferibile in formato digitale. L’auto-potenziamento, i meccanismi di rinforzo e il supporto umano sono i principali aspetti che promuovono il cambiamento dell’individuo e la sua aderenza al trattamento. Alcuni IMI sviluppati per la prevenzione del suicidio sono Stay Alive (Regno Unito), Virtual Hope Box (USA), This way up (Australia) e Jaspr Health (USA). Conclusioni. Gli IMI sembrano essere un valido aiuto nella prevenzione del suicidio. Riteniamo importante continuare le ricerche che ne supportino l’efficacia e implementare questo tipo di interventi in Italia. Many suicidal people do not receive professional assistance due to economic problems, the desire to autonomously solve the problem, or the stigma. Internet and Mobile-based Interventions (IMIs) can overcome many of these obstacles, offering flexible and accessible interventions. We conducted a narrative literature review about the characteristics of IMIs focused on suicide risks. We studied their efficacy and some examples of applications and websites used to prevent and treat suicide risk. METHOD: Literature research was conducted on Pub Med and PsycINFO databases. RESULTS: IMIs are a viable alternative to traditional treatments and several studies supported their effectiveness in reducing suicidal ideation and behaviors. Most IMIs are based on cognitive-behavioral therapy, which is very structured and easily transferable to digital format. Empowerment, reinforcement mechanisms and human support are the main features that promote the change of the individual and her or his adherence to the treatment. Some IMIs developed for suicide prevention are Stay Alive (UK), Virtual Hope Box (USA), This way up (Australia), and Jaspr Health (USA). CONCLUSIONS: IMIs can be considered a valid aid in suicide prevention. It is necessary to continue the research supporting their effectiveness and implement their interventions in Italy.

Background Suicide outcomes in cancer patients represent a major public health concern. We performed an umbrella review (UR) including all meta-analyses (MAs) and systematic reviews (SRs) published on the association between cancer and suicide outcomes. Methods Eligible studies were searched in the main scientific databases up to January 23rd, 2021. Eligible MAs/SRs focused on all suicide phenotypes among cancer patients. Evidence of the association was extracted; the credibility and quality of the included studies were evaluated using ad-hoc tools, including “A MeaSurement Tool to Assess systematic Reviews-2-Revised” (AMSTAR-2-R). Results Six MAs and 6 SRs were included. The standardized mortality ratio of suicide in cancer patients was 1.5 to 1.7-fold higher than in the general population. Risk factors for suicide outcomes among cancer patients were male sex and older age, a cancer diagnosis within the prior year, and some specific cancer sites. Among 107 associations, 90 (84.1%) were supported by high credibility of evidence (class II). However, all studies reported a large heterogeneity (I2> 50%) and the majority of them reported considerable heterogeneity (I2> 75%). All MAs used random-effects measures. All MAs but one assessed publication bias and only one disclosed it. The majority of MAs/SRs showed critically low quality based on AMSTAR-2-R. Limitations We could not perform additional analyses due to the limited number of MAs. Conclusions This UR underlines the inflated risk for suicide among cancer patients. Upcoming, well-designed studies are needed to account for a broader set of variables. Several methodological issues likewise warrant attention.

Background Due to the high pressure they sustain, family members of substance users are thought to experience negative consequences in mental and physical health. This scoping review provided a comprehensive overview on the mental and physical health of adult Affected Family Members (AFMs). Method We searched in-journal English articles in PubMed, with no date limit, guided by the concepts of stress, strain, and burden, and including several terms related to substance use. Eligibility criteria included focus on adult AFMs, mental and physical health, and clinical forms of substance use. Results PubMed search identified 3549 articles, with 46 additional papers from other sources. Fifty-six articles were included, quantitative (N = 39), qualitative (N = 15) and both (N = 2). Quantitative findings show that AFMs are subject to increased stress and burden, and impaired mental health. Variable rates of physical problems emerge, with some medical conditions being more common among AFMs of substance users versus controls. Finally, evidence shows increased risk for aggression and reduced quality of life and social adjustment. AFMs report higher stress and strain if they are women, in low socio-economic families, and co-habiting with more severe substance users. Qualitative studies additionally suggest that stigma, self-blame, and social isolation are common. Conclusions AFMs of substance users represent a population at higher risk for negative health-related outcomes and should be systematically regarded as targets for treatment.

Purpose of Review We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). Recent Findings Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1–3 years in 10–40%. Depressive symptoms are reported in 27.5–50.7%, insomnia symptoms in 34–36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Summary Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs’ mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services. Electronic supplementary material The online version of this article (10.1007/s11920-020-01166-z) contains supplementary material, which is available to authorized users.

We argue that clinical information related to an object-relations model of personality pathology can be used by untrained and clinically inexperienced students to rate personality-disordered patients on the Level of Personality Functioning Scale (LPFS). To do so, 73 clinically inexperienced undergraduate students were asked to assess personality functioning of 10 female inpatients using the LPFS from audio recordings of the Structured Interview of Personality Organization (STIPO). LPFS ratings showed acceptable interrater reliability. Moreover, LPFS ratings were significantly associated with external measures of severity of personality pathology (number of DSM-IV-TR personality disorders) as assessed by experienced clinicians. Finally, the students' ratings were also associated with the level of personality organization as measured by experienced clinicians using the STIPO. Our findings confirm that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM-5 Alternative model are discussed.

ObjectivesTo evaluate the incidence and risk factors for liver enzyme elevations (LEE) in patients initiating first-line ART in the ICONA prospective observational cohort, between June 2009 and December 2017.Patients and methodsIn total, 6575 ART-naive patients were selected, initiating two NRTIs with the third drug being a boosted PI (n=2436; 37.0%), an NNRTI (n=2384; 36.3%) or an integrase strand transfer inhibitor (INSTI) (n=1755; 26.7%). HBV surface antigen and HCV RNA were detected in 3.9% and 5.8% of the study population. Inverse probability weighted Cox regression analysis was used to calculate the HRs, according to first-line regimen, for LEE, defined as ALT or AST increases of ≥2.5× upper limit of normal (ULN) for patients with normal baseline values or ≥2.5× baseline for patients with higher baseline values.ResultsOne hundred and eighty-three LEE occurred over 20722 patient-years of follow-up. After adjusting for the main confounders, the risk of LEE halved with INSTIs compared with NNRTIs (HR 0.46, 95% CI 0.25–0.86), with a significant reduction in the raltegravir group (HR 0.11, 95% CI 0.02–0.84 using the NNRTI class as reference). HRs for LEE were significantly higher in subjects with HBV or HCV coinfection, in patients with poorly controlled HIV infection and in those who acquired HIV through homosexual transmission.ConclusionsIn our study, INSTI use almost halved the risk of LEE compared with other regimens. This finding could be particularly important for choosing ART in patients with risk factors for liver toxicity such as HCV and HBV coinfections.

BACKGROUND: There is a lack of studies testing accuracy of fast screening methods for alcohol use disorder in mental health settings. We aimed at estimating clinical utility of a standard single-item test for case finding and screening of DSM-5 alcohol use disorder among individuals suffering from anxiety and mood disorders. METHODS: We recruited adults consecutively referred, in a 12-month period, to an outpatient clinic for anxiety and depressive disorders. We assessed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) single-item test, using the Mini- International Neuropsychiatric Interview (MINI), plus an additional item of Composite International Diagnostic Interview (CIDI) for craving, as reference standard to diagnose a current DSM-5 alcohol use disorder. We estimated sensitivity and specificity of the single-item test, as well as positive and negative Clinical Utility Indexes (CUIs). RESULTS: 242 subjects with anxiety and mood disorders were included. The NIAAA single-item test showed high sensitivity (91.9%) and specificity (91.2%) for DSM-5 alcohol use disorder. The positive CUI was 0.601, whereas the negative one was 0.898, with excellent values also accounting for main individual characteristics (age, gender, diagnosis, psychological distress levels, smoking status). DISCUSSION: Testing for relevant indexes, we found an excellent clinical utility of the NIAAA single-item test for screening true negative cases. Our findings support a routine use of reliable methods for rapid screening in similar mental health settings.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. Language: en

Background: Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. Methods: The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernberg's dimensional model of personality. Results: Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. Conclusions: The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients. © 2014 Elsevier Inc. All rights reserved.

The purpose of this study was to examine the basic psychometric proprieties of the Dutch Eating Behavior Questionnaire (DEBQ) and its measurement invariance across sex, BMI-status (normal weight/overweight), and age in a community sample of 990 Italian adults. The analysis of the dimensionality of the DEBQ using exploratory factor analysis revealed the existence of three major factors - emotional, restrained and external eating. Single and multi-group confirmatory factor analyses replicated the three-factor structure, and this dimensional structure proved to be invariant across sex, BMI-status, and age. Findings upheld the criterion-related validity (e.g., via its associations with Eating Attitudes Test-26). The DEBQ's subscales displayed high internal consistency and test-retest reliability over a 4-week period. Statistically significant differences were found when sex, BMI and age groups are compared in the latent means of emotional, external and restrained eating and they are discussed with reference to theory, past and recent empirical findings. Overall, results support the measurement invariance of the DEBQ and suggest that the Italian version is a psychometrically reliable, valid and useful measurement instrument for assessing adult eating behaviors.

Background and Objectives: Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). Methods: We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders. Results: Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from −1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). Discussion and Conclusions: DSM-5 criteria did not inflate AUD rates. Scientific Significance: Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53–56).

Objective: The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample. Method: The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = ±5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress. Results: Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life. Conclusions: Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses. © 2009 Elsevier Inc. All rights reserved.

This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernberg's model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed good levels of internal coherence and, in the nonclinical sample, good test-retest reliability. Associations with the convergent measures were in line with theoretical expectations and supported the benefit of adopting a 4-factor solution. The 4 factors showed the expected criterion relations: All the dimensions discriminated between clinical and nonclinical subjects, whereas only Instability of self/others and Instability of goals discriminated patients with borderline personality disorder from patients with other diagnoses. Our results suggest that the Italian version of the IPO is a reliable and valid tool for the assessment of personality organization according to Kernberg's model. Results are discussed in the context of the current directions in the evaluation of personality disorders proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

The Drive for Muscularity Scale and Male Body Dissatisfaction Scale were developed for use with men and correspond to measures of drive for thinness and body dissatisfaction in women. The psychometric properties of these measures were evaluated in a sample of 655 Italian men, who completed other 11 measures also. Both scales demonstrated excellent internal consistency and temporal stability as well as criterion-related and concurrent validity. Both measures distinguished between men with high and low levels of disordered eating. Confirmatory factor analysis replicated the unidimensional factor structure of both scales. Directions for future research are discussed.

A meta-analysis of the published literature was performed to evaluate the common effect size (r) of the association between childhood sexual abuse (CSA) and Borderline Personality Disorder (BPD). An online search from 1980 to 1995 was used to gather published papers. r coefficient was used as an effect size measure, and 21 studies were retrieved. A moderate pooled r (.279) for the association between CSA and BPD was observed. Pooled effect size estimates were also obtained for CSA parameters. No significant effect of moderators was evidenced. The results of this study did not support the hypothesis that CSA is a major psychological risk factor or a causal antecedent of BPD.

Body dissatisfaction is recognized as a robust risk factor for eating disorders. Despite over 80% of college men being body dissatisfied, not all men report several levels of eating disorder symptoms. In this study, we examined poor impulse control, social anxiety and internalization of media ideals as potential moderators. Data collected from 405 college-aged men were analysed, using latent variable structural equation modelling approach. All variables investigated have been found to moderate the body dissatisfaction–eating disorder symptomatology, such that male body dissatisfaction was strongly related to men’s eating disorder symptomatology when each moderator was at its highest level. Practical implications are discussed.

DSM-III and DSM-III-R defined the diagnostic criteria of brief reactive psychosis (BRP) identifying some personality disorders (PDs) as predisposing factors: up to now no experimental data support this hypothesis. In this research, the authors studied the link between BRP and PDs, assessing axis II diagnosis (SIDP-R), after recovery of BRP in a group of 23 patients. Eighty-seven percent of the patients (n = 19) received at least one diagnosis of PDs. The widespread presence of PDs and, particularly, the high prevalence of cluster C (n = 11, 47.8%), are only partially in accordance with the hypothesis of DSM-III. A possible alternative model of interaction is suggested.

Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.

We present the factor structure and psychometric properties of the Italian version of the SCL-90-R based on a large sample of the Italian population. The sample (N = 3631) included high-school and university students and adults from the community (age range=13–70 yrs; 39.2% males). Principal component analysis (PCA) supported by parallel analysis, yielded eight components, partially overlapping those in the original version; no evidence of Psychoticism and Paranoid Ideation as separate subscales emerged. Twenty-one items were consecutively deleted, leading to a 69-item version of the scale. Internal coherence was good for all subscales (α values between 0.70 and 0.96). However, the eight-factor solution did not prove consistent when analyses were replicated after dividing the sample in subgroups according to gender and age. A second-order PCA yielded a single factor, supporting the adoption of the GSI as an index of general distress. A 69-item brief version of the scale has been empirically derived in this study, and can possibly be adopted as a screening measure for general distress in Italian adults and adolescents; however, caution should be exercised when interpreting the clinical profile due to the instability of factor structure.

The aim of the present study is to assess the prevalence of Axis II disorders (DSM-IV-TR) in a sample of clients requesting sex reassignment surgery (SRS), consecutively admitted to a Gender Identity Disorder (GID) psychiatric unit. Fifty clients selfreferred as transsexuals (34 biological males and 16 biological females; mean age = 31.74 ± 7.06 years) were assessed through the SCID-II after a preliminary evaluation to exclude current major psychiatric disorders. Prevalence of any Axis II disorder was 52% (N = 26), with no significant differences related to biological sex. The most frequent personality disorders were Cluster B PDs (22% of total sample), followed by Cluster C (12%) and Cluster A PDs (2%). A significant prevalence of NOS PD (16%) was also found. Our data offers prevalence estimates slightly higher than those found in previous studies and does not provide evidence for any differences in the psychopathological profile and severity between MtF and FtM transsexuals.

IntroductionThis study provides data on the rates, characteristics, and correlates of self-injury (SI) in an Italian nonclinical sample, a population previously unexamined within the SI literature. This study examined the associations between SI and defense mechanisms, as well as the differences between self-injurers (episodic and recurrent) and non self-injurers with regard to the severity and variety of their psychiatric symptoms and psychological distress.Materials and methodsFive hundred and seventy-eight university students (82.5% female; mean age = 22.3; S.D. = 3.4) were administered a battery of self-report questionnaires, including the “Deliberate Self Harm Inventory” for SI, the Response Evaluation Measure-71 for defense mechanisms, and the “Symptom Checklist-90-Revised” for psychological distress and psychiatric symptoms.ResultsOne hundred and nineteen participants (20.6%) reported having engaged in SI at least once during their lifetime. Individuals with recurrent SI (SI ≥ 5) reported significantly higher levels of all psychiatric symptoms and many maladaptive defense mechanisms than individuals without SI. Results also provided evidence for differences between individuals with recurrent and episodic SI.ConclusionResults suggest that recurrent self-injurers are distinguished from both episodic self-injurers and non self-injurers by their greater use of maladaptive defense mechanisms, rather than their lesser use of adaptive defenses. Further, results suggest that recurrent self-injurers differ from episodic self-injurers not in terms of the severity of their psychiatric symptoms, but the variety and number of these symptoms.

The influence of the model of object relations on modern psychodynamic research has led to increased emphasis on the importance of relations and traumatic events in the genesis of some psychic disorders, especially with regard to personality disorders. The development of axis II in the DSM-III system has increased the number of empiric studies in this field. In this paper, the Authors report data relating to a sample of 49 subjects with personality disorders (DSM-III-R) in which the presence of sexual abuse, physical maltreatment and negative family atmosphere was examined using a self-administered questionnaire (CAT). The results suggest a significant presence of these events throughout the sample and reveal a correlation between some personality disorders and specific traumatic events. It may therefore be hypothesized that the presence of these events represents an important factor from the point of treatment, both in technical and in prognostic terms.