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Despite evidence from case series, the comorbidity of eating disorders with psychosis is less investigated than their comorbidity with anxiety and mood disorders. We investigated the occurrence of symptoms of psychosis in 112 female patients diagnosed with DSM-IV eating disorders (anorexia nervosa=61, bulimia nervosa=51) and 631 high school girls in the same health district as the patients: the items of the SCL-90R symptom dimensions "paranoid ideation" and "psychoticism" were specifically examined. No case of co-morbid schizophrenia was observed among patients. Compared with controls, the patients with anorexia nervosa were more likely to endorse the item "Never feeling close to another person"; the patients with bulimia nervosa were more likely to endorse the item "Feeling others are to blame for your troubles". Both groups of patients were more likely than controls to endorse the item "Idea that something is wrong with your mind". The students who were identified by the EAT and the BITE as being "at risk" for eating disorders were more likely to assign their body a causative role in their problems. Symptoms of psychosis can be observed in patients with eating disorders, but these could be better explained within the psychopathology of the disorders rather than by assuming a link with schizophrenia.

Suicidality is high in schizophrenia, particularly in first-episode patients. Little is known about patients with prodromal symptoms of psychosis or otherwise high-risk persons. In a sample enrolled in an early intervention program implemented in Milan (Italy), a history of attempted suicide before enrollment was found in 6 first-episode schizophrenia (out of 87, 6.9%), and 7 high-risk of psychosis (out of 81, 8.6%) patients. In the first-episode group, a history of suicide attempts was related to a shorter duration of untreated psychosis. In the high-risk group, a family psychiatric history in first/second degree relatives of patients and a personal history of substance abuse were both associated with an enhanced risk of attempted suicide before enrollment. During the first year of treatment, 3 new attempted suicides were recorded among 57 (5.3%) high-risk patients, and none among first-episode patients (n=58) (no dropout in the sample). The levels of suicide ideation on the BPRS did not differ by group at assessment, and significantly declined from assessment at entry to 1-year follow-up, except in seven HRP patients who become positive for core symptoms of schizophrenia, as measured on the BPRS. At enrollment, patients at high risk of psychosis had the same prevalence of past suicide attempts than first-episode schizophrenia patients: since suicide attempt is the most important predictor of a future suicidal attempt, the assessment of suicide risk should be given a privileged role in patients at high risk of psychosis as well.

To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients’ discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.

Latent class analysis (LCA) has emerged as the best suitable statistical tool to identify separate dimensions (latent classes) when analyzing dichotomous data; its objective is to categorize people into classes using the observed items and to identify those items that best distinguish between classes. LCA was applied to the Peters et al. delusions inventory, an inventory in a dichotomous format (Yes/No) aimed at investigating proneness to delusion in the general population. The study involved 82 patients diagnosed with a psychotic disorder and 210 well-matched healthy controls from the community. Four classes were identified in the sample: a normative one, and 3 classes traceable to the 3 major dimensions of psychosis, i.e., paranoia, grandiosity/hypomania, and the schizophrenia-like profile. The coherent multidimensional structure of the model emerging from LCA of Peters et al. delusions inventory suggests that single clusters of symptoms may be indicative of specific diagnostic categories within the spectrum of psychoses, allowing a more subtle determination of their boundaries and correlates.

Discharge from a psychiatric forensic institution is a critical moment for patients with severe mental disorders; often it leads to relocation to a non-forensic residential facility (RF) where treatment and support needs can be met. The present study used data from the Italian PROGRES project (aimed at studying the country's residential mental health care system) to investigate the characteristics of a large sample of patients formerly admitted to forensic mental hospitals (FMH) living in a psychiatric RF, and to compare them with RF patients never admitted to FMH. Structured interviews were conducted with the managers and staff of a representative sample of Italian RFs (n = 265); residents were also evaluated using standardized rating instruments. Among 2,962 surveyed residents, a total of 193 patients (6.5%) had previously been admitted to a FMH. The majority had a diagnosis of schizophrenia or a related disorder (n = 149, 78.0% of FMH patient vs. 1830, 66.8% of non-FMH patients). Overall, the symptom p...

Objective: This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000. Methods: Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary. Results: The programme focuses on young people aged 17–30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients. Conclusions: Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.

Naturalists have not identified suicide in nonhuman species in field situations, despite intensive study of thousands of animal species. In this review, evidence on suicidal behavior among animals is analyzed to discover analogies with human suicidal behavior. Literature was retrieved by exploring Medline/PubMed and PsychINFO databases (1967–2007) and through manual literature searches. Keyword terms were “suicide or suicidal behavior” and “animal or animal behavior.” Few empirical investigations have been carried out on this topic. Nevertheless, sparse evidence supports some resemblance between the self-endangering behavior observed in the animal kingdom, particularly in animals held in captivity or put under pressure by environmental challenges, and suicidal behavior among humans. Animal models have contributed to the study of both normal and pathological human behaviors: discovering some correlates of suicide among animals could be a valid contribution to the field.

Background The global increase in surface temperature (known as global warming) was found to impact on mortality through ill health, particularly among the elderly and in summer. This study sets out to explore the impact of global warming on suicide mortality, using data from Italy. Methods Monthly data on suicide mortality and temperature were obtained for a 30-year period (from January 1974 to December 2003), and the relation between them was investigated using the Gaussian low-pass filter, linear correlation analysis and rank analysis. Results For males, increasing anomalies in monthly average temperatures associated to a higher monthly suicide mean from May to August and, to a lower extent, in November and December. In January, on the other hand, increasing anomalies in monthly average temperatures appeared to be coupled to a lower number of suicides. For females, the links between temperature and suicides are less consistent than for males, and sometimes have a reverse sign, too. Limitations Data could not be analyzed according to age, since this information was not available across the whole time interval. The use of monthly data, instead of daily data (unavailable), is another major limitation of this study. Conclusions An improvement in the ability of communities to adjust to temperature changes by implementing public health interventions may play an important part in preserving the wellness of the general population, and also in limiting the worst consequences of suicidal behaviour.

Background Recent studies have reported changes in the time patterns of suicide, with conflicting findings regarding the direction of these changes: data from Italy were investigated to evaluate the influence of recent social and medicine-related changes on the seasonality of suicides in the country. Methods A total of 71 227 male suicides and 26 466 female suicides occurring in Italy from 1974 to 2003 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by five-year intervals. Results The suicide rates of both males and females showed a rising trend, with an evident peak in the 1987–1994 period and a decrease thereafter. Seasonality of suicides, with a clear peak in spring as against the other seasons, accounted for a statistically significant proportion of total variance: around 40% among males and 39% among females. Seasonality did not change across time in a relevant way; however, an anticipation of the peak was observed in both males and females over time, with amplitude increasing or decreasing as a function of yearly suicide rates. Limitations Data could not be analysed according to age or to the method of suicide, since this information was not available across the whole time interval. Conclusion The seasonal effect on mortality by suicide is positively related to suicide rates, so much that changes in suicide rates over time correspond to changes in suicide seasonality.

Despite huge advances in the neuroscience of substance abuse and dependence in the past 20 years, no approved pharmacological treatment exists for cocaine abuse. The available drugs for the treatment of cocaine abuse are poorly effective, hence the need for new compounds to be screened and tested for efficacy: targeting symptoms might improve the effectiveness of the treatment of cocaine abuse and dependence. On the basis of the known neurochemistry of cocaine, some target compounds have been studied: among others, BP-897, a D3 partial agonist; vanoxerine, a highly selective inhibitor of dopamine uptake; aripiprazole, a partial mixed-action agonist approved for the treatment of schizophrenia. Recently modafinil, approved for the treatment of narcolepsy, proved effective in favouring cocaine abstinence in cocaine-abusing people. Some placebo-controlled studies also reported the effectiveness of topiramate, a licensed antiepileptic drug, and of tiagabine, a gamma-aminobutyric acid (GABA) re-uptake inhibitor also approved as an anticonvulsant; both compounds increased cocaine abstinence with no serious adverse events. Promising results came from two more compounds acting on the GABA circuits, baclofen and valproic acid. Finally disulfiram, prescribed with active psychosocial therapy, was found to favour higher retention rates and longer abstinence periods from both alcohol and cocaine in polydrug-abusing patients. An alternative approach rests on the use of vaccines, to date in the experimental stage still. Psychosocial treatments are a useful companion in the pharmacotherapy of cocaine abuse, with group therapy and contingency management therapies improving motivation and social functioning, particularly in patients abusing alcohol as well.

Despite evidence that the reporting of delusion-like or hallucinatory experiences are predictive of the future development of a mental disorder in the spectrum of psychosis, the exact nature of such a kind of unusual subjective experience in the general population is still disputed. We investigated the multidimensionality of these experiences with the Peters et al. Delusions Inventory (PDI) and a modified Italian version of the Launay-Slade Hallucination Scale (LSHS-R) in 250 subjects of both genders drawn from the normal population, using the General Health Questionnaire (GHQ) as a measure of psychic distress of a clinically relevant nature. We found that GHQ scores are positively related to both the PDI and the LSHS-R scores, but the GHQ did not act as a mediator in the links between the 2 psychosis-proneness measures. Conversely, the LSHS-R scores fully mediated the links between GHQ and PDI scores. It can be argued that hallucination proneness and psychosis proneness do not overlap in the nonclinical population but can both cause distress separately.

Atypical handedness has been repeatedly reported in schizophrenia, with quantitative review of evidence showing an increase of non-right-handedness in patients diagnosed with schizophrenia. Mixed-handedness is also higher among non-clinical people scoring high on questionnaires aimed at measuring psychosis-proneness. However, the greatest part of information on non-clinical samples came from samples collected in North America or in the UK: differences by countries in the socio-cultural pressure to use the right hand could influence the results. In this study 604 Italian non-clinical participants (248 males, 41.1%; 356 females, 58.9%; mean age = 34.5 ± 11.9) completed the Annett Hand Preference Questionnaire (HPQ), the General Health Questionnaire (GHQ), and the Peters et al. Delusions Inventory (PDI). In the sample, 527 subjects (87.3%) were classified on the HPQ as right-handed, 53 (8.8%) were classified as mixed-handed, and 24 (4.0%) were classified as left-handed. Mixed-handed scored statistically higher on the PDI than the right-handed and left-handed, but right-handed and left-handed did not differ from each other on a statistical ground. The difference by handedness was specific for PDI, since scores on the GHQ-12 did not differ by handedness group. The links between mixed-handedness and psychosis-proneness in non-clinical samples are a reliable finding, deserving further investigation as a model for the risk of schizophrenia.

Objective To establish sensitivity, specificity, and discriminative validity of the Peters et al Delusions Inventory (PDI), a recently released self-compiled questionnaire aimed at measuring psychosis proneness in the general population. Method Eighty-one patients diagnosed with a mental disorder with psychotic features (schizophrenia, schizoaffective disorder, bipolar disorder, major depression) and 210 putatively healthy individuals were invited to complete the PDI and the brief version of the General Health Questionnaire (GHQ-12). The receiver operating characteristic analysis has been used to extract the best threshold to discriminate between cases, those with a psychotic disorder, and noncases, those without a psychotic disorder. Results The best PDI threshold in discriminating between cases and noncases was 8 (sensitivity, 74%; specificity, 79%). The corresponding figures of sensitivity and specificity for a GHQ-12 cutoff of 6 were 63% and 83%, respectively. The value of the area under the receiver operating characteristic curve was found to be higher for the PDI (0.815) than for the GHQ-12 (0.770), although at a barely detectable, statistically significant difference (Z = 1.45, P = .073). Conclusion The expected high negative predictive value of the PDI (96%) in the general population suggests it will be a valuable tool in future research on psychosis proneness.

The short version of the Oxford-Liverpool Inventory of Feelings and Experiences (sO-LIFE) is a widely used measure assessing schizotypy. There is limited information, however, on how sO-LIFE scores compare across different countries. The main goal of the present study is to test the measurement invariance of the sO-LIFE scores in a large sample of non-clinical adolescents and young adults from four European countries (UK, Switzerland, Italy, and Spain). The scores were obtained from validated versions of the sO-LIFE in their respective languages. The sample comprised 4190 participants (M = 20.87 years; SD = 3.71 years). The study of the internal structure, using confirmatory factor analysis, revealed that both three (i.e., positive schizotypy, cognitive disorganisation, and introvertive anhedonia) and four-factor (i.e., positive schizotypy, cognitive disorganisation, introvertive anhedonia, and impulsive nonconformity) models fitted the data moderately well. Multi-group confirmatory factor analysis showed that the three-factor model had partial strong measurement invariance across countries. Eight items were non-invariant across samples. Significant statistical differences in the mean scores of the s-OLIFE were found by country. Reliability scores, estimated with Ordinal alpha ranged from 0.75 to 0.87. Using the Item Response Theory framework, the sO-LIFE provides more accuracy information at the medium and high end of the latent trait. The current results show further evidence in support of the psychometric proprieties of the sO-LIFE, provide new information about the cross-cultural equivalence of schizotypy and support the use of this measure to screen for psychotic-like features and liability to psychosis in general population samples from different European countries.

Introduction:Mental disorders are the largest cause of the burden of disease in the world. Most of the burden affecting adult life has its onset during childhood and adolescence. The European Pact for Mental Health and Wellbeing calls for immediate action and investments in the mental health of children and adolescents. Schools may be the ideal location for promoting health and delivering healthcare services, since schools are a location where young people usually spend their daytime and socialize, schools are easily accessible to families, can provide non-stigmatizing health actions, and form links with the community.Aims and Goals of this Special Issue:This issue is developed within the framework of the Joint Action on Mental Health promoted by the European Commission. This special issue presents a set of systematic reviews on the evidence of the international literature on school interventions for the promotion of the mental health and wellbeing of children and adolescents. It is focused on five topical main areas: promoting general health and wellbeing; programs targeting specific mental disorders and conditions and integration of adolescents with mental health problems; Bullying; Sport; Alcohol and Drugs. An additional paper on the results of the largest epidemiological study conducted in some European countries on the prevalence and relative risk factors of mental disorders in school-age completes the issue.Conclusion:These reviews are a first contribution to address future European research and interventions, in particular about the multiple ways through which European policies could support the schooling and wellbeing of children and adolescents.

The goal of the study was to estimate the prevalence of current and lifetime mental disorders in a consecutive sample ( n =300) of detainees and prison inmates held in an Italian prison and compare it with the prevalence observed in a sample randomized from the community ( n =300) within the same age interval (18–55 years) and sex proportion of prisoners, and with a similar socio-economic status. Psychiatric disorders were identified with the Mini International Neuropsychiatric Interview (MINI). Current psychiatric disorders were present in 58.7% of prisoners and 8.7% of the comparison group. Lifetime psychiatric disorders were present in 88.7% of prisoners and 15.7% of the comparison group. Current anxiety disorders and current stress-related disorders were related to prisoners serving their first-ever prison sentence. A variable fraction of prisoners with an ongoing psychopathology is not diagnosed or does not receive proper treatment. The provision of effective treatment to prisoners with psychiatric disorders might have potentially substantial public health benefits.

The schizotypal personality questionnaire (SPQ) is used to characterize schizotypy, a complex construct helpful for the investigation of schizophrenia-related psychopathology and putative endophenotypes. The SPQ factor structure at item level has been rarely replicated and no study had tested a bifactor model of the SPQ so far. The unidimensional, the correlated, the second-order and the bifactor models of the SPQ were tested to evaluate whether the items converge into a major single factor defining the schizotypy-proneness of the participants, to be used for grouping purpose. Parallel principal component analysis (PCA) and confirmatory factor analysis (CFA) were used to determine the optimal number of factors and components in a cross-sectional, survey design involving 649 college students (males: 47%). The first-order, nine-subscale model was confirmed by CFA in the whole sample. The best evidence from parallel PCA in the training set was in favor of a two-factor model; the bifactor implementation of this model showed good fit in the subsequent CFA. Two main dimensions of positive and negative symptoms underlie schizotypy in non-clinical samples, entailing specific risk of psychosis. On a measurement level, the study provided support for the use of the total scores of the SPQ to characterize schizotypy.

Selon Freud, tous les suicides comportent a la fois le desir de mourir, stimule par une pression d’auto destruction irresistible et l’intention de nuire a l’individu que le suicide pense etre responsable de l’insupportable souffrance qui l’a contraint a mettre fin a ses jours.Cependant, la litterature et les sources ethnographiques montrent a l’evidence trois categories de suicides : avec des intentions manifestement hostiles et agressions suicide par vengeance, essentiellement dans la zone grecque mais egalement observe en Oceanie – le suicide type Samson au Moyen Orient et en Afrique, et suicide par « devouement » essentiellement rencontre chez les soldats Romains.La dynamique de ces formes de suicide peut rendre compte d’autres conduites menacant la vie, telles les attaques par des « hommes bombes » et les comportements pathologiques d’extravagants tueurs qui se vengent en s’immolant pour provoquer le plus grand nombre de victimes possibles, comme dans l’evenement de Colombine.De plus profondes investigations sur les dynamiques exercant jusqu’ici dans la categorie des suicides avec intention hostile pourraient aider a organiser des strategies preventives contre la violence en general.

Data on suicides, attempted suicides and other self-harming behaviours that occurred in Italian prisons from 1990 to 2002 was studied on official records, as documented by the Ministry of Justice. Over the study interval, completed suicide rates in Italian prisons were constantly about ten times higher than among the general population, but over time they did not increase significantly despite nearly a doubling in the absolute number of inmates. The rate of completed suicides in overcrowded prisons was about ten times higher than in non-overcrowded ones. Attempted suicides were about ten times higher than completed suicides, with females being significantly more likely to attempt to take their own lives and males being more likely to complete suicide. Self-injuring acts without the intent to die involve about one in every ten individuals, with foreigners (non-EU citizens mostly) being twice as likely to self-harm than residents. A better identification of the people suffering from mental disorders and a reduction in prison overcrowding are two key issues that need to be implemented to reduce the impact of suicide and self-harming behaviours among convicts.

In order to assess whether substance-abusing people show a higher risk of dying from unintentional acute intoxication in specific periods of the year, and whether this unevenly distributed risk is subject to the same seasonal influences observed in suicide cases, we studied a total of 15 792 drug-related deaths (males = 14259; females = 1533) and 20 332 deaths by suicide (males = 15 571; females = 4761), ascertained in Italy among 15 - 44-year-old people from 1984 to 2000. Distribution of deaths by month was studied with circular statistic techniques, based on the maximization of mean vector length method and the Rayleigh test. The monthly distribution of deaths over the study period followed an uneven trend that clearly differed, however, between the two time-series characterizing suicides and drug-related deaths. A clear seasonal variation was found for suicides in both genders, recurring on a significant circannual cycle. No circannual cycle was observed in the monthly distribution of drug-related deaths, which seem to be influenced by non-casual oscillations following a thrice-yearly cycle, linked to a significantly more evident 6-month recurrence. Some periods of the year, however, are clearly and consistently linked to an enhanced risk of dying by unintentional, acute intoxication by illicit drugs.

This study set out to explore the frequency and correlates of suicidal ideation in a community sample of school-aged adolescents living in a northeastern area of Italy. The study involved a mixed male-female sample of 1,000 adolescents, corresponding to 10% of the young population aged 15-19 in the district. We investigated psychological distress through the revised Symptom Checklist (SCL-90-R), from which we also derived our indicators on suicidality (items concerning hopelessness and suicidal ideation). Propensity to aggression was measured with an Italian version of the Aggression Questionnaire. Females scored significantly higher than males on all SCL-90-R subscales, with the exception of the hostility subscale. In our sample, 30.8% of females and 25.3% of males reported having thought about suicide; one adolescent out of 20 reported suicidal ideation of high intensity (5% out of the total sample in both genders). Males scored significantly higher than females on the Aggression Questionnaire. Both males and females who reported suicidal feelings had significantly higher scores on the Aggression Questionnaire than did those who denied suicidal ideation. Suicidal ideation is a rather widespread occurrence among adolescents and correlates with other indicators of psychological distress. Psychological distress in adolescence might also be expressed through turbulent behaviors and conduct disorders. Identification of the mental disorders underlying a higher propensity to aggression might help to prevent other negative outcomes such as suicide.

OBJECTIVE: To explore the links between propensity to aggression and eating disorders in a sample of school-aged adolescents in a northeastern area of Italy. METHOD: In a mixed male-female sample of 1000 adolescents (10% of the district's population aged 15-19 years) we administered the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh and the Body Attitudes Test, as measures of abnormal eating attitudes and behaviours, and the Aggression Questionnaire, as a measure of the propensity to aggression. RESULTS: Females scored significantly higher than males at all eating disorders inventories (P Language: en

Objective: To explore the links between social desirability and eating disorders in a sample of adolescents in a north-east area of Italy. Method: A mixed male–female sample of 1000 school-aged adolescents, corresponding to 10% of the young population aged 15–19 years living in the district, were investigated with self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Questionnaire (BAT), and an Italian version of the Marlowe–Crowne Social Desirability Scale (MC-SDS). Results: Females scored higher than males at all eating disorder inventories. In both genders there was a negative relationship (in all cases P

Background An increasing number of young people have made contact with the Child and Adolescent Mental Health Services (CAMHS). However, only a small proportion of the population with emotional problems, actually seek specialized care. Research concerning the help-seeking process and pathways to care of a clinical sample could help to develop effective health policies to facilitate access to specialized care. Aim To analyze the access pattern for CAMHS, reasons of contact and care pathways of a consecutive sample of first-time patients. Our aim was to analyze the association between source of referral, socio-demographic and clinical variables. Methods Standardized assessment instruments and information concerning access patterns and care pathways were collected from 399 patients at first-time contact with CAMHS in a Northern Italian Region. Results Most patients were referred to CAMHS by school teachers (36 %) or health professionals (32 %), while only 17 % of the parents sought help by themselves. School issues (50 %) and emotional problems (17 %) were the most frequent reasons for contact. The proportion of first-time contacts with no diagnosis of mental disorder at their first consultation did not differ by source of referral. Parents of children who did not receive a clinical diagnosis of mental disorders described them as “psychosocially impaired” and their condition as “clinically severe” likewise parents of patients who received a psychiatric diagnosis. Patients with externalizing problems were more frequently referred by the parents themselves, while youth with internalizing problems were more often referred through health professionals. Families with non-traditional structures (adoptive, foster care, mono-parental) were more likely to consult CAMHS directly, while immigrant youth were more often referred by teachers. Conclusion Socio-demographic and clinical characteristics can affect pathways to care. To improve early access to care for children and adolescents with ongoing mental disorders, a plan for proper action addressed to teachers and health professionals may well be important. This would improve their ability to recognize emotional and behavioral problems and use proper referral pathways, while informative intervention addressed to non-Italian families should inform them about the functioning and the mission of CAMHS.

Background: The school setting may be the optimal context for early screening of and intervention on child mental health problems, because of its large reach and intertwinement with various participants (child, teacher, parent, other community services). But this setting also exposes children to the risk of stigma, peer rejection and social exclusion. This systematic literature review investigates the efficacy of mental health interventions addressed to children and adolescents in school settings, and it evaluates which programs explicitly take into account social inclusion indicators.Method: Only randomized controlled trials conducted on clinical populations of students and carried out in school settings were selected: 27 studies overall. Most studies applied group Cognitive Behavioural Therapy or Interpersonal Psychotherapy.Results: Findings were suggestive of the effectiveness of school-based intervention programs in reducing symptoms of most mental disorders. Some evidence was found about the idea that effective studies on clinical populations may promote the social inclusion of children with an ongoing mental disorder and avoid the risk of being highly stigmatized.Conclusion: School programs are still needed that implement standardized models with verifiable and evidence-based practices involving the whole school community.

Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research. publishedVersion

Most first lifetime episodes among persons eventually diagnosed with bipolar disorder are depressive, often with years of delay to a final differentiation from unipolar major depression. To support early differentiation, we tested several predictive factors for association with later diagnoses of bipolar disorder.With data from mood-disorder patients with first-lifetime episodes of major depression, we used multivariate, logistic modeling and Bayesian methods including Receiver Operating Characteristic curves to evaluate ability of one or more selected factors to differentiate patients who later met DSM-IV-TR diagnostic criteria for bipolar disorder and not unipolar major depressive disorder.We analyzed data from 2146 patients (642 bipolar, 1504 unipolar) at risk for 13 years following initial depressive episodes. In multivariate modeling for 812 subjects with information on all clinical factors considered, seven significantly and independently differentiated bipolar from unipolar disorders, ranking (by significance): (a) ≥4 previous depressive episodes, (b) suicidal acts, (c) cyclothymic temperament, (d) family history of bipolar disorder, (e) substance-abuse, (f) younger-at-onset, or onset-age25, and (g) male sex; four of these (c, d, f, g) can be identified at illness-onset. Bayesian analysis indicated optimal sensitivity and specificity at 2-4 factors/person and correct classification of 64-67% of cases, and ROC analysis of factors/person yielded a significant area-under-the-curve of 0.72 [CI: 0.68-0.75].In multivariate modeling, 7 factors were significantly and independently associated with bipolar disorder diagnosed up to 13 years after initial depression.

Little is known about the effectiveness of pharmacological interventions on autism spectrum disorder (ASD). This is a systematic review of the randomized controlled trials (RCTs) of oxytocin interventions in autism, made from January 1990 to September 2013.A search of computerized databases was supplemented by manual search in the bibliographies of key publications. The methodological quality of the studies included in the review was evaluated independently by two researchers, according to a set of formal criteria. Discrepancies in scoring were resolved through discussion.The review yielded seven RCTs, including 101 subjects with ASD (males=95) and 8 males with Fragile X syndrome. The main categories of target symptoms tested in the studies were repetitive behaviors, eye gaze, and emotion recognition. The studies had a medium to high risk of bias. Most studies had small samples (median=15). All the studies but one reported statistically significant between-group differences on at least one outcome variable. Most findings were characterized by medium effect size. Only one study had evidence that the improvement in emotion recognition was maintained after 6 weeks of treatment with intranasal oxytocin. Overall, oxytocin was well tolerated and side effects, when present, were generally rated as mild; however, restlessness, increased irritability, and increased energy occurred more often under oxytocin.RCTs of oxytocin interventions in autism yielded potentially promising findings in measures of emotion recognition and eye gaze, which are impaired early in the course of the ASD condition and might disrupt social skills learning in developing children. There is a need for larger, more methodologically rigorous RCTs in this area. Future studies should be better powered to estimate outcomes with medium to low effect size, and should try to enroll female participants, who were rarely considered in previous studies. Risk of bias should be minimized. Human long-term administration studies are necessary before clinical recommendations can be made.

The prevalence of eating disorders (ED) in the community is still under debate, as well as the measure of their impact on the well-being of individuals. It was decided to evaluate the prevalence of eating disorders in an Italian community sample as well as to measure the burden of the quality of life of people and to compare it to those attributable to other chronic illnesses. A community survey of 4,999 people using a questionnaire on health services utilization, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), a semi-structured clinical interview derived from the non-patient version of the DSM-IV (SCID/NP) and Short Form Health Survey (SF-12) was conducted. A total of 3,398 individuals were interviewed (68% of those recruited). Lifetime prevalence for overall ED was 1.7%; for anorexia 0.7%; for bulimia 0.6% and for binge eating disorder 0.5%. ED was more frequent in women than in men. No cases of anorexia in men were identified. ED showed an attributable burden in impairing quality of life with no statistically significant differences with those due to major depressive disorder, bipolar spectrum disorders and Wilson's disease. Of the pathological conditions considered, only multiple sclerosis showed a worsening attributable burden. ED thus has a non-negligible frequency in Italy, with severe impact on quality of life comparable to that produced by severe chronic psychiatric and general medical conditions. These elements emphasize that ED is a serious public health issue.

The Annett Hand Preference Questionnaire (AHPQ) is amongst the most widely used self-report measures of handedness. The psychometric properties of the AHPQ have been rarely evaluated outside the Anglo-Saxon culture where the majority of the studies on the AHPQ were done. In this study, 1,023 students (males=49.5%) from four large high schools operating in the district of Cagliari (Italy) were invited to fill in the Italian version of the AHPQ. The AHPQ was proved to measure a unidimensional latent trait, and the questionnaire was good at assessing deviation from right-handedness with high discrimination between subjects. Some items were more informative than others, and in particular the non-equivalence between the primary and the non-primary actions was confirmed by both the confirmatory factor and the item response theory analysis. The use of the rule of thumb that classifies subjects on the basis of the primary actions was supported for the distinction between consistent right- and left-handed. However, the mixed-handed group identified on the basis of the rule of thumb was not entirely consistent with the mixed-handed class predicted by the latent class analysis. Males were about twice as likely as females to be in the mixed-handed class.

Background: The revised NEO Personality Inventory (NEO-PI-3) includes 240 items corresponding to the Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience) and subordinate dimensions (facets). It is suitable for use with adolescents and adults (12 years or older). The aim of the current study was to validate the Greek translation of the NEO-PI-3 in the general Greek population. Material and methods: The study sample included 734 subjects from the general Greek population of whom 59.4% were females and 40.6% males aged 40.80±11.48. The NEO-PI-3 was translated into Greek and back-translated into English, and the accuracy of the translation was confirmed and established. The statistical analysis included descriptive statistics, confirmatory factorial analysis (CFA), the calculation of Cronbach’s alpha, and the calculation of Pearson product–moment correlations. Sociodemographics groups were compared by ANOVA. Results: Most facets had Cronbach’s alpha above 0.60. Confirmatory factor analysis showed acceptable loading of the facets on their own hypothesized factors and very good estimations of Cronbach’s alphas for the hypothesized factors, so it was partially supportive of the five-factor structure of the NEO-PI-3.The factors extracted with Procrustes rotation analysis can be considered reasonably homologous to the factors of the American normative sample. Correlations between dimensions were as expected and similar to those reported in the literature. Discussion: The literature suggests that overall, the psychometric properties of NEO-PI-3 scales have been found to generalize across ages, cultures, and methods of measurement. In accord with this, the results of the current study confirm the reliability of the Greek translation and adaptation of the NEO-PI-3. The inventory has comparable psychometric properties in its Greek version in comparison to the original and other national translations, and it is suitable for clinical as well as research use.

The goal of this study was to determine whether cases with schizophrenia or related disorders show a history of obstetric complications significantly more often than control subjects and, if so, whether the enhanced risk of a negative pregnancy outcome also extends to the non-schizophrenic offspring of cases. Data based on the obstetric birth case-notes of patients with diagnosed schizophrenia or related disorders were compared to those of normal ‘healthy' control subjects; each case/control pair was individually matched by gender, time and parity of birth, maternal age and marital status. Forty-four case/control pairs born in Padova (Italy) between 1964 and 1978 were assessed for prenatal and perinatal complications, including abnormal gestational age or birthweight. No significant differences were observed between cases and control subjects in the general characteristics of birth; gestational age and birthweight in particular were strictly comparable between cases and control subjects. The schizophrenia spectrum patients (75%) were more likely than control subjects (59%) to have experienced at least one definite obstetric complication: odds ratio=2.07 (95% CI: 0.83–5.15). Cases also suffered more complications per birth than control subjects (average 2:1). In particular, obstetric complications involving a clear damaging potential were seen significantly more often among cases than control subjects: 34% vs. 9%, Fisher's exact test, P =0.008 (odds ratio=5.17, 95% CI: 1.55–17.21). Moreover, severe obstetric complications were noted more often among males ( n =13, 41%) than females ( n =2, 15%). When any previous pregnancies of the mothers of patients were compared with those of the mothers of control subjects, mothers of cases were seen to have suffered unfavorable pregnancy outcomes significantly more often. In particular mothers of cases were seen to have had more miscarriages (OR=4.66), and pre-term births (OR=2.58) than control subects' mothers. Severe, brain-damaging obstetric complications would seem to be a possible antecedent to a diagnosis of schizophrenia or a related disorder in adulthood. Indeed, some early onset cases may be accounted for by prenatal brain lesions. This enhanced risk of negative pregnancy outcome may be under genetic control, contributing to the persistence of schizophrenia in the general population. The ‘healthy' status of control subjects was ascertained indirectly, not by individual assessment of the subjects. The sample size limits the statistical power of calculations.

To investigate the role of sociodemographic factors in the risk of death by homicide in Italy, official statistics from 1980 to 1994 concerning death by homicide have been studied. Homicide rates increase from 1980 to 1994 for males and, to a much lesser extent, for females. Clear differences exist by age and gender, with rates peaking in both genders at young adult age (25-34) and men having five times higher rates than women. Mean rate in the general population is 1.98 per 100,000, one of the highest rates in the civilized world. These findings are mostly influenced by higher homicide rates for both males and females in southern regions, where cultural attitudes towards violence, linked to the greater diffusion of criminal organizations, greatly influence the risk of death by homicide. About 75% of homicides involve firearms: clearly in Italy availability of lethal weapons is a key factor in homicide. Intervention aimed at increasing community awareness of the causes and methods of prevention of violence (including the roles of substance abuse and social inequality) are needed if adequate policies are to be developed to reduce the risk of death by homicide. Differences in homicide rates across countries clearly indicate that homicide is a preventable cause of death.

Despite reports of falling first-admission rates for schizophrenia in some Western countries, methodological problems and bias preclude a definite conclusion about a genuine fall in the incidence of schizophrenia. This study set out to test the hypothesis that first admissions for schizophrenia in Italy have fallen in recent years. All admissions rated as ‘first contact’ in Italy from 1984 to 1994 for severe mental illnesses to general hospital psychiatric services, as reported in the Italian National Institute for Statistics Health-Care Yearbooks, were considered. Data were analyzed as rates per 100 000 in the general population, and changes over time in incidence of schizophrenia, paranoia, affective psychoses and drug-induced psychoses (diagnosed according to ICD 9) were recorded. Changes in rates over time, with rates as the dependent variable and years as the independent variable, were the main outcome measure. First-admission rates for schizophrenia and paranoia increased progressively from 1984 to 1994, as did those for affective psychoses, mania and, to a lesser extent, major depression. In the same period, all admissions (both total and rated as ‘first-contact’) for mental disorders increased. Although linear regression tests for admission rates in most, but not all, cases indicate a significant ascending linear trend, quadratic model results show a significantly better fit than does the simple linear regression model for the majority of data. The change described by the quadratic model suggests an increase in admission rates more marked in the second half than in the first half of the period of the study. First-admission rates for schizophrenia and, to a lesser extent, paranoia seemed to increase concurrent to a decrease in first-admission rates for ‘other’ non-organic psychoses. Contrary to reports from other Western countries, hospital incidence in Italy for schizophrenia is on the increase, as is that for other severe psychoses. This increase is likely to be a reflection of changes in mental health-care organisation, in treatment and diagnostic patterns, and in cultural attitudes towards mental illness. Radical changes in the true incidence of psychoses, in particular of mood disorders, as described elsewhere, cannot be ruled out as contributing factors. Data bias and limitations preclude a generalisation of results, however.

Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological, and sociological research, and the effects of seasonal factors on suicidal behavior have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have generally favored interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are a unitary phenomenon, not influenced by age, gender, or circumstances of the act. In particular, the seasonal occurrence of suicides has been found to differ significantly between the young and the elderly, and differences have also been found between male and female cycles of occurrence. Suicides using violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods (such as drug or gas poisoning), possibly reflecting the greater impulsive component involved in the choice of a violent lethal means. In this paper, findings from Italy are used to illustrate the clinical implications of studies into the topic of season and suicide, with the aim of developing more effective preventative strategies.

To verify if attempted suicides follow different seasonal distributions according to the method chosen, we studied the Italian monthly distribution of admissions for attempted suicide in the period 1984–1995 according to gender and age, distinguishing between non-violent (ICD 950–952) and violent (ICD 953–958) attempted suicides. The effect of temperature was also taken into account. A clear asymmetry in seasonal distribution of events can be observed in the oldest age groups in both genders, with a peak in warmer months. Only male attempted suicides by violent methods show a clear asymmetry in seasonal distribution, with a peak in spring months and a trough in autumn months. Spectral analysis, more accurate in detecting seasonal rhythms than analyses that only compare monthly seasonal means, identifies a circannual rhythm for violent suicides in both genders. The seasonal components of total variance in attempted suicides account for 16.5 and 12.4%, respectively, of violent male and female attempted suicides. Among males, a significant (p < 0.05) 4 cycles/year pattern is seen alongside the more relevant (89.4%, p < 0.01) 1 cycle/year distribution. Among females, aside from the 1 cycle/year distribution (63.3%, p < 0.01) noted, a 6 cycles/year pattern is found to contribute significantly (16.9%, p < 0.05) to the seasonal component of variance. A clear relationship with temperature indicators is noted among males: higher temperatures positively correlate with attempted suicides, whereas cooler temperatures seem to exert a protective action. Female attempts show a less evident correlation with indicators of temperature. Sample composition by age and gender and the lack of distinction between methods of attempted suicide may have obscured the seasonal component of some classes of attempted suicide in previous studies. The circannual rhythm found in this study of violent attempted suicide in relation to climate seasonal change confirms the importance of taking chronobiological variables into account in the evaluation of patients at risk of suicide.

To evaluate suicide risk by profession among eminent artists data from Garzanti's Encyclopaedia, a broad biographical repertory, were used. Six categories in the visual and literary arts were compared: architects, painters, sculptors, writers, poets, and playwrights. Only people whose deaths occurred in the 1800s or 1900s were included since it is likely that underestimation of suicide has been lower in the more recent centuries. A total of 59 suicides were observed in a sample of 3,093 people: this corresponds to a ratio of 1.90%. Suicides were 51 among men (ratio 1.75%) and 8 among women (ratio 4.30%). The comparison by profession indicates that poets and writers exceed the mean suicide ratio of the sample. Painters and architects, conversely, have a clearly lower risk than the mean. Mean age of suicides was 44 yr. ( SD = 12), with writers being slightly older (48 yr., SD = 12) than other artists. Artists who died of causes other than suicide reach a mean of 65 yr. ( SD = 10). Suicide among artists seems to have a peculiar pattern, clearly different from the pattern of the general population, wherein suicide risk is higher among men and older people. Adverse financial circumstances and the stress attributed to rejection of personal products may contribute to the specific risk of suicide among artists. The link between mental disorders, such as manic-depression, which imply a higher risk of suicide, and creativeness is discussed as a contributing factor.

In order to ascertain if and how age, gender and choice of lethal means influence the seasonal distribution of suicide in Italy, data concerning all suicides registered in Italy from 1984 to 1995 have been analyzed, taking these variables into account. In the age group 14–65 years and over a total of 31 771 male suicides (mean yearly rate, 12.6 per 100 000) and 11 984 female suicides (mean yearly rate, 4.4 per 100 000) have been identified in Italy during the study period. Suicides in the younger age ranges, both among males and females, show a less marked asymmetrical seasonal distribution than those in the older age groups. Only suicides committed by violent methods (ICD 953–958) show clear evidence of seasonality, with a peak in spring and a low in late autumn. Suicides committed by non-violent methods (950–952) follow no seasonal trend in either sex. Spectral analysis reveals a circannual rhythm for violent suicides (ICD 953–958) in both genders. For male non-violent suicides (ICD 950–952), a period with a frequency of 0.0833 (12 months) has been identified, but with a polarity opposite to that of male violent suicides. For female non-violent suicides, no period of frequency of 0.0833 could be identified, but, as for female violent suicides, a period with frequency close to 0.2500 (4 months) has been found. Changes in climate, then, correlate with the monthly distribution of violent and non-violent suicides in opposite ways: male violent suicides show a significant positive relationship with indicators of temperature and exposure to the sun, and a significant negative relationship with indicators of humidity and rainfall. Female suicides show less significant relationships with climate indicators. Work aimed at suicide prevention should therefore take into account the complex influence of seasonal climate both on human biological rhythms (particularly on 5-HT related functions and their actions on mood and impulsivity) and on sociorelational habits.

A growing number of studies report an asymmetry in the seasonal distribution of suicides, with a peak in the late spring months for both sexes. The aim of this study is to verify if the climate, apart from its seasonal change, exerts a direct influence on suicidal behaviour. To this end, deaths by suicide in 17 Italian towns which all have a meteorologic station have been analyzed, taking into account some climatic indicators. Results of analyses show an unequal distribution of suicides with respect to latitude, with a peak in the North. The distribution of deaths by suicide shows a negative relationship with mean yearly temperature values, max and min, and with sun exposure indicators, and a positive, but less significant relationship with rainfall values. As far as climatic variables considered as a whole are concerned, stepwise regression identifies three relevant factors with significant relationships to suicide rates: humidity grade, rainfall mean, and sunlight exposure. These three climatic indicators explain up to 63% (Adj R2) of the variance in the distribution of suicide rates for both genders, with sunlight exposure offering the most significant contribution, when regressed on suicide rates via a multiple regression model. Higher suicide rates, therefore, correspond to dry places which are less exposed to the sun. However, the variable which shows the most significant correlation with suicide rates for both sexes is not a climatic one, but the percentage of the population aged 65 and over. The distribution of people at greater biological risk for possible disruption of brain neurochemistry (i.e. older people), therefore, predicts the distribution of suicide rates. Climate contributes to this biological risk by modifying both the responsiveness of the circuits that control mood and behaviour, and also the frequency and intensity of social interaction.

Objective:This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings.Methods:Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation.Results:Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2.Conclusions:The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network.The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato).Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five.Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.

Background The study of hallucination-like experiences (HLEs) in non-clinical populations is increasingly used to corroborate etiological models of psychosis. This method capitalizes on the absence of confounding factors that typically affect the study of hallucinations in clinical subjects. Aim To estimate the prevalence of HLEs in young adults; validate the mutidimensionality and explore the correlates of latent HLEs clusters. Methods Cross-sectional survey design. The extended 16-item Launay–Slade Hallucination Scale (LSHS-E) and the 12-item General Health Questionnaire (GHQ-12) were administered to 649 Italian college students (males: 47%). Confirmatory factorial analysis was used to test multidimensionality of the LSHS-E. Hierarchical nested, progressively constrained models were used to assess configural, metric and scalar invariance of the LSHS-E. Latent class analysis was used to test the existence of different profiles of responding across the identified hallucination-proneness dimensions. Results Factor analysis showed that the four-factor model had the best fit. Factors were invariant across demographic variables and levels of psychological distress. Three latent classes were found: a large class with no HLEs (70% of participants), a multisensory HLEs class (18.8%), and a high hallucination-proneness class (11%). Among those reporting high levels of HLEs, approximately half reported scores indicative of considerable psychological distress. Conclusions Although HLEs have a relatively high prevalence in the general population, the majority of those experiences happen in isolation and are not associated to psychological distress. Approximately half of those individuals experiencing high levels of HLEs report significant psychological distress. This may be indicative of general risk for mental health conditions rather than specific risk for psychosis.

Sparse evidence of a co-aggregation of the risk of schizophrenia and bipolar disorder provides support for a shared but nonspecific genetic etiology of bipolar disorder and schizophrenia. Temperaments are conceptualized as trait sub-syndromic conditions of major pathologies. This study set out to test the hypothesis of a continuum between schizotypy and affective temperaments versus the alternative hypothesis of their independence based on a cross-sectional, survey design involving 649 (males: 47%) college students. The short 39-item TEMPS-A and the SPQ were used as measures of the affective temperaments and of schizotypy, respectively. Confirmatory factor analyses were applied to a unidimensional model, to a standard correlate traits model, to second-order representations of a common latent structure, and to a bifactor model. Confirmatory bifactor modeling provided evidence against a complete independence of the dimensions subsumed by the affective and the schizotypal traits. The best solution distinguished between two sub-domains grouping positive symptoms and negative symptoms as measured by the SPQ subscales, and a sub-domain related to the affective temperaments as measured by the TEMPS-A. Limitations due to the use of subscales from two different tools should be taken into account.

The negative attitudes surrounding mental disorders and their treatment are a major obstacle to the correct identification and treatment of emerging psychopathologies. The purpose of this study was to investigate mental health literacy in a large and representative sample of high school students in Italy, via a booklet containing several questionnaires delivered to 1032 teenagers. The items in the questionnaires probed knowledge about mental health and illness, stigmatization, stereotypes, behaviors, opinions, and attitudes. In general, the students had a reasonable knowledge of mental disorders and were able to distinguish these from somatic disorders. However, a large portion of the students nourished some misconceptions about mental disorders and was also rather skeptical about the effectiveness of treatment or the chance of recovery for people with severe mental disorders. Nevertheless, roughly half of the students reported being willing to provide help to someone with a mental disorder when in need. Poor mental health literacy is a major barrier to seeking help and receiving effective treatment. Young people are the ideal target of raising awareness and antistigma campaigns because they are at a higher risk for developing a psychopathology.

Background The Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Autoquestionnaire (TEMPS-A) is a widely used self-reported tool aimed at measuring the affective temperaments that define the bipolar spectrum, with cyclothymic, depressive, irritable, hyperthymic, and anxious subscales. Confirmatory factor analysis (CFA) was rarely used to confirm the expected five-factor model. Measurement invariance was never tested. Methods Cross-sectional, survey design involving 649 Italian college students (males: 47%). The short 39-item TEMPS-A and the 12-item General Health Questionnaire (GHQ-12) were used as measures of the affective temperaments and of psychological distress, respectively. CFA was applied to the TEMPS-A. Measurement invariance by gender, age and levels of psychological distress on the GHQ-12 was calculated with the establishment of subsequent equivalence constraints in the model parameters across groups. Results The expected five-factor model had the best fit for all CFA indexes. Configural, metric and scalar invariance of the five-factor model of the TEMPS-A was proved across gender, age and levels of psychological distress of the participants. The hyperthymic temperament subscale has low or no links with the other affective temperament subscales, which were interrelated with medium to large effect sizes. Limitations College students might be not representative of the general population. No information on the clinical status of the students was available beyond self-report data. Conclusion The study proved the measurement invariance of the (short) TEMPS-A, which is a pre-requisite to compare groups or individuals in cross-sectional and longitudinal surveys. Generalizability cannot be assumed without replication of the findings in clinical samples.

Background: It has been reported that baclofen, a drug used in the treatment of spasticity, reduces the severity of withdrawal symptoms and substance use disorders (SUDs) for some psychoactive drugs. Aims and Methods: To evaluate the effectiveness and safety of baclofen in the treatment of withdrawal syndrome and/or SUDs, providing (1) an outline of its pharmacological features; (2) a summary of studies that have suggested its possible effectiveness in the treatment of SUDs, and (3) a review of randomized, controlled trials (RCTs) on baclofen and SUDs. Results: Baclofen tolerability is generally considered to be good. Eleven RCTs investigated its effectiveness in the treatment of SUDs. Of these, 5 RCTs found that baclofen is effective, 5 RCTs found that it is ineffective and the results of 1 RCT were not appreciable because it did not achieve the preplanned level of participation. Conclusions: The number of RCTs on baclofen and SUDs is still low, and their results are divergent. Further RCTs should be undertaken, particularly with higher doses of baclofen. Its administration may be suggested in patients who fail to respond to other approved drugs or who are affected by liver disease that prevents their administration, or in patients affected by SUDs for which no approved drugs are available. Treatment should be conducted under strict medical supervision.