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Il problema della violenza nelle persone affette da schizofrenia pone spinosi dilemmi clinici e sociali. Da una parte, il comportamento aggressivo nella schizofrenia può essere una pericolosa, anche se rara, complicanza della malattia. I medici sono tenuti ad anticipare, valutare, gestire e ridurre i rischi di violenza dei loro pazienti, con interventi e trattamenti adeguati. D’altra parte, pazienti psichiatrici capaci di decidere autonomamente, spesso riducono o sospendono il trattamento nel corso del tempo, il che è un loro diritto, e in ogni caso molte cause di violenza non possono essere trattate con i farmaci (Swanson et al., 2008a). Inoltre, concentrarsi semplicemente sul potenziale di violenza dei pazienti, può rappresentare una grossa limitazione nel passaggio verso la “normalizzazione” dei servizi di salute mentale nel territorio; ciò potrebbe addirittura rafforzare la deleteria percezione comune che gli individui affetti da patologie mentali siano pericolosi in generale, e quindi può contribuire indirettamente al rifiuto sociale ed allo stigma di cui le persone con disabilità psichiatriche continuano a fare esperienza nel territorio. I pazienti affetti da schizofrenia non sono, per la maggior parte, violenti. Tuttavia, la malattia conferisce un elevato rischio di violenza in confronto alla popolazione generale. Il rischio è ulteriormente aumentato da concomitanti disturbi da uso di sostanze e dalla non-aderenza al trattamento. La violenza nella schizofrenia è eziologicamente eterogenea. Le evidenze empiriche supportano almeno due sottotipi alternativi di violenza nella schizofrenia: uno in pazienti con storia di comportamenti antisociali nell’infanzia e un altro in pazienti senza questo fattore di rischio. I sintomi psicotici positivi sono legati alla violenza nel secondo sottotipo, ma non nel primo. Questa eterogeneità ha implicazioni in termini di gestione clinica. La violenza nei pazienti schizofrenici con storia di problemi della condotta nell’infanzia è probabilmente meno responsiva al trattamento farmacologico, e gli approcci non farmacologici aggiuntivi sono particolarmente appropriati nei pazienti in cui la violenza persistente non ha risposto ai soli farmaci. Esistono programmi cognitivo comportamentali promettenti. Una gestione efficace deve comprendere la capacità di avere a che fare con i disturbi da uso di sostanze in comorbilità e ogni sforzo deve essere concentrato nel mantenere l’aderenza al trattamento. Il trattamento farmacologico dell’agitazione acuta e dell’aggressività si basa su forme iniettabili di farmaci antipsicotici atipici (ziprasidone, olanzapina e aripiprazolo). Anche il lorazepam è ampiamente utilizzato, a volte in combinazione con l’aloperidolo. La clozapina è il farmaco di prima linea per il trattamento farmacologico a lungo termine del comportamento violento persistente nella schizofrenia. Altri antipsicotici hanno anche degli effetti anti-aggressivi, ma questi sono meno consistenti. Sono stati sperimentati gli anticonvulsivanti, il litio, i beta-bloccanti e gli SSRI, ma le prove per la loro efficacia anti-aggressiva sono limitate.

Introduction There are strong enough evidences of the fact that risk of psychosis is augmented by cannabis use. In a recent analysis, the strongest predictor of case-control status was daily-skunk use, i.e. the ORs for skunk users increase with the frequency of use5. We know also that FEP who smoked cannabis in their lifetime are less neuropsychologically impaired i.e. they have better premorbid and current IQ6. In this study we wanted to test what augments the probability to be everyday users, taking into account premorbid social and academic adjustment and cognition as predictors, along with age at first cannabis-use and % of THC in cannabis used. Methods The sample was made of 834 First Episode Psychosis (FEP) cannabis-using and non-using patients from different European countries and 1.061 healthy controls, as part of the EUGEI-STUDY. A logistic regression was computed, using frequency of cannabis use among those who reported to have used cannabis in their lifetime, as an outcome variable in order to estimate the risk to be an everyday-user (heavy user) or a less-than-everyday user (recreational user), taking into account a list of predictors: sociodemographics, age at first cannabis-use, % of THC, premorbid social factor (PSF), premorbid academic factor (PAF), extracted from the Premorbid Adjustment Scale (PAS) and the four scales of WAIS-brief version. Results The risk to be an everyday-smoker was higher for cases, in interaction with age at first use, i.e. while the risk of controls diminishes when age at first use increases, this is not true for cases, whose risk stay higher even when age at first use increases (OR=1.2, p=0.001, CI 95% 1.09, 1.45). THC absolute concentration >10% augmented almost 2 folds the risk to be an everyday-smoker (OR=1.8, p=0.001, CI 95% 1.29, 2.60). A lower premorbid academic adjustment (OR=0.8, p=0.040, CI 95% 0.68, 0.99) and higher premorbid social adjustment before 16 years (OR=1.6, p=0.019, CI 95% 1.08, 2.60) increased the risk to be a heavy cannabis user, along with having a lower education level and being unemployed (all p

Background: Several studies report that patients with psychosis who used cannabis have a better cognitive performance than those whodid not (Rabin et al. 2011). In a previous study we found out a higher premorbid IQ, and a better IQ in psychotic patients who smoked cannabis in their lifetime, and our findings were consistent with the idea that this association is due to a better premorbid functioning rather than to an ameliorative effect of cannabis use on cognitive performance (Ferraro et al., 2013). A number of authors have hypothesized that psychotic patients who consume cannabis constitute a differentiated subgroup of patients that have better cognitive and social skills, necessary to engage in illegal drug consumption, than non-using patients (Compton et al., 2011; Løberg et al., 2014; Arnold et al., 2015). Given that the prevalence, and patterns, of cannabis use are culturally driven, we wanted to test the hypothesis of a better premorbid functioning in First Episode Psychosis (FEP) cannabis-using and non-using patients coming from different European countries (England, Italy, Spain, France, the Netherlands) as part of the EUGEI-STUDY. Methods: 1.745 people (746 cases; 999 controls) completed the assessment for Intellectual Quotient (IQ) (WAIS-brief version) premorbid adjustment (Premorbid Adjustment Scale – PAS) and cannabis use (CEQ-Revised). We first performed a factor analysis on PAS components, by obtaining two main factors: “Premorbid Social Adjustment” (PSA) and “Premorbid Academic Adjustment” (PAA). We therefore performed linear mixed models with IQ, PSA, and PAA as dependent variables and cannabis lifetime (Yes/No), subject status (Cases/Controls), gender and age as independent variables. Results: Across all countries, IQ was higher in those patients who smoked cannabis in their lifetime compared to those who did not (P = 0.027). This IQ difference was only 3 points and was the same for cases and healthy controls (P = 0.949). Similarly, patients who had smoked cannabis in their lifetime showed better PSA scores than non users (P = 0.009). The difference in PSA score between cannabis-users and non-users was significantly greater in cases than controls (P = 0.038). Conversely, across all countries, PAA resulted worst in patients who smoked cannabis lifetime than patients who did not (Po0.001) and this PAA score difference was the same for cases and controls (P = 0.693). Discussion: Our cannabis-using FEP patients have higher IQ, better PSA and lower PAA than non user patients across 5 different European countries. Starting from these preliminary results, we can conclude that a better PSA is significantly associated with cannabis use in FEP patients. Nevertheless, in an exploratory analysis, a better IQ resulted related to a better PAA (o0.001) but not to PSA (P = 0.260); thus indicating an independent relationship of IQ and PSA with cannabis use. Further analysis are required in order to model these multivariate relationships.

IntroductionA number of authors have hypothesized that psychotic patients who consume cannabis constitute a differentiated subgroup of patients that have better cognitive and social skills, necessary to engage in illegal drug consumption, than non-using patients.ObjectivesGiven that the prevalence, and patterns, of cannabis use are culturally driven, we wanted to study first-episode psychosis (FEP) cannabis-using and non-using patients coming from different European countries as part of the EUGEI-STUDY.AimsWe tested the hypothesis of better premorbid social adjustment in cannabis-using FEP patients, by comparing them to FEP non cannabis users and to their respective healthy controls.MethodsA total of 1745 people (746 cases; 999 controls) completed the assessment for premorbid adjustment [Premorbid Adjustment Scale (PAS)] and cannabis use (CEQ-Revised). We first extracted the Premorbid Social Adjustment Factor (PSA) from PAS and then performedlinear mixed models with PSA as dependent variable and cannabis lifetime (Yes/No) and subject status (Cases/Controls) as independent variables. We then considered “Country” as random intercept.ResultsAcross all countries, PSA scores were better in patients who had smoked cannabis in their lifetime than patients who had not (P = 0.009). The difference in PSA score between cannabis users and non-users was significantly greater in cases than controls (P = 0.038). The relationship between PSA, cannabis lifetime (Yes/No) and subject status among nations (random intercept) is shown on Fig. 1.ConclusionsCannabis-using psychotic patients show better premorbid social adjustment than non-using patients, across 5 European countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Il capitolo descrive Il progetto “Interventi Psicologici e Riabilitativi nei Reparti ad alta Criticità” Nato da una collaborazione tra l’Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” dell’Università degli Studi di Palermo e l’Assessorato della Salute della Regione Sicilia, si è inscritto nel Progetto Obiettivo di Piano Sanitario Nazionale (intesa Stato Regione del 20/04/2011) con l’obiettivo di rispondere all’esigenza di ascolto e sostegno che molte persone sperimentano attraversando momenti critici, in grado di mettere a dura prova la loro qualità di vita. Avvalendosi di una equipe di psicologi che, nel primo anno ha annoverato tre unità, affiancate da un Tecnico della Riabilitazione Psichiatrica e che si è arricchita di ulteriori sei unità nella seconda annualità, ha operato in seno ai diversi reparti del Policlinico, con l’obiettivo di offrire interventi di prevenzione e presa in carico del disagio psicologico. Oltre al tempo ed al numero di interventi effettuati tra il gennaio 2013 e l'ottobre 2014 si esaminano gli obiettivi raggiunti e quelli da raggiungere. I punti di forza del progetto possono essere, in sintesi riassunti come segue: 1. L’attivazione del progetto è stata in grado di stimolare una sensibilizzazione importante in molte delle Unità Operative coinvolte nella fase di pubblicizzazione, facendo sorgere la richiesta di una presenza mensile per il monitoraggio degli utenti di alcune di esse (ad es. Malattie Infettive, Ambulatorio di Terapia del Dolore ed Audiologia). 2. I pazienti inviati in consulenza erano in effetti portatori di un disagio psicologico cui è stato prestato ascolto. 3. Gli interventi effettuati si sono dimostrati benefici in termini di outcome sintomatologico.

Purpose: several studies report that patients with psychosis who used cannabis in their lifetime have a better cognitive performance than those who did not and this association is most likely due to a better premorbid functioning. We aimed to test the hypothesis of a better premorbid functioning in First Episode Psychosis (FEP) cannabis-using and non-using patients coming from different European countries. Materials and Methods: 1.745 people (746 cases; 999 healthy controls) completed the assessment for Intellectual Quotient (IQ) (WAIS-brief version) premorbid adjustment (Premorbid Adjustment Scale – PAS) and cannabis use (CEQ-Revised). We first obtained two main factors from PAS: “Premorbid Social Adjustment” (PSA) and “Premorbid Academic Adjustment” (PAA). We therefore performed linear mixed models with IQ, PSA, and PAA as dependent variables and cannabis lifetime (Yes/No) and subject status (Cases/Controls) as independent variables. Results: across all countries, IQ was higher in cannabis users patients compared to non users (p=0.027). Conversely, PAA resulted worst in cannabis-users patients than non users (p

IntroductionAlthough the diagnosis of bipolar disorder is currently based on clinical criteria, preliminary studies showed that palmitic and arachidonic acid levels are able to discriminate adult patients with major depressive disorder (MDD) from those with bipolar disorder (BD).ObjectivesTo replicate and to expand previous findings by investigating the relation between mood disorders and platelet and plasmatic fatty levels.AimsTo compare the lipidic profile of individuals with different mood disorder (MDD vs. BD) and to investigate the relation with specific clinical features (duration of illness, attempted suicide, psychotic symptoms).MethodsPotential participants were recruited from the outpatient and inpatient psychiatric units of the university hospital of Palermo (Italy). Diagnosis of DSM IV mood disorders was made using the MINI. Symptom severity was assessed using the HAM-D rating scale and the YMRS. Fatty acid profile was analyzed using mass spectrometry.ResultsPreliminary analyses were performed on 8 patients with MDD and 6 with BD. Groups were similar in terms of demographic variables. Patients with MDD showed highest levels of platelet palmitic acid, stearic acid, and arachidonic acid. Furthermore, plasmatic docosahexaenoic acid was negatively related with manic symptoms severity (Rho = –0.697; P = 0.025) and platelet alpha linolenic acid was positively related with illness duration (Rho = 0.845; P = 0.040).ConclusionsThese preliminary findings suggest that platelet fatty acids may be possible biological markers to improve the diagnosis of BD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Paul Bebbington's recent Special Article provides an excellent synthesis of recent advances in psychosocial research on psychosis. However, we doubt that a model based solely on social epidemiology and cognitive theory can totally describe psychosis, and to be fair, Bebbington does not suggest that it does. A complete model must also incorporate what we have learned from non-social epidemiology, neuroscience, and genetics. Evidence indicates that both the social risk factors that interest Bebbington and biological risk factors, such as abuse of stimulants and cannabis, can provoke psychotic symptoms by dysregulating striatal dopamine. The role of neurodevelopmental deviance also needs to be considered in the etiology of schizophrenia-like psychosis. Moreover, the striking advances in our understanding of the genetic architecture of psychosis open an exciting door into studies examining gene-environment correlation and gene-environment interaction. In short, Bebbington demonstrates the value of cognitive and social researchers talking to each other, but the occasional chat with the more biologically inclined could produce a more comprehensive model.Paul Bebbington 最近发表的专题文章对精神病的社会心理学研究的最新进展做了一个极好的综述。然而，我们对一个仅仅基于社会流行病学和认知理论的模型可以完全描述精神病持有疑虑，并且公平地说，Bebbington 也不认为这个模型可以完全描述。一个完整的模型必须纳入我们从非社会流行病学、神经科学和遗传学中汲取的经验教训。有证据表明，Bebbington 感兴趣的社会风险因素，和诸如滥用兴奋剂和大麻之类的生物危险因素都可以通过纹状体多巴胺失调而激发精神病症状。在精神分裂症样精神病的病因学中，我们也需要考虑神经发育异常。此外，我们对精神病的遗传学理解上的惊人进展为研究探讨基因- 环境相关性和基因-环境相互作用打开一扇令人兴奋的大门。总之，Bebbington 阐述了认知领域的学者与社会研究者互相交流的价值，但偶尔更倾向于生物学方面的角度可能发展出一个更全面的模型。.本文全文中文版从2015年8月6日起在http://dx.doi.org/10.11919/j.issn.1002-0829.215067可供免费阅览下载.

Lo stalking descrive una varietà di comportmanti di minaccia e di controllo, messi in atto intenzionalmente dall'autore allo scopo di provocare paura nella propria vittima. Nel corso degli ultimi vent'anni questa condizione è diventata oggetto di attenzione giuridica e clinica. é noto che più della metà degli stalker afferenti ai servizi psichiatrici e giudiziari è affetta da almeno un disturbo psichiatrico in comorbilità, tuttavia ad oggi non esiste un inquadramento diagnostico univoco del fenomeno che viene di volta in volta accostato alle esperienze psicotico, ai disturbi ossessivo-compulsivi ed alla psicopatia.

Introduction Given the centrality of insight in promoting change, the relevance of measures for assessing this construct has become increasingly clear. This paper describes a new self-report measure for assessing some of the characteristics of insight, the insight orientation scale (IOS). Aims In study 1, we evaluated the factor structure and the reliability of the scale. In study 2, we analyzed the concurrent and discriminant validity of the scale in patients with different clinical diagnoses. Methods In study 1 participants were 600 individuals (41.1% male, 58.9% female) with a mean age of 33.95 years (SD = 13.04). In study 2 participants were 136 individuals divided into the following groups: 1) schizophrenia spectrum and other psychotic disorders ( n = 26); 2) substance-related disorders ( n = 55); 3) depressive disorders ( n = 27); and 4) personality disorders ( n = 28). Instruments Instruments are the insight orientation scale (IOS) and the Beck cognitive insight scale. Results The goodness-of-fit indices showed a satisfactory fit of a one factor model. We found also a good internal consistency (α = .77). Conclusions These findings support the dimensionality of the IOS and suggest that it may be useful as an assessment tool for use in guiding psychotherapy.

clinical practice identifies the reactivation of reality testing as the most achievable and desirable aim in the healthcare-specialized treatment of psychosis. In summary, in the cases of psychotic onset and similar scenarios, a positive intervention is represented by those circumstances in wich the patient is able to regain his status quo ante the acute phase of the disorder. This phase, just to be clear, is the on throughout which the most representative symptoms, such as delusions and hallucinations, arise determining the dissociative state-. In addition, if during the reorganization of reality testing thethe patient is able to have a critical position relating to his acute state, and thus, an acknowledgement that what he has gone through was just a period of "alteration of the normal neuropsychological functioning" or a "psychopatological disorder", syntesisable as the concept of "mental disease", then the most desirable therapeutic aim can be considered achieved. At that point , the healthcare staff will be able to deem that phase as being over, with the hope that no further episode occurs in the future, which would indicate a non-chronic development. In these circumstances, the acute phase is seen as a brief interval throughout which we have dealt with the disease in a sort of surgical way, as is with the removal of a cancerous tissue.Our experience, gathered over a ten-year period of clinical practice, has led us to believe that, if we listen and pay attention to the psychotic contents in the acute and non-acute phases, the therapeutic pathway may obtain benefits. This highlights the potential of the integration of a psychotherapeutic component and medical care as a way to alleviate the various forms of suffering, in addition to the usual treatments of psychosis.The integration also gives meaning to the personal experience of disease and, in the more opportune cases, reduces the dissociative relapses significantly.

Il Cyberstalking è una forma diffusa di molestia effettuata tramite l'utilizzo delle nuove tecnologie, come e-mail, chat e social network. Si stima che tra il 2-13% e l'8-32% delle donne negli Stati Uniti è vittima di cyberstalking. Il crescente interesse per questo nuovo crimine informatico è testimoniato dal recente adeguamento del sistema legislativo italiano (art. 612-bis del Codice Penale). Le azioni dei cyberstalker potrebbero essere mosse dal desiderio di vendetta, da un'ossessione d'amore o dalla ricerca di intimità.

Introduction A growing awareness of psychological and functional impairment due to burns have led to the development of specific instruments to evaluate Quality of Life in this population, such as the Burn Specific Health Scale - Brief (BSHS-B), whose psychometric properties have been consistently verified. The aim of this study was to translate the BSHS-B into Italian and to investigate its reliability and validity. Methods Translation procedures were carried out according to accepted standards. Internal reliability was assessed using Cronbach's alpha coefficient. Concurrent validity was evaluated through correlations between the BSHS-B and the Short-Form 36 Health Survey (SF-36), the Self-report Clinical Inventory (SCL-90), and the Body Uneasiness Test (BUT). Results The overall Cronbach's alpha value for the scale was 0.887. Significant correlations were found between the Italian BSHS-B domains, the SF-36 subscales (Spearman's rho: 0.184-0.414), and several SCL-90 subscales (Spearman's rho: -0.173 to -0.477). Furthermore, the affect and relationship domain and the skin domain of the BSHS-B negatively correlated with the compulsive self-monitoring and depersonalization subscales of the BUT. Conclusion The Italian translation of BSHS-B has shown satisfactory internal consistency, criterion validity, and convergent validity, supporting its application in routine clinical practice as well as in international studies. © 2013 Elsevier Ltd and ISBI.

Introduction: A growing body of literature suggests that people affected by psychotic disorders are more likely to be unemployed, tend to live alone, have a poor social network, and are not able to establish long-term relationships (Morgan et al., 2008). Aims: To investigate social disadvantage in a sample of first-episode of psychosis patients and geographically matched controls. Methods: The study sample consists of 52 healthy controls and 37 FEP who were assessed using the MRC Sociodemographic Schedules. Results: Preliminary results suggest that, consistently with the literature, cases are more exposed than controls to social disadvantage. They tend to reach a lower education degree (OR 6.66; CI 95%, 1.67-26.50, p 0.005) and to have an underpaid job 5 years before the onset (OR 2.84; CI 95%, 1.08-7.45, p 0.03). Furthermore, cases are more likely to live longer with their parents rather than independently (OR 3.33; CI 95%, 1.25- 8.86, p 0.01) and are more exposed to house overcrowding (OR 3.92; CI 95%, 1.03-14.93, p 0.05). It was also found that an higher percentage of cases have never been in a stable relationship in the previous 5 years (OR 2.61; CI 95%, 1.08-6.27, p 0.03). Conclusions: In line with the previous literature, we found that lower educational and occupational status and poor relationship status are associated to risk for psychosis. However, in contrast with North European cases, Italian FEP are more likely to live with their family rather than alone and, therefore, to be exposed to house overcrowding. Morgan C, Kirkbride J, Hutchinson G, Craig T, Morgan K, Dazzan P, Boydell J, Doody GA, Jones PB, Murray RM, Leff J, Fearon P. Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study. Psychol Med. 2008; 38(12):1701-15.

In their provocative paper, Bentall and Varese (2012) criticize our review on child abuse and schizophrenia (Sideli, Mule, La Barbera, & Murray, 2012) and suggest that we have a biological bias whi...

Introduction: Cannabis is one of the most common substances used by patients with a first episode of psychosis. The aim of the study was to investigate the most frequent effects of cannabis use, their relationship with psychotic symptoms and characteristics of the consumption. Methods: 116 first episode psychosis were recruited, 50% of which (n=58) used cannabis lifetime. We investigated the characteristics of the consumption and the effects of cannabis using the Cannabis Experience Questionnaire-mv (CEQmv) and the psychotic symptoms using the Positive and Negative Symptoms Scale (PANSS). Results: The effects more often experienced by cannabis users were slowed down thinking and feeling to be able to understand the world better. Feeling fearful was associated with interruption of consumption (U= 287,500, p=0.046). Hearing voices was associated with more than 50 times lifetime cannabis use (U=223,00, p=0.043). In addition, we found correlations between feeling fearful and like going crazy after cannabis use and positive and general PANSS. Conclusions: Those who have experienced more psychotic-like effects of cannabis present stronger positive symptoms. In addition, awareness of negative effects involves the interruption of consumption. These evidences underline the importance of primary and secondary prevention regarding the effects of cannabis use among people at high risk for psychotic disorders.

Background: A number of studies have reported that patients with psychosis who use cannabis have better cognitive performance than those who do not. This is surprising as cannabis can impair cognition in healthy subjects. An obvious question is whether the better current performance of psychotic patients who have used cannabis is a reflection of their having a higher premorbid IQ than those psychotic patients who haven't used cannabis. Aim: In a sample of patients at their first episode of psychosis, we tested the hypothesis that patients who smoked cannabis would have a higher premorbid IQ than patients who did not. Methodology: 279 participants (119 patients and 160 healthy controls) were assessed in order to obtain current and premorbid IQ measures and detailed information on cannabis use. We examined the association between cannabis use and both premorbid and current IQ in patients and controls. Results: Patients who had ever smoked cannabis had significantly higher current (p < .001) and premorbid IQ (p = .004) compared to patients who had never used cannabis. This difference was not found among controls. Conclusions: These findings suggest that the better cognitive performance of patients with their first episode of psychosis who have used cannabis compared with those who haven't is due to the better premorbid IQ of the former.

lo studio ha confrontato le funzioni esecutive di pazienti con disturbi psicotici coinvolti in programmi riabilitativi in Strutture Residenziali di Palermo. Metodi: sono stati reclutati 16 utenti di Comunità Alloggio (CA) e 14 utenti di Comunità Terapeutiche Assistite (CTA), tra 18 e 65 anni, valutati tramite somministrazione di Trail Making Test(TMT), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Stroop Test, 4 subtest della WAIS-R e Brief Psychiatric Rating Scale (BPRS). Risultati: i due campioni presentano caratteristiche sociodemografiche omogenee. Gli utenti delle CTA fanno rilevare maggiore uso di neurolettici (73,3% vs. 18.8% p 0,004) e un trend non significativo di minore espressività sintomatologica (BPRS: 2,39 vs. 2,58); essi, inoltre, sono maggiormente coinvolti in interventi riabilitativi avanzati con uso di tecniche cognitive (40,0% vs. 6,3% p 0,037) ed espressive (83,3% vs. 16,7% p 0,000) e presentavano migliori prestazioni cognitive al FAB(p 0,048), agli Errori Perseverativi del WCST(p 0,000) e allo Stroop Test(p 0,027). Conclusioni: l’analisi dei risultati suggerisce che gli utenti delle CA presentano deficit in differenti domini cognitivi, maggiore difficoltà a distribuire l’attenzione tra più compiti simultanei e scarsa flessibilità cognitiva, riconducibile a storia clinica e durata di trattamento antipsicotico più datati. Pertanto, la maggiore partecipazione degli utenti delle CTA in training riabilitativi intensivi,cognitivi ed espressivi, potrebbe spiegare il più efficace recupero delle funzioni esecutive studiate. Bibliografia Addington J, Girard TA, Christensen BK, et al. Social cognition mediates illness-related and cognitive influences on social function in patients with schizophrenia-spectrum disorders. J Psychiatry Neurosci 2010;35:49-54. McGurk SR, Mueser KT. Cognitive functioning,symptoms, and work in supported employment: an review and heuristic model. Schizophr Res 2004;70:147-73. Krabbendam L, Aleman A. Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled

La gestione del paziente oncologico in corso di trattamento radioterapico non può prescindere da un’attenta valutazione delle variabili soggettive legate all’emotività e al vissuto interno. Questo lavoro si pone gli obiettivi di indagare la presenza di alessetimia, ansia, depressione e qualità della vita in un gruppo di pazienti oncologici e di valutare in che termini l’introduzione di un intervento psicologico possa avere delle ricadute sul benessere psico-fisico.Il campione è costituito da 68 pazienti suddivisi, con modalità random, in un gruppo sperimentale (n= 45) e uno di controllo (n=23), reclutati presso due U.O di Radioterapia di Palermo e di Pisa. Entrambi sono stati valutati al T0 (prima del trattamento), T1 (inizio del trattamento), e al T2 (fine del trattamento). Il gruppo sperimentale è stato sottoposto ad un intervento psicologico-supportivo tramite la tecnica cognitiva del diario. Nel gruppo sperimentale abbiamo riscontrato una riduzione statisticamente significativa dei livelli di alessitimia (p

Research in obsessive-compulsive disorder (OCD) produced inconsistent results in demonstrating an association between patients’ symptom severity and their cognitive impairments. The process involved in volition aspects of behavioral syndromes can be extensively analyzed using specific tests developed in virtual environments, more suitable to manipulate rules and possible breaks of the normal task execution with different, confusing or stopping instructions. The study involved thirty participants (15 OCD patients and 15 controls) during task execution and the relative interferences. At this purpose, the virtual version of Multiple Errands Test was used. Virtual reality setting, with a higher ecological validity respect to a classic neuropsychological battery, allowed us to take into account deficits of volition and the relative dysexecutive functions associated with OCD patients. The proposed paradigm also allows the development of innovative prototypes of coevolving technologies based on new theories and models and deeper understanding of human behavior.

Background: Additive interaction between childhood trauma and cannabis use in increasing risk for psychotic disorders has been recently demonstrated in a prospective (Harley et al., 2009) and a cross sectional study (Konigs et al., 2011), although not replicated in another survey (Kuepper et al., 2011). This study aimed to analyse additive interaction between lifetime cannabis and severe child abuse in increasing the risk for psychosis in a sample of first episode psychosis patients and geographically matched controls. In addition, analyses were re-run separately for males and females in order to investigate whether the association was moderated by gender. Methods: The sample consisted of 231 patients with psychosis at their first admission to the South London and Maudsley Mental Health NHS Foundation Trust, and 214 controls. Severe childhood trauma was assessed using the Childhood Experience of Care and Abuse Questionnaire (Bifulco et al., 2005) and it was defined as history of any physical abuse involving injuries or any sexual abuse involving intercourse which occurred before age of 17 years. Lifetime cannabis use was assessed using the Cannabis Experience Questionnaire modified version (Di Forti et al., 2010). Results: Controlling for ethnicity, level of education, and psychiatric family history, both childhood abuse (Adj OR1.87, 95%CI 1.08-3.21) and lifetime cannabis use (Adj OR 1.89, 95%CI 1.18-3.00) were associated with an increased risk for psychosis. Moreover, the joint effect of early trauma and cannabis use (Adj OR 3.82, 95%CI 1.79-8.14) was higher than the effect of either variable alone, suggesting an additive interaction between them. Although cannabis × trauma interaction was observed both in males and females, the effect appeared stronger in the latter group. Discussion: Our findings support the previous literature about an additive interaction between childhood trauma and cannabis use in increasing risk for psychosis.

INTRODUCTION: IntroductionaaAlthough childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues. METHODS: Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results. RESULTS: An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated. CONCLUSION: Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors. Language: en

Executive functions are often impaired in obsessive compulsive disorder (OCD). We used a Virtual Reality (VR) version of the Multiple Errand Test (MET) inside a virtual supermarket, in order to evaluate the executive functions in daily life in 10 OCD patients and 10 controls. It is performed in a shopping setting where there are items to be bought and information to be obtained. The specific goal of this study was to implement a tool for the assessment of executive functions.

Background: The incidence of psychotic disorders varies in different geographical areas (McGrath 2004). Recent data suggest that the incidence is higher in males, migrant minorities and in urban areas. There aren’t many available epidemiological data on the incidence of psychotic disorders in Italy. This is the first incidence study on psychotic disorders carried out in Palermo, the capital of Sicily. Methods: we screened all patients presenting with their first episode of psychosis to the mental health services of our catchment area (5 inpatient, 5 outpatient units and 3 private psychiatric hospitals) over a period of three years (2008-2011). The diagnosis of psychosis was defined using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN Wing, J. K., et al., 1990).The main socio-demographic data were collected using the MRC Social Data Schedule. When subjects were not available (did not consent) for interview, information was collected from clinical notes. The population at risk referred to the people aged from 18-65 who were resident in the same catchment area (Palermo Municipality) in the period considered, according to the data of the Statistic Office of Palermo Municipality). Results: we identified 216 patients affected by a first episode of psychosis (FEP): 135 M (62.5%) and 81 F (37.5%), mean age 31.42 years (SD: 11.44). 77.1% of FEP had a diagnosis of non affective psychosis, 12.8% of affective psychosis and 10.1% received a diagnosis of other psychosis. 204 subjects were Caucasian, 12 non Caucasian belonging to various ethnicities and they were all first generation migrants (4 Indian, 3 African, 2 Bangladeshi, and 3 Mixed). Population at risk is 425.194 people. The mean age of onset was lower in men than women M: 29.98 years (SD: 10.41) vs. F: 34.28 (SD:12.64) (p=0.013)The incidence of psychotic disorders in our catchment area is 16,9 per 100.000 person years. It was higher in men 21,9 per 100.000 than women 12,2 per 100.000. Discussion: Our study is the first epidemiological study in Sicily investigating the incidence of psychotic disorders. In our population men have a higher incidence of psychotic disorders than women and an earlier age of onset.

L’allarme sociale in ordine agli abusi sessuali sui minori è accresciuto negli anni unitamente alla consapevolezza dell’importanza della tutela del minore e del valore fondamentale delle sue relazioni nel corso dello sviluppo. Il presente studio intende essere un contributo di conoscenza su una specifica categoria di abusanti: i minorenni. Uno studio delle peculiarità di tale fenomeno è premessa indispensabile per predisporre idonee ed efficaci strategie di trattamento. Al fine di identificare il numero e le caratteristiche dei minori abusanti si è proceduto a consultare i fascicoli del Tribunale per i Minorenni di Palermo relativi ad un periodo compreso fra il 2005 e il 2009. Tale indagine ha permesso di censire 67 procedimenti a carico di presunti aggressori sessuali minorenni. I dati analizzati hanno rivelato una significativa associazione fra abusi e ambienti sociali degradati (contraddistinti da alto tasso di disoccupazione tra i genitori, precarie condizioni abitative, precedenti penali in famiglia) e il ricorrere di eventi di vita avversi, idonei a determinare ripercussioni sulla sfera psichica. In 11 casi (16,5% del totale) il sospetto abusante era stato a propria volta vittima di abusi sessuali o maltrattamenti. L’analisi ha rivelato, inoltre, la sussistenza di disturbi mentali di rilevanza clinica su 12 dei 67 minori processati. Le diagnosi più comuni sono state quelle di disturbi di personalità (cluster “B”, cosiddetto “drammatico”) e di ritardo mentale. In alcuni casi l’inquadramento clinico è variato nel corso del processo a seguito di nuove osservazioni cliniche, effettuate da altri operatori, o all’avvio di terapie psicologiche e farmacologiche. Lo studio ha mostrato come, nelle prime fasi dei procedimenti, non siano stati progettati specifici interventi terapeutici e di supporto centrati sull'abusante sessuale.

Introduzione: La gestione del paziente oncologico in corso di trattamento radioterapico non può prescindere da un’attenta valutazione delle variabili soggettive legate all’emotività e al vissuto interno del paziente, essendo tali aspetti implicati nella compliance al trattamento (Neilson et al., 2010). Questo lavoro si pone un duplice obiettivo: indagare la presenza di ansia, depressione e qualità della vita in un gruppo di pazienti oncologici non omogeneo per patologia, stadio della malattia e trattamento; valutare in che termini l’introduzione di un intervento psicologico possa avere delle ricadute sul benessere psico-fisico dei pazienti. Metodologia: Il campione è costituito da 50 pazienti suddivisi, con modalità random, in un gruppo sperimentale e uno di controllo. Strumenti: Toronto Alexithymia Scale (TAS-20, Taylor GJ,1992), EORTC QLQ-C30-BR23 (Fayers PM et al 1998), HADS (The Hospital Anxiety and Depression Scale, Zigmond e Snaith 1983), Scheda “Credenze e aspettative nei confronti del trattamento”. Per il gruppo sperimentale è previsto uno spazio di ascolto e condivisione dei vissuti legati al trattamento mediante compilazione e lettura di un diario. Risultati: si attende di riscontrare una riduzione dei livelli di ansia e di depressione, un miglioramento della qualità della vita e una maggiore compliance al trattamento nei pazienti del gruppo sperimentale. Conclusioni: Interventi di tipo psicologico costituirebbero un valido aiuto per i pazienti nel fronteggiare paure e angosce legate alla malattia e per migliorare la loro qualità della vita. La ricerca-intervento è ancora in corso di sperimentazione per cui i risultati definitivi saranno discussi in sede congressuale. Bibliografia: Fayers PM., Aaronson NK., Bjordal K., Groenvold M., Curran D., Bottomley A. (2001), EORTC QLQ-C30 Scoring Manual (3rd edition), EORTC Quality of Life Group, Brussels. Neilson KA., Pollard AC., Boonzaier AM., Corry J., Castle DJ., Mead KR., Gray MC., Smith DI., Trauer T., Couper JW. Psychological distress (depression and anxiety) in people with head and neck cancers. Med J Aust. 2010 Sep 6;193(5 Suppl):S48-51. Taylor GJ, Bagby RM., Parker JDA. (1992), “Toronto Alexitymia Scale” in Caretti Vi., La Barbera D., “Alessitimia, Valutazione e Trattamento”, Astrolabio, Roma, 2005.

Classification of glaucomatous visual field defects for different severity levels is important. The reasons for this are numerous, and include: to distinguish between healthy and diseased individuals, to have homogeneous grouping criteria when perimetry is used to define the severity of glaucoma, to adjust therapy on the basis of disease severity, to describe visual field conditions in a short and simple format, to monitor the progression of the disease, and to provide a common language for both clinical and research purposes. Many severity classification methods have been proposed, although none have had widespread use in clinical practice. Other methods, like the cumulative defect curve (Bebie curve), can be used to distinguish the type of visual field loss as diffuse, localized, or mixed. This article provides a review of the main classification methods that have been proposed in the past 40 years.

Introduzione: Il presente lavoro indaga la qualità delle reazioni emotive e psicologiche delle pazienti affette da cancro mammario, sottoposte a intervento chirurgico e in diversi stadi di malattia. Metodologia: Il campione è composto da 110 pazienti così suddivise: 40 in follow-up, 41 sottoposte a chemioterapia adiuvante, 29 metastatiche. Strumenti: Defense Mechanisms Inventory (DMI, Ihilevich e Gleser, 1986), Toronto Alexithymia Scale (TAS-20, Taylor GJ,1992), EORTC QLQ-C30-BR23 (Fayers PM et al 1998). Risultati: Nei tre gruppi si rivela differenza alle scale F1 (p

Una buona capacità di insight pare costituire un fattore predittivo di minore espressività psicopatologica nei pazienti affetti da psicosi. In questo lavoro intendiamo analizzare le relazioni tra grado di insight e gravità dei sintomi psicotici utilizzando i punteggi totali e parziali ottenuti alla Positive and Negative Syndrome Scale (PANSS) in un gruppo di pazienti affetti da psicosi all'esordio nell'ambito del progetto SGAP "Sicilian Genetic and Psychosis" svolto in collaborazione con il GAP Study dell'Institute of Psychiatry, King's College of London.

Aim: The study aimed to inquire place attachment bonds in a sample of psychiatric patient hosted in Residential Mental Health Facilities of Palermo. Satisfaction for current accommodation in the Facility, reasons for place preference and housing perspectives were explored. Methods: A questionnaire consisting in 31 open questions was administered to 39 subjects living in three Residential Mental Health Facilities of Health Department of Palermo. Results: Own room and terraces with plats are the patients' favourite places in the Facilities. During the first month of stay, these places satisfy need for retirement and distraction, while in the following period they become spaces where meet people and join interests and activities. Among places associated with negative emotions, corridors, stairs, infirmary and toilet were reported. Also places and furniture coming from the previous Psychiatric Hospital (windows with grating, long corridors, gates) are source of anxiety. About half of the subjects are satisfied by their accommodation in a multiple room with 2 or 3 people, while others would prefer either a single room or different room-mate. The majority of the patients wish they come back to their family's house, or their district, either for restoring familiar and affective bonds, or for experiencing new working and social roles. Furthermore, many of them long for a life with other people. Conclusions: A good relationship with place of care is a relevant aspect of psychiatric residential program. Place attachments change during the time, suggesting also transformations of self-concept and interpersonal relationship. Residential Mental Health Facility could be represented as “transitory accommodation” that hold patients' need and difficulties, letting people plan a possible future.

Riassunto Introduzione Studi recenti mostrano un aumento dei disturbi psicotici in fase giovanile con prognosi peggiore rispetto alle forme tardive. Il presente lavoro intende valutare i potenziali benefici dell’intervento integrato precoce sugli outcome globali. Scopo dello studio Si e presa in esame l’organizzazione dei servizi nella citta di Palermo, rispetto alla quale sono da evidenziare l’integrazione degli interventi dell’UO di Psichiatria dell’Azienda Ospedaliera Universitaria Policlinico e del Dipartimento di Salute Mentale, l’integrazione degli interventi tra personale del Servizio di Neuropsichiatria dell’Infanzia dell’Azienda Sanitaria Provinciale e dell’Unita Operativa di Riabilitazione Psichiatrica Universitaria, nonche la realizzazione di una banca dati per il passaggio dei pazienti dalle competenze della Neuropsichiatria dell’Infanzia e dell’Adolescenza (NPIA) ai Centri di Salute Mentale. Materiali e metodi Sono riportate le osservazioni sull’intervento integrato a favore di un paziente nel corso di 8 mesi, che evidenziano gli effetti positivi della suddetta strategia assistenziale. Si e presa in esame l’efficacia dell’intervento integrato su un gruppo di pazienti transitati dalla NPIA ai Servizi di Psichiatria per adulti comparandolo con un gruppo di utenti che in tale passaggio non ha usufruito di strategie integrate. Come criteri descrittivi si sono utilizzati: valutazioni testologiche, criteri anamnestico-osservazionali, criteri riabilitativi. Conclusioni La tempestivita dell’intervento costituisce la variabile che mira a una diminuzione del numero, della durata e della gravita delle ricadute, favorendo un migliore outcome funzionale del paziente.

Introduzione: Un consistente numero di studi suggerisce un’elevata prevalenza di eventi traumatici nella storia di soggetti con disturbi psicotici (Shevlin et al, 2008). Piu’ che l’impatto di un singolo evento di vita stressante, l’esposizione cumulativa ad esperienze traumatiche sembra incrementare il rischio di psicosi (van Winkel et al, 2008). Scopo dello studio e’ valutare la prevalenza di tali eventi in soggetti al primo episodio psicotico a confronto con controlli sani e la possibile correlazione con la sintomatologia psicotica e l’età di esordio. Metodologia: In atto sono stati reclutati 74 soggetti al primo episodio psicotico (51 m, 23 f; em=26.39, ds=9.36) e 27 controlli sani (18 m, 9 f; em=25.93, ds=7.65). Sono state somministrate le seguenti interviste: CECA-Q (Bifulco et al, 2005) per la valutazione retrospettiva degli eventi avversi infantili; List of Threatening Experiences (Brugha et al, 1985) per la valutazione degli eventi di vita stressanti durante il corso di vita e la PANSS (Kay et al, 1987) per la valutazione della sintomatologia psicotica. Risultati e Conclusioni: I risultati preliminari mostrano una maggiore prevalenza nel gruppo dei primi episodi psicotici di almeno un evento di vita stressante nell’arco della vita (p