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The COVID-19 pandemic has had a significant impact on the quality of life (QoL), daily lifestyle, and mental health of people suffering from a mental disorder. This study aimed to investigate the effects of the prolongation of the COVID-19 emergency on QoL and lifestyles in a sample of 100 outpatients at the Psychiatry Unit in Palermo University Hospital, Italy. QoL was measured through the 12-item Short Form Survey and the COV19-Impact on Quality of Life. Lifestyle changes during the pandemic were measured through the lifestyle change questionnaire. The majority of participants reported a great impact of COVID-19 on the QoL, and almost half reported worsened lifestyles. Worsened lifestyles were predictive of both poor mental and physical health related QoL. These results suggest that people with mental illness need interventions targeting lifestyles, and the mental health service in Italy should adjust to the ongoing pandemic, developing virtual treatments.

Several studies investigated the specific neural correlates of trans people, highlighting mixed results. This study aimed to investigate the presence of specific functional connectivity in trans men, compared to a homogeneous group of cisgender men and cisgender women. 42 participants (19 trans men, 11 cisgender men, and 12 cisgender women) underwent a resting state fMRI; a blood sample was collected in order to evaluate the hormonal status of testosterone, estradiol, and progesterone. Screening measures were administered for evaluating the intellectual ability and manual preference. Moreover, all participants underwent a neuropsychological evaluation of executive functions, attention, visual-perceptual ability, and verbal fluency. Trans men showed a weaker functional connectivity in the precentral gyrus, subcallosal cortex, paracingulate gyrus, temporal pole, and cingulate gyrus in contrast to cisgender men. Furthermore, trans men showed a worse performance than cisgender men and similar to that of cis women in verbal and visuospatial working-memory. In trans men, functional connectivity of precentral gyrus was positively correlated with blood testosterone and negatively correlated with estradiol and progesterone; the cluster involving the subcallosal cortex showed a positive correlation with testosterone and negative with estradiol, and the functional connectivity from a cluster involving the paracingulate gyrus showed a positive correlation with testosterone. This study sheds light to the importance of overpassing the binary-model, by highlighting the presence of neural pathways that could represent the peculiarity of the neural profile of people with gender dysphoria.

This study was funded by the Medical Research Council, the European Community’s Seventh Framework Program grant [agreement HEALTH-F2-2009-241909 (Project EU-GEI)], São Paulo Research Foundation (grant 2012/0417-0), the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King’s College London, the NIHR BRC at University College London and the Wellcome Trust (grant 101272/Z/12/Z)., Tripoli, G., Quattrone, D., Ferraro, L., Gayer-Anderson, C., Rodriguez, V., La Cascia, C., La Barbera, D., Sartorio, C., Seminerio, F., Tarricone, I., Berardi, D., Szöke, A., Arango, C., Tortelli, A., Llorca, P.-M., De Haan, L., Velthorst, E., Bobes, J., Bernardo, M., Sanjuán, J., Santos, J.L., Arrojo, M., Del-Ben, C.M., Menezes, P.R., Selten, J.-P., Jones, P.B., Jongsma, H.E., Kirkbride, J.B., Lasalvia, A., Tosato, S., Richards, A., O'donovan, M., Rutten, B.P.F., Os, J.V., Morgan, C., Sham, P.C., Murray, R.M., Murray, G.K., Di Forti, M.

Premorbid functioning and cognitive measures may reflect gradients of developmental impairment across diagnostic categories in psychosis. In this study, we sought to examine the associations of current cognition and premorbid adjustment with symptom dimensions in a large first episode psychosis (FEP) sample. We used data from the international EU-GEI study. Bifactor modelling of the Operational Criteria in Studies of Psychotic Illness (OPCRIT) ratings provided general and specific symptom dimension scores. Premorbid Adjustment Scale estimated premorbid social (PSF) and academic adjustment (PAF), and WAIS-brief version measured IQ. A MANCOVA model examined the relationship between symptom dimensions and PSF, PAF, and IQ, having age, sex, country, self-ascribed ethnicity and frequency of cannabis use as confounders. In 785 patients, better PSF was associated with fewer negative (B=-0.12, 95% C.I. -0.18, -0.06, p

Background A symptom dimension approach may best examine the heterogeneous expression of psychosis. However, whether and how premorbid predisposition and cognitive factors explain phenotypes variation is still debated. This study aimed to test the predictive value of combined cognition and premorbid adjustment on transdiagnostic symptom dimensions in a large sample of people suffering from the first episode of psychosis (FEP). Methods FEP patients were part of the EUGEI study. Psychopathology was rated using the OPerational CRITeria system. Multidimensional item response modelling estimate a bifactor model of psychosis by Mplus, composed of a general factor and five specific symptom dimensions. WAIS-brief version measured IQ, and Premorbid Adjustment Scale estimated premorbid social (SF) and academic adjustment (AF). We set a multivariate analysis of the covariance having symptom-dimensions as the output and SF, AF, and IQ as the main predictors, adjusted by age, gender, country, and ethnicity. Since lifetime frequency of cannabis use related to both premorbid and cognitive characteristics, and symptom dimensions, it was added as an independent predictor, collected by the Cannabis Experience Questionnaire. Sensitivity analyses were run with IQ subtests. Results The sample included 785 FEP patients [61.2% (N=481) males; Mean age=33.8 (12.3)]. IQ [Pillai=0.019, F(6, 765)=2.52; p=0.020] and SF [Pillai=0.032, F(6, 765)=4.26; p Positive symptoms were slightly predicted by a lower IQ (B=-0.005, 95% C.I. -0.01, 0.0, p=0.038) and sensitivity analysis revealed the role of a worse processing speed (B=-0.04, 95% C.I. -0.07, -0.01, p=0.003) and working memory (B=-0.02, 95% C.I. -0.05, -0.04, p=0.013) abilities in this relationship. Negative symptoms were higher in subjects with a worse SF (B=-0.12, 95% C.I. -0.18, -0.06, p Discussion The opposed relationship between premorbid sociability and an IQ, particularly its “hold” perceptual-reasoning sub-test – linked to an early coherent self-construction – with manic and negative symptoms, suggests divergent neurodevelopmental trajectories among patients endorsing these different phenotypes. On the other hand, the specific predictive value for positive symptoms of lower processing speed and working memory – well-recognised cognitive markers in psychosis – implies an encoding problem. Worse premorbid sociability but not low general cognition predicted depressive symptoms, thus suggesting a difference between mood downregulation and flat affect, often unrecognised. The cannabis-effect on positive symptoms was expected; this analysis suggests its possible interaction with cognitive characteristics, which deserves further attention.

Background: Circuits is a computerized cognitive remediation program for individuals with schizophrenia. this study aimed to evaluate the feasibility of the italian version of circuits. MethODs: Feasibility was measured through ad-hoc questionnaires in a non-clinical sample (N.=30; target-score 70%; study 1); in patients with schizophrenia (N.=5; target-score 60%; study 2) and cr therapists (N.=3; target-score 60%; study 2). study 3 was a pilot study investigating: 1) enrolment, compliance, and retention rates; 2) satisfaction; 3) potential post-treatment and follow-up improvements in patients with schizophrenia (N.=20). these results were used to estimate sample size and feasibility for a future trial. resULts: all non-clinical participants rated high feasibility of circuits (83.3-100% scores). all patients (60-100% high-scores) and cr therapists (66-100% high-scores) evaluated circuits feasible. high rates of retention in treatment (74.5%) and satisfaction (85-100%) in patients were showed. Post-treatment assessment revealed an improvement in all cognitive measures. a sample size of 32 was calculated for each arm of the trial, at the desired power of 80%, to recruit for 18 months. cONcLUsiONs: results showed the feasibility of the italian version of circuits, they will inform a controlled future trial and implementation study of this therapy approach in the italian mental health system.

BackgroundThe “jumping to conclusions” (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.Methods817 FEP patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC (assessed by the number of beads drawn on the probabilistic reasoning “beads” task) and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.ResultsThe estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia Polygenic Risk Score (SZ PRS) was non-significantly associated with a higher number of beads drawn (B= 0.47, 95% CI −0.21 to 1.16, p=0.17); whereas IQ PRS (B=0.51, 95% CI 0.25 to 0.76, pp=0.006), but did not relate to delusions in patients.Conclusionsthe JTC reasoning bias in psychosis is not a specific cognitive deficit but is rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to psychotic-like experiences, independent of IQ. The work has potential to inform interventions targeting cognitive biases in early psychosis.

Importance: Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s. Objectives: To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors. Design, Setting, and Participants: An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics. Exposures: Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures. Main Outcomes and Measures: Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist. Results: A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95% CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95% CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95% CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95% CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95% CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95% CI, 0.2-0.5). Conclusions and Relevance: This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses., The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project is funded by grant agreement HEALTH-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework Programme. The Brazilian study was funded by grant 2012/0417-0 from the São Paulo Research Foundation. Dr Kirkbride is funded by the Wellcome Trust and grant 101272/Z/13/Z from the Royal Society. Ms Jongsma and Dr Jones are funded by the National Institute of Health Research Collaboration of Leadership in Applied Health Research and Care East of England.

Background Jumping to conclusions (JTC) is a well-established reasoning and data gathering bias found in patients with psychosis even at illness onset (First Episode Psychosis, FEP). Preliminary work in this field focused primarily on the association with delusions, although jumping to conclusions has also been found in non-deluded schizophrenia patients after remission, and in individual with at risk mental state. Moreover, psychotic patients tend to show impairments in social cognition, struggling in identifying, processing and interpreting social clues. Deficits in facial emotion recognition (FER) – a key component of the construct – represent a well-replicated finding in schizophrenia. Furthermore, deficits in global facial affect recognition have been found in FEP with the same severity as at further stages, especially for anger recognition. The present study aims to measure JTC and FER bias in a sample of FEP recruited across 5 European countries, compared with healthy controls. Methods Data on JTC (Beads task 60:40), FER (Degraded Facial Recognition task – DFAR) and socio-demographics have been analysed in a sample of 643 FEP and 1019 population controls recruited as part as the EU-GEI study across UK, Netherlands, France, Spain, and Italy. IQ scores were used to exclude cases and controls with current IQ

Purpose: The incidence of psychotic disorders varies in different geographical areas. As there have been no reports from Southern Italy, this study aimed to determine the incidence rate of first-episode psychosis in Palermo, Sicily. Methods: All patients, aged 18–65 years, presenting with a first episode of psychosis (FEP) (ICD-10 F20–29, F30–33) to mental health services in Palermo, were recorded over a 3-year period. Incidence rates of psychotic disorders and their 95% confidence intervals (95% CI) were estimated. Poisson regression was applied to estimate the differences in incidence rate ratio (IRR) by age, sex and migrant status. Results: Two hundred and four FEP participants were identified during the 3 years; 183 (89.7%, males n = 112) participants were native Italians and 21 were migrants (10.3%, males n = 14). The crude incidence of all psychoses was 15.9 (95% CI 13.7–18.1). As predicted, the risk of schizophrenia F20 was higher in males compared to females (adjusted IRR = 1.99, 95% CI 1.36–2.88) and in migrants compared to native Italians (adjusted IRR = 4.02, 95% CI 2.39–6.75). Conclusions: This study, the first from Sicily, confirms previous findings from Northern Italy that the risk of schizophrenia and other psychoses is much lower in Italian cities than those reported from cities in Northern Europe; the reasons for this disparity may provide important clues to the aetiology of psychosis.

Background Jumping to conclusions (JTC) is a well-established reasoning and data gathering bias found in patients with psychosis even at illness onset (First Episode Psychosis, FEP). Preliminary work in this field focused primarily on the association with delusions, although jumping to conclusions has also been found in non-deluded schizophrenia patients after remission, and in individual with at risk mental state. Moreover, psychotic patients tend to show impairments in social cognition, struggling in identifying, processing and interpreting social clues. Deficits in facial emotion recognition (FER) – a key component of the construct – represent a well-replicated finding in schizophrenia. Furthermore, deficits in global facial affect recognition have been found in FEP with the same severity as at further stages, especially for anger recognition. The present study aims to measure JTC and FER bias in a sample of FEP recruited across 5 European countries, compared with healthy controls. Methods Data on JTC (Beads task 60:40), FER (Degraded Facial Recognition task – DFAR) and socio-demographics have been analysed in a sample of 643 FEP and 1019 population controls recruited as part as the EU-GEI study across UK, Netherlands, France, Spain, and Italy. IQ scores were used to exclude cases and controls with current IQ

IntroductionDiscrimination towards people with schizophrenia (PWS) by healthcare professionals is responsible of underdiagnosis and undertreatment of these patients. Negative attitudes toward PSW in health care professionals tend to be present since their university studies and are related to their knowledge and experience about the disease.Objectives and aimsTo assess opinion towards PSW in medical, nursing and psychology students and to investigate the relation with their knowledge of schizophrenia and its causes.MethodsThe study involved 133 medical, 200 nursing and 296 psychology undergraduate students. The opinion on mental illness questionnaire, the Devaluation Consumers Scale, and the Devaluation of Consumer Families Scale were administered to the sample. ANOVA and ANCOVA were used to test differences between groups and the relation between causal explanation of schizophrenia and discrimination towards PWS.ResultsPsychology students were more aware than the other student of public stigma towards PWS and their families (F 12.57, P < 0.001; F 32.69, P < 0.001) and expressed a more positive view on treatments’ effectiveness (F 30.74, P < 0.001). Psychology (OR 0.48, 95% CI 0.26–0.88) and nursing (OR 0.29, 95% CI 0.15–0.55) students were more likely to identify psychological and social risk factors as more frequent causes of schizophrenia (vs. biogenetics) and these, in turn, were related to a better opinion towards social equality of PWS.ConclusionsThese preliminary findings underline the relevance of biopsychosocial model of schizophrenia within stigma-reduction programs for health science students.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Introduction A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions – JTC). Aims To investigate a possible correlation between working memory, JTC and ER in FEP. Methods 41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task. Results According to the literature, cases had poorer performance in working memory tasks (Digit Span: μ7,72 [ds=2,98] vs μ10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: μ5,36 [ds=2,43] vs μ10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: μ5,46 [ds=2,76] vs μ8,74 [ds=3,24], U=865,50, p=0,00; Block Design: μ4,82 [ds=2,72] vs μ7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, χ 2 =10,27, p=0,001, μ2,53 [ds=3,57] vs μ4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: μ21,62 [ds=7,43] vs μ16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: r rho =0,276, p=0,003; Digit Symbol: r rho =0,275, p=0,002; Arithmetic: r rho =0,265, p=0,003; Block Design: r rho =0,292, p=0,001), but only Digit Span with ER (r rho =-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (r rho =-0,281; p=0,004). Conclusions Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients.

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.