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Purpose Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. Methods We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008–2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. Results Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78–1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01–2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. Conclusion Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

The EU-GEI Project was funded by grant agreement Health-F2-2010-241909 from the European Community’s Seventh Framework program. The Brazilian study was funded by grant 2012-0417-0 from the São Paulo Research Foundation, D'Andrea, Giuseppe; Lal, Jatin; Tosato, Sarah;Gayer-Anderson, Charlotte;Jongsma, Hannah E.;Stilo, Simona A.; van der Ven, Els;Quattrone, Diego;Velthorst, Eva;Berardi, Domenico;Rossi Menezes, Paulo; Arango, Celso; Parellada, Mara; Lasalvia, Antonio; La Cascia, Caterina; Ferraro, Laura; La Barbera, Daniele; Sideli, Lucia; Bobes, Julio; Bernardo, Miguel; Sanjuan, Julio; Santos, Jose Luis; Arrojo, Manuel; Marta Del-Ben, Cristina; Tripoli, Giada; Llorca, Pierre-Michel; de Haan, Lieuwe; Selten, Jean-Paul; Tortelli, Andrea; Szoke, Andrei; Muratori, Roberto; Rutten, Bart P.; van Os, Jim; Jones, Peter B.; Kirkbride, James B.; Murray, Robin M.; di Forti, Marta; Tarricone, Ilaria; Morgan, Craig

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.

BackgroundIn Europe, the incidence of psychotic disorder is high in certain migrant and minority ethnic groups (hence: ‘minorities’). However, it is unknown how the incidence pattern for these groups varies within this continent. Our objective was to compare, across sites in France, Italy, Spain, the UK and the Netherlands, the incidence rates for minorities and the incidence rate ratios (IRRs, minorities v. the local reference population).MethodsThe European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study was conducted between 2010 and 2015. We analyzed data on incident cases of non-organic psychosis (International Classification of Diseases, 10th edition, codes F20–F33) from 13 sites.ResultsThe standardized incidence rates for minorities, combined into one category, varied from 12.2 in Valencia to 82.5 per 100 000 in Paris. These rates were generally high at sites with high rates for the reference population, and low at sites with low rates for the reference population. IRRs for minorities (combined into one category) varied from 0.70 (95% CI 0.32–1.53) in Valencia to 2.47 (95% CI 1.66–3.69) in Paris (test for interaction: p = 0.031). At most sites, IRRs were higher for persons from non-Western countries than for those from Western countries, with the highest IRRs for individuals from sub-Saharan Africa (adjusted IRR = 3.23, 95% CI 2.66–3.93).ConclusionsIncidence rates vary by region of origin, region of destination and their combination. This suggests that they are strongly influenced by the social context.

Aim To estimate the association between the inpatient admissions and Emergency Department (ED) visits before age of 18 years and adulthood-onset first-episode psychosis (FEP). Methods We conducted a FEP incidence and case-control study and calculated the odds ratios (ORs) for incident FEP associated with inpatient admissions and ED visits prior to age of 18 years, adjusting our results for cannabis use, parental socio-economic class and childhood trauma. Results In multivariate logistic regression analysis, odds of FEP increased significantly if the participant had a history of at least one inpatient admission (OR = 3.52; 95% confidence interval [95%CI] 1.07-11.54; P = .04) or at least one ED visit (OR = 8.93; 95%CI 2.41-33.14; P = .001) before age of 18. The associations remained significant adjusting for cannabis use, education, parental socio-economic class and childhood trauma. Conclusion Consistently with the socio-neurodevelopmental model, we found a significant association between a positive history of hospital care in childhood and adulthood-onset psychosis.

Introduction Our aim was to, firstly, identify characteristics at first-episode of psychosis that are associated with later antipsychotic treatment resistance (TR) and, secondly, to develop a parsimonious prediction model for TR. Methods We combined data from ten prospective, first-episode psychosis cohorts from across Europe and categorised patients as TR or non-treatment resistant (NTR) after a mean follow up of 4.18 years (s.d. = 3.20) for secondary data analysis. We identified a list of potential predictors from clinical and demographic data recorded at first-episode. These potential predictors were entered in two models: a multivariable logistic regression to identify which were independently associated with TR and a penalised logistic regression, which performed variable selection, to produce a parsimonious prediction model. This model was internally validated using a 5-fold, 50-repeat cross-validation optimism-correction. Results Our sample consisted of N = 2216 participants of which 385 (17 %) developed TR. Younger age of psychosis onset and fewer years in education were independently associated with increased odds of developing TR. The prediction model selected 7 out of 17 variables that, when combined, could quantify the risk of being TR better than chance. These included age of onset, years in education, gender, BMI, relationship status, alcohol use, and positive symptoms. The optimism-corrected area under the curve was 0.59 (accuracy = 64 %, sensitivity = 48 %, and specificity = 76 %). Implications Our findings show that treatment resistance can be predicted, at first-episode of psychosis. Pending a model update and external validation, we demonstrate the potential value of prediction models for TR. Funding: This work was supported by a Stratified Medicine Programme grant to JHM from the Medical Research Council (grant number MR/L011794/1 which funded the research and supported S.E.S., D.A., A.F.P, L.K., R.M.M., D.S., J.T.R.W, & J.H.M.); funding from the National Institute for Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London to D.A. and D.S; and funding from the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London at King's College Hospital National Health Service Foundation Trust to S.E.S. The views expressed are those of the author(s) and not necessarily those of the Medical Research Council, National Health Service, the National Institute for Health Research, or the Department of Health. The AESOP (London, UK) cohort was funded by the UK Medical Research Council (Ref: G0500817). The Belfast (UK) cohort was funded by the Research and Development Office of Northern Ireland. The Bologna (Italy) cohort was funded by the European Community's Seventh Framework Program under grant agreement (agreement No.HEALTH-F2-2010–241909, Project EU-GEI). The GAP (London, UK) cohort was funded by the UK National Institute of Health Research(NIHR) Specialist Biomedical Research Centre for Mental Health, South London and Maudsley NHS Mental Health Foundation Trust (SLaM) and the Institute of Psychiatry, Psychology, and Neuroscience at King's College London; Psychiatry Research Trust; Maudsley Charity Research Fund; and the European Community's Seventh Framework Program grant (agreement No. HEALTH-F2-2009-241909, Project EU-GEI). The Lausanne (Switzerland) cohort was funded by the Swiss National Science Foundation (no. 320030_135736/1 to P.C. and K.Q.D., no 320030-120686, 324730-144064 and 320030-173211 to C.B.E and P.C., and no 171804 to LA); National Center of Competence in Research (NCCR) “SYNAPSY - The Synaptic Bases of Mental Diseases” from the Swiss National Science Foundation (no 51AU40_125759 to PC and KQD); and Fondation Alamaya (to KQD). The Oslo (Norway) cohort was funded by the Research Council of Norway (#223273/F50, under the Centers of Excellence funding scheme, #300309, #283798) and the South-Eastern Norway Regional Health Authority (#2006233, #2006258, #2011085, #2014102, #2015088 to IM, #2017-112). The Paris (France) cohort was funded by European Community's Seventh Framework Program grant (agreement No. HEALTH-F2-2010–241909, Project EU-GEI). The Prague (Czech Republic) cohort was funded by the Ministry of Health of the Czech Republic (Grant Number: NU20-04-00393). The Santander (Spain) cohort was funded by the following grants (to B.C.F): Instituto de Salud Carlos III, FIS 00/3095, PI020499, PI050427, PI060507, Plan Nacional de Drogas Research Grant 2005-Orden sco/3246/2004, and SENY Fundatio Research Grant CI 2005-0308007, Fundacion Marques de Valdecilla A/02/07 and API07/011. SAF2016-76046-R and SAF2013-46292-R (MINECO and FEDER). The West London (UK) cohort was funded The Wellcome Trust (Grant Number: 042025; 052247; 064607).

Introduction: Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs). Objectives: This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. Methods: Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. Results: Thirty-eigth studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4–47.8), 37.2% (CI:23.8–51.6) and 66.1% (CI:53.5–77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8–37.6), 18.4% (CI:10.2–28.3) and 38.3% (CI:35.0–41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9–22.8) and 40.4% (CI:35.7–45.3), respectively (no data available for lifetime suicidal ideation). Conclusions: The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.

The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project was funded by grant agreement Health-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework programme., Tarricone, I., D'Andrea, G., Jongsma, H.E., Tosato, S., Gayer-Anderson, C., Stilo, S.A., Suprani, F., Iyegbe, C., Van Der Ven, E., Quattrone, D., Di Forti, M., Velthorst, E., Rossi Menezes, P., Arango, C., Parellada, M., Lasalvia, A., La Cascia, C., Ferraro, L., Bobes, J., Bernardo, M., Sanjuán, I., Santos, J.L., Arrojo, M., Del-Ben, C.M., Tripoli, G., Llorca, P.-M., De Haan, L., Selten, J.-P., Tortelli, A., Szöke, A., Muratori, R., Rutten, B.P., Van Os, J., Jones, P.B., Kirkbride, J.B., Berardi, D., Murray, R.M., Morgan, C.

The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project was 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 Jongsma is funded by the Economic and Social Research Council (grant ES/S011714/1). Dr Kirkbride is funded by the Wellcome Trust and Royal Society (Grant 101272/Z/13/Z). Dr Jongsma and Professor Jones are funded by the National Institute of Health Research Collaboration of Leadership in Applied Health Research and Care East of England. Professor Rutten is funded by the Netherlands Scientific Organisation (VIDI award number 91718336). Dr Jongsma and Dr Kirkbride are supported by the National Institute for Health Research, University College London Hospital, Biomedical Research Centre., Jongsma, H.E., Gayer-Anderson, C., Tarricone, I., Velthorst, E., Van Der Ven, E., Quattrone, D., Di Forti, M., Menezes, P.R., Del-Ben, C.M., Arango, C., Lasalvia, A., Berardi, D., La Cascia, C., Bobes, J., Bernardo, M., Sanjuán, J., Santos, J.L., Arrojo, M., De Haan, L., Tortelli, A., Szöke, A., Murray, R.M., Rutten, B.P., Van Os, J., Morgan, C., Jones, P.B., Kirkbride, J.B.

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., Aas, M; Alameda, L; Di Forti, M; Quattrone, D; Dazzan, P; Trotta, A; Ferraro, L; Rodriguez, V; Vassos, E; Sham, P; Tripoli, G; La Cascia, C; La Barbera, D; Tarricone, I; Muratori, R; Berardi, D; Lasalvia, A; Tosato, S; Szoke, A; Llorca, PM; Arango, C; Tortelli, A; de Haan, L; Velthorst, E; Bobes, J; Bernardo, M; Sanjuan, J; Santos, JL; Arrojo, M; Del-Ben, CM; Menezes, PR; Selten, JP; Jones, PB; Jongsma, HE; Kirkbride, JB; Rutten, BPF; van Os, J; Gayer-Anderson, C; Murray, RM; Morgan, C

Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.

The EU-GEI Project is funded by the European Community’s Seventh Framework Programme under grant agreement No. HEALTH-F2-2010–241909 (Project EU-GEI)., Ajnakina, O., Rodriguez, V., Quattrone, D., Di Forti, M., Vassos, E., Arango, C., Berardi, D., Bernardo, M., Bobes, J., De Haan, L., Del-Ben, C.M., Gayer-Anderson, C., Jongsma, H.E., Lasalvia, A., Tosato, S., Llorca, P.-M., Menezes, P.R., Rutten, B.P., Santos, J.L., Sanjuán, J., Selten, J.-P., Szöke, A., Tarricone, I., D'andrea, G., Richards, A., Tortelli, A., Velthorst, E., Jones, P.B., Arrojo Romero, M., La Cascia, C., Kirkbride, J.B., Van Os, J., O'donovan, M., Murray, R.M.

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.

Objective According to the gene-environment interaction model the pathogenesis of psychosis relies on an adverse neuro-socio-developmental pathway. Perinatal stress represents an important risk factor for the development of psychosis because of the increasingly evident interference with socio-neuro-development in the earlier phases of life. We aim to investigate the correlation of perinatal risk factors with the onset of psychosis with a case–control–incidence study. Results Patients (and their mothers) were eligible if they presented with first-episode psychosis at the Bologna West Community Mental Health Centre (Bo-West CMHC) between 2002 and 2012. The Bo-West CMHC serves a catchment area of about 200,000 people. The controls were recruited in the same catchment area and study period. 42 patients, 26 controls and their mothers were included. We collected the history of peri-natal stress and calculated crude and adjusted Odds Ratios for onset of first-episode psychosis. Adjusted logistic regression showed that psychosis onset was significantly associated with stressful situations during pregnancy, lower level of maternal physical health before or during pregnancy, use of anti-inflammatory drugs during pregnancy, and low level of maternal education. The results of our study suggest that stress during perinatal period increases the risk of developing psychosis.

Background: Several evidence have shown hyperglycemia and diabetes are frequent in patients with psychoses. There are evidences that some ethnic minorities are at higher risk of psychosis. It is less clear if migration history is a risk factor for diabetes and hyperglycemia during first-episode psychosis (FEP). The present study aims to evaluate if migration history might influence fasting plasma glucose change during antipsychotic treatment (APs) in (FEP). Materials and Methods: We carried out a retrospective follow-up of all FEP drug na?ve patients at their first contact with Bologna West Community Mental Health Centres from January 2010 to December 2015. Blood tests carried out during the follow-up period were collated from clinical charts to evaluate the baseline fasting plasma glucose level upon starting APs treatment and at the time of follow-up. Out of 50 patients who had FEP during the recruitment period and consented to take part in the study, 25 cases had blood test results available at follow-up. We performed linear multivariate regression analysis to adjust the association between migrant status and fasting plasma glucose level of follow-up by gender, age, education, employment, APs treatment and dose. Results: At baseline, the mean fasting plasma glucose level was within the normal range and at follow-up we observed a significant increase in the mean fasting plasma glucose in migrants. Upon multivariate linear regression analysis, migration history remained significantly associated with the follow-up fasting plasma glucose level. Conclusions: In conclusion, we found that migrants with FEP are particularly at risk of developing hyperglycemia and type II diabetes during APs treatment.

Background: Resilience is defined as the capacity to cope successfully with change or adversity. The aims of our study were to investigate levels of resilience in Italian healthcare professionals (HCPs) during the Coronavirus disease 2019 (COVID-19) pandemic and to identify potential predictors of resilience. Methods: We performed a web-based survey of HCPs (n = 1009) working in Italian hospitals during the COVID-19 pandemic. The survey contained a 14-item resilience scale (RS14) and questionnaires to evaluate depression and anxiety symptoms. Non-HCP individuals (n = 375) from the general population were used for comparison. Results: HCPs showed significantly lower resilience compared to the control group (p = 0.001). No significant differences were observed after stratification for geographical area, work setting, role, or suspected/confirmed diagnosis of COVID-19. In a linear regression analysis, RS14 was inversely correlated with depression (R2 = 0.227, p &lt, 0.001) and anxiety (R2 = 0.117, p &lt, 0.001) and directly correlated with age (R2 = 0.012, p &lt, 0.001) but not with body mass index (BMI, R2 = 0.002, p = 0.213). In male HCPs, higher depression score (odds ratio (OR) 1.147, p &lt, 0.001) or BMI (OR 1.136, p = 0.011) significantly predicted having low resilience. In female HCPs, higher depression score (OR 1.111, p &lt, 0.0001) and working in a COVID-19 free setting (OR 2.308, p = 0.002) significantly predicted having low resilience. HCPs satisfied with personal protective equipment had higher levels of resilience (p &lt, 0.010). Conclusions: Our findings suggest that resilience was lower in Italian HCPs than in the general population after the first COVID-19 wave. Specific factors can be identified, and targeted interventions may have an important role to foster resilience of HCPs.

Large-scale longitudinal studies show that specific borderline personality disorder (BPD) symptoms are more likely to remit over time, suggesting that clinical features of BPD may vary between younger patients and older ones. The objective of the present report is to provide a direct comparison between younger (age 18-25 years; n = 44) and older (age 40-59 years; n = 49) BPD patients on the nine DSM-4 BPD criteria (self-harm, emotional dysregulation, impulsiveness, and work and social functioning). Younger and older patients reported similar levels of impulsiveness, emotional dysregulation, and work and social functional impairment. Younger adults were more likely to show anger and self-damaging behaviors compared with older patients, which in turn were more likely to endorse chronic emptiness. In conclusion, older patients with BPD are still impaired in impulsiveness, emotional regulation, and social functioning; treatments for older BPD population should be long term and focused on emotion dysregulation and impulsive behaviors.

© 2017 The Australian Psychological Society.Background: Impulsivity is considered a core clinical feature in borderline personality disorder (BPD). Evidence also indicates that impulsivity is part of the biological vulnerability for BPD. The purpose of the study was to verify if the presence of substance-related and addictive disorders (SRADs) may increase impulsivity and aggression in BPD. Methods: Eighty patients (27 with BPD, 26 with BPD and SRAD, 27 with other personality disorders (OPDs)) completed a comprehensive assessment for personality disorder symptoms, impulsivity, and aggressive behaviour. Results: BPD patients with SRAD showed higher scores on impulsivity and aggression compared with other groups. Furthermore, no significant difference was observed between BPD and OPD patients on impulsivity and aggression. Conclusion: The presence of SRAD was found to be a mediator between BPD and impulsive and aggressive behaviour. The findings are discussed and directions for future research presented.

Impulsivity has often been related to aggressive and self-mutilative behavior in Borderline Personality Disorder (BPD). Many authors focused on the key role of emotion dysregulation in explaining vulnerability to dysfunctional behavior in BPD in addition to trait impulsivity. Furthermore, recent works have shed light on a gap in empirical research concerning the specific mechanisms by which a lack of affective regulation produces aggression proneness. The purpose of the study was to investigate the role of impulsivity and emotion dysregulation in determining vulnerability to aggression and deliberate self-harm in a sample of BPD outpatients. Enrolled patients with BPD (N =79) completed a comprehensive assessment for personality disorder symptoms, trait impulsivity, emotional dysregulation, aggressive and self - mutilative behavior. Trait impulsivity significantly predicted both aggressive and self-mutilative proneness. Furthermore, emotion dysregulation was found significantly to account for the vulnerability to aggression and self-injury, in addition to the variance explained by impulsivity. In conclusion, these findings support evidence that emotion dysregulation plays an important role in increasing the risk of dysfunctional behavior in impulsive BPD individuals.

Purpose: Epidemiological studies in the Netherlands have reported an excessive gender gap in the risk for non-affective psychotic disorder (NAPD) among immigrants from Morocco with a higher risk elevation in males compared to females. We examined the consistency of these findings and their generalizability to immigrants from the Maghreb (Mauritania, Morocco, Algeria, Tunisia and Libya) in other European countries. Methods: Systematic review and meta-analysis. Medline, PsychINFO and EMBASE databases were searched for publications in the period from January 1970 to April 2014. We included incidence and prevalence studies of non-affective psychotic disorder (NAPD) among migrants from the Maghreb in Europe and studies of subclinical psychotic symptoms (SPS) in representative samples. A meta-analysis was performed on the subgroup of incidence studies. Results: Five incidence and three prevalence studies of NAPD, and two prevalence studies of SPS, conducted in the Netherlands (n=7), Belgium (n=1), France (n=1) and Italy (n=1) met our inclusion criteria. Across all research designs, the risks of NAPD and SPS were consistently increased among male, not female immigrants from the Maghreb. The meta-analysis of incidence studies of NAPD yielded male-to-female risk ratios of 5.1 [95 % confidence interval (CI) 3.1–8.4] for migrants from the Maghreb, 2.0 (95 % CI 1.6–2.5) for other migrant groups, and 1.8 (95 % CI 1.3–2.5) for non-migrant Europeans. Conclusions: The marked gender gap in psychosis risk among migrants from the Maghreb appears a consistent finding, foremost among the Moroccan-Dutch. The small number of studies limits the strength of conclusions that can be drawn about countries other than the Netherlands. Achievement–expectation mismatch, social marginalization and an increased prevalence of illicit drug use are possible explanations.

Background: Some recent studies have challenged the direction of causality for the association between cannabis use and psychotic disorder, suggesting that cannabis use initiation is explained by common genetic variants associated with risk of schizophrenia. We used data from the European Union Gene-Environment Interaction consortium (EUGEI) case-control study to test for the independent and combined effect of heavy cannabis use, and of Schizophrenia Polygenic risk score (SZ PRS), on risk for psychotic disorder. Methods: Genome-wide data were obtained from 492 first episode psychosis patients (FEPp) and from 787 controls of European Ancestry, and used to generate SZ PRS from the summary results of an independent meta-analysis. Information on pattern of cannabis use was used to build a 7-level frequency-type composite cannabis use measure that we previously found was a strong predictor of psychotic disorder. Results: SZ PRS did not predict cannabis initiation (b=0.027; p=0.51) or how frequently controls (b=0.027; p=0.06) or FEPp (b=0.006; p=0.91) used it, or the type of cannabis they used (Controls: b = 0.032; p=0.31); FEPp: b= 0.005; p=0.89). The frequency-type composite cannabis use measure (OR=1.32; 95% CI 1.22-1.44) and SZ PRS (OR=2.29; 95%CI 1.71-3.05) showed independent effects from each other on the OR for psychotic disorder. Conclusion: SZ PRS does not predict an individual s propensity to try cannabis, frequency of use, or the potency of the cannabis used. Our findings provide the first evidence that SZ PRS and heavy cannabis use exert effects independent from each other on the risk for psychotic disorder.

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.

Global migration and the increasing number of immigrant diversities influence the needs in the psychosocial and health-care system. Migration is a process during which a person moves from one cultural setting to another in order to settle for a longer period of time or permanently [1]. A ‘migrant’ is any person who has crossed an international border, regardless of the length of their stay. Immigrants may move en masse or singularly. Many people can be viewed both as ‘immigrants’ and as ‘members of ethnic minorities’. The latter covers groups that do not belong to the category ‘migrant’. For instance, the offspring of immigrants, especially the so-called second and third generation, are not immigrants themselves but may nevertheless be affected by many of the same issues as the first generation, including cultural, linguistic or biological factors, as well as social factors like acceptance or rejection as well as acculturation stress factors by the majority. Immigrants are a heterogeneous group in regard to their country of origin, reasons for migration, experience during the migration and legal status. Migration takes many forms, including forced and voluntary movement even if it is difficult to distinguish between forced and voluntary migration; the reasons for migration often include both. Immigrants experience stress-related risk factors during the stages of premigration, migration and post-migration. The number of immigrants in the world has more than doubled since 1975. In January 2015, the number of people living in the EU-28 who were citizens of non-member countries was at 19.8 million, the number of people living in the EU-28 who had been born outside of the EU was at 34.3 million, and all together 54.1 million immigrants were living in Europe [2]. The composition of immigration by countries is very different. In 2015 the main hosting countries were Germany (7.5 million persons), the United Kingdom (5.4 million), Italy (5.0 million), Spain (4.5 million) and France (4.4 million). These five Member States collectively hosted 76% of all immigrants in EU. The same five Member States had a 63% share of the EU-28’s population [2]. Women comprise slightly less than half of all international migrants. The share of female migrants fell from 49% in 2000 to 48% in 2017. Female migrants outnumber male migrants in Europe, Northern America, Oceania and Latin America and the Caribbean, while in Africa and Asia, particularly Western Asia, migrants are predominantly men [3].

Migrants and ethnic minorities are at higher risk to develop mental disorders compared to native population. Culture has an important impact on the symptom presentation, diagnostic process and treatment strategies in all populations. Cultural competence represents good clinical practice and can be defined as a two-way learning encounter where clinician acknowledges the patient’s culture as well as his own cultural values and prejudices. Cultural competent response to the mental health care requires knowledge, skills and attitudes. Both individual and organizational cultural competences are needed to improve the effectiveness of psychiatric treatment. In this chapter, we revised the WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants and list a series of recommendations for policy-makers, service providers and clinicians. Cultural competent experiences in the treatment of somatization and other psychiatric disorders across several countries in Europe are also presented.

Evidence from previous research demonstrated a gap in mortality between patients with mental disorders and the general population. However, a more exhaustive assessment is required to address this public health issue. The aim of this study was to provide comprehensive analysis of mortality examining all causes of death and all psychiatric diagnoses. We conducted a 10-year retrospective cohort study, including all in and out patients registered in the Mental Health Registry of Emilia-Romagna, Italy. Standardized mortality ratios (SMRs) were calculated. The cohort consisted of 137,351 patients 11,236 of whom died during the study period and the overall SMR was 1.99. 85.9 % of excess mortality was attributable to a broad range of natural causes. Diseases of circulatory and respiratory systems as well as neoplasms were the principal contributors to the mortality gap. All psychiatric conditions led to a higher risk of death. The greatest excess was due to neoplasms in depressed and neurotic patients and to cardiovascular diseases in patients with schizophrenia and personality disorders. Our results highlight the need for close collaboration between mental and primary health care services with the aim of reducing excess mortality as a result of medical diseases among all patients suffering from psychiatric condition.

Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004&ndash, 2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects&rsquo, characteristics. For every 1 &deg, C above 24 &deg, C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0&ndash, 2.6, p &lt, 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4&ndash, 8.6, p &lt, 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.

Background Incidence of psychotic disorders is higher in many migrant groups; however little is known about internal migrants (IM). This study aims to describe the IR in natives (NA), IM and external migrants (EM). Method All patients aged 18–64 years, with First Episode Psychosis (FEP), who made contact with the Bologna West psychiatric services, between 2002 and 2010, were included. Results 187 cases were included. Age and sex adjusted IR of psychosis per 100,000 per year were: 12.6 for NA, 25.3 for IM and 21.4 for EM. The IRR was 1.93 (1.19–3.13, P = 0.007) for IM and 1.79 (1.06–3.02, P = 0.03) for EM compared to NA. Conclusion Rates of psychosis were significantly elevated in IM as well as in EM. This result adds evidence as to the role of migration itself (versus ethnicity) on the risk of psychosis.

Aims Many studies show that migrants have a higher incidence of psychosis compared to natives, but the influence of migration on psychosis outcomes is little investigated. We aimed to evaluate the occupational outcomes of a first episode psychosis (FEP) sample in Bologna (Northern Italy). Methods An incidence cohort of FEP patients presenting at the Bologna West Community Mental Health Centers between 2002 and 2009 was assessed at the baseline and at 12th month follow-up. Return to school or work was used as occupational outcome. Results Most of the patients (82.8%) were still in contact at 12 months. Migrants showed significantly higher rate of return to work compared to natives (adjusted OR 4.45, 95% CI 1.55-12.76). Conclusions First generation migrants had better occupational outcomes. Further cross-cultural studies are needed to further explain these findings.

PurposeThis study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs).MethodsNew LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively.ResultsAmong the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18-2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47-2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22-4.59), immigration (HR 3.13, 95%CI 1.28-7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01-1.97).ConclusionsPsychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.

Il criticismo viene definito come un ricorso pervasivo e ripetitivo al rimprovero. Molte ricerche hanno dimostrato che il livello di criticismo familiare percepito dal paziente (CP) predice peggiori esiti di malattia nella schizofrenia, nei disturbi d’ansia e dell’umore e nel disturbo da uso di sostanze. Secondo il modello di M. Linehan, nel disturbo borderline di personalita (DBP) la disregolazione emotiva (DE) e causata dalla combinazione di una vulnerabilita emotiva biologica e un ambiente invalidante. In accordo con tale modello, il presente studio ha l’obiettivo di verificare se: 1) nei pazienti con DBP il CP predice la disregolazione emotiva e i comportamenti problematici peculiari del DBP, come la tendenza a mettere in atto azioni aggressive e auto lesive; 2) la difficolta di regolazione emotiva e un fattore di mediazione tra il CP e i comportamenti problematici. Sono stati somministrati a 57 soggetti adulti con diagnosi di DBP e 35 con altri disturbi di personalita, questionari per la valutazione del Criticismo Percepito, della tendenza all’aggressivita, dell’autolesionismo, e della disregolazione emotiva. I risultati mostrano che il contenuto del CP predice la tendenza all’aggressivita e all’autolesionismo nei pazienti con DBP ma non nei controlli. La disregolazione emotiva e un mediatore parziale tra il contenuto del CP e i comportamenti auto-lesivi e tra il contenuto del CP e i comportamenti aggressivi. Il CP puo essere uno dei fattori predisponenti all’emergere dei comportamenti aggressivi e autolesivi nei pazienti DBP. La difficolta di regolazione emotiva tipica del DBP spiega tale relazione in maniera parziale.

BACKGROUND: Emotional instability and dyscontrolled behaviours are central features in borderline personality disorder (BPD). Recently, some cognitive dysfunctional mechanisms, such as anger rumination, have been found to increase negative emotions and promote dyscontrolled behaviours. Even though rumination has consistently been linked to BPD traits in non-clinical samples, its relationship with problematic behaviour has yet to be established in a clinical population. AIM: The purpose of the study was to explore the relationships between emotional dysregulation, anger rumination and aggression proneness in a clinical sample of patients with BPD. METHODS: Enrolled patients with personality disorders (93 with BPD) completed a comprehensive assessment for personality disorder symptoms, anger rumination, emotional dysregulation and aggression proneness. RESULTS: Anger rumination was found to significantly predict aggression proneness, over and above emotional dysregulation. Furthermore, both BPD diagnosis and anger rumination were significant predictors of aggression proneness. CONCLUSION: Future research should examine whether clinical techniques aimed at reducing rumination are helpful for reducing aggressive and other dyscontrolled behaviours in treating patients with BPD. Copyright © 2015 John Wiley & Sons, Ltd. Language: en

Objective To identify descriptors of Antipsychotic (AP) prescription, focusing on second generation antipsychotics (SGAs), polypharmacy, and long-acting injections (LAIs). Methods Outpatients of the Bologna-Community-Mental-Health-Centres with at least one AP prescription were selected. Patients' characteristics, service utilization, and AP prescriptions were collected from administrative databases. Prescriptions were grouped by class (SGA vs. First Generation Antipsychotics), drug combination (polypharmacy vs. monotherapy), and preparation (LAIs vs. regular administration). Multi-variate analyses were performed to identify prescription descriptors among socio-demographic and clinical variables. Results Among 6,074 patients and 41,121 AP prescriptions, SGAs were used in 70.7% of subjects, AP polypharmacy in 25.3%, and LAIs in 17.5%. SGAs were prescribed more often for young, Italian patients, with higher education, voluntary hospital-ization, and high number of visits. Descriptors of AP polypharmacy were: high number of visits and hospitalization, length of treatment, non-urban residency, male gender, unemployment. Characteristics associated to LAI prescription were: long duration of treatment, high number of visits, compulsory admissions, non-Italian nationality, male gender, age > 34, low education, unmarried status. Conclusions Besides illness severity, this study identified different socio-demographic descriptors of AP choices, raising concerns on the equity of treatments. Efforts should be directed to investigate appropriateness of AP treatments especially in social disadvantaged populations.

BACKGROUND: Anger and depressive ruminations have recently received empirical attention as processes related to borderline personality disorder (BPD). The Emotional Cascade Model (Selby, Anestis, & Joiner, 2008) suggests that negative affect (such as anger and sadness) may trigger rumination, which in turn may increase the duration and extent of negative affect, leading to dysregulated behaviours aimed at reducing such intense and unpleasant emotions. AIM: The aim of this study is to explore the relationships between emotional dysregulation, anger and depressive ruminations, and their role in predicting dysregulated behaviours (such as aggression and self-harm) in a clinical sample of patients with BPD. METHODS: Ninety-one patients with a diagnosis of BPD were recruited from three outpatient community mental health centres and asked to complete a comprehensive assessment for personality disorder symptoms, emotion dysregulation, anger and depressive ruminations, aggression, and self-harm. RESULTS: Anger and depressive ruminations were found to be significantly associated to, respectively, self-harm and aggression, beyond the variance accounted by emotional dysregulation. CONCLUSIONS: Rumination may act as a mediator between emotional dysregulation and dysregulated behaviours in BPD. Future research should examine whether clinical techniques aimed at reducing rumination may be helpful in reducing dysregulated behaviours in patients with BPD. "This is the pre-peer reviewed version of the following article: Martino, F., Caselli, G., Di Tommaso, J., Sassaroli, S., Spada, M.M ., Valenti, B., Berardi, D., Sasdelli, A and Menchetti, M (2017) Anger and depressive ruminations as predictors of dysregulated behaviours in borderline personality disorder. Clinical Psychology and Psychotherapy., which has been published in final form at 10.1002/cpp.2152 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."

The aim of the current study was to validate the Italian version of the Attitude Toward Personality Disorders Questionnaire (APDQ), assess its psychometric properties, and investigate nurses' attitudes toward patients with personality disorders. An Italian version of the APDQ was produced and administered to nurses working in the Bologna Mental Health Department. The instrument demonstrated good psychometric proprieties and a robust structure and supported the five-factor solution of the original English version. Findings showed that nurses experience negative feelings toward patients with personality disorders and found them difficult to care for. Attitude was found to be better among less experienced nurses and among those working in inpatient settings. The Italian version of the APDQ appears to be a useful instrument for assessing clinicians' attitudes in a variety of settings. Italian nurses were inclined to perceive these patients in a negative manner, frequently expressing aversive feelings.

In Italy, the importance of integrating primary care and mental health has only recently been grasped. Several reasons may explain this delay: a) until 2005, primary care physicians worked individually instead of in group practices, without any functional network or structured contacts with colleagues; b) community mental health centers with multiprofessional teams were well structured and widespread in several regions but focused on people with severe and persistent mental disorders; and c) specific national government health policies were lacking. Only two regions have implemented explicit policies on this issue. The "G. Leggieri" program started by the Emilia-Romagna region health government in 1999 aims to coordinate unsolicited bottom-up cooperation initiatives developing since the 1980s. In Liguria, a regional work group was established in 2010 to boost the strategic role of collaborative programs between primary care and mental health services. This article describes the most innovative experiences relating to primary care psychiatry in Italy.

Il Counseling Interpersonale - Interpersonal Counseling (IPC) - e un adattamento della Psicoterapia Interpersonale, sviluppato per i disturbi depressivi che si osservano nel contesto delle cure primarie. Questo approccio mette in relazione l’insorgenza e il perdurare dell’episodio depressivo con le difficolta interpersonali che coinvolgono il paziente. Obiettivo iniziale della terapia e la riduzione dei sintomi depressivi ma la finalita piu generale e quella di migliorare la qualita delle relazioni e il funzionamento sociale del paziente. La forma piu utilizzata di IPC prevede 6 incontri a cadenza settimanale della durata di 30 minuti. L’intervento include un’appropriata valutazione dei sintomi e della loro relazione con eventi di vita, tecniche di supporto, miglioramento delle strategie relazionali e delle abilita comunicative e un eventuale invio per altri trattamenti (farmacologici, psicologici) da effettuarsi nelle cure primarie o in ambiente specialistico. L’articolo descrivera le basi teoriche, la struttura dell’IPC, esemplificata con un caso clinico, e includera una breve revisione di letteratura sugli studi sperimentali che hanno testato l’intervento.

Riassunto Introduzione L’integrazione tra i settori delle cure primarie e della salute mentale e di grande importanza per i sistemi sanitari. L’Emilia-Romagna ha attivato da tempo il Programma Regionale “Giuseppe Leggieri” volto a razionalizzare i percorsi assistenziali e migliorare la qualita dei trattamenti per i disturbi psichiatrici comuni. Questo studio intende realizzare un monitoraggio e una prima valutazione del modello di cura “a gradini” (“stepped care”) previsto dal Programma Regionale. Materiali e metodi L’indagine riguarda i nuovi casi 2007-2009 dei Centri Salute Mentale (CSM) di Bologna (N = 15.534). I dati sono stati forniti dal sistema informativo dei CSM. E stato analizzato l’andamento dei tassi di incidenza, degli invii da parte dei Medici di Medicina Generale (MMG) e dei livelli di cura dei pazienti inviati dai MMG. Le caratteristiche dei primi contatti e i trattamenti nei tre anni sono stati confrontati tra casi inviati e non inviati dai MMG e tra livelli di stepped care. Risultati Dal 2007 al 2009 i tassi annuali di incidenza trattata CSM variano da 64,7 a 65,8 ogni 10.000 maggiorenni. I nuovi casi inviati dai MMG sono il 52%, passando nel triennio dal 48% al 54%. Tra questi, il 55% viene preso in cura specialistica, il 14% in cura condivisa, il 31% e trattato dai CSM in consulenza. Per gli immigrati l’accesso tramite i MMG e elevato, avvicinandosi al 50%, ma inferiore alla percentuale degli italiani. In tutte le aree si osserva, nel tempo, un aumento degli invii dai MMG e un bilanciamento dei tre livelli di stepped care, con riduzione delle decisioni di presa in cura CSM, aumento delle consulenze e degli episodi di cura condivisa. Tra i pazienti inviati dai MMG, piu spesso donne di eta matura con disturbi psichiatrici comuni, i casi con presa in cura specialistica risultano piu gravi degli altri e ricevono un trattamento piu intenso e duraturo. Conclusioni Il processo di integrazione tra cure primarie e salute mentale si e consolidato progressivamente e appare appropriato. Coerentemente con gli obiettivi regionali, cio e avvenuto soprattutto per i disturbi psichiatrici comuni. La collaborazione relativa ai disturbi piu gravi necessita di essere ulteriormente indagata: per queste patologie, riguardanti spesso fasce di eta giovanili e ad alto rischio di comorbilita e cronicizzazione, il riconoscimento precoce e la gestione integrata rappresentano difatti un obiettivo cruciale per il prossimo futuro.

Riassunto Introduzione Gli attuali sistemi classificativi considerano autismo e schizofrenia come due entita cliniche separate, sebbene i loro confini diagnostici siano al centro del dibattito scientifico da molti anni. Il presente articolo propone una revisione della letteratura tesa a individuare, da un lato, le aree di sovrapposizione e, dall’altro, gli elementi distintivi e caratteristici dei due disturbi. Discussione Partendo da una ricostruzione storica del termine “autismo” e dalla sua classificazione nel Manuale diagnostico e statistico dei disturbi mentali e evidente che i confini diagnostici tra le due patologie, inizialmente molto labili, si sono fatti sempre piu marcati. Nel tempo, pero, anche le singole dimensioni diagnostiche si sono ampliate e si e passati ai concetti di “spettro autistico” e “spettro schizofrenico”. Conclusioni Ai limiti estremi dei due spettri, numerose evidenze rintracciano aree di sovrapposizione a vari livelli: clinico, eziopatogenetico, neuroanatomico, neuropsicologico e di neuroimaging. A fronte di queste evidenze mancano, tuttavia, strumenti di assessment idonei per dirimere i dubbi diagnostici e fornire una corretta diagnosi differenziale.

Background It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. Methods/Design The “Italian study on first-episode psychosis and migration (PEP-Ita)” is a prospective observational study over a two-year period (1 January 2012–31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose (“core”) of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. Discussion The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy.

High Function (HF) Autism Spectrum Disorders (ASD) in adulthood is highly prevalent but insufficiently recognized. In Italy, in particular, awareness of this condition is still insufficient and many psychiatrists have no cases of HF ASD to mention. Adult patients with HF ASD come to the attention of Mental Health Services complaining of difficulties within their social context and interpersonal relationships. Objectives: Describe emblematic clinical examples of misdiagnosed HF ASD to understand reasons that conducted to misdiagnosis. Procedure: We contact five specialized Italian Center in diagnosis of ASD. Each center have to describe two or three emblematic cases of adult patient with diagnosis of ASD validated by ADOS-4 but referred to clinicians with another diagnosis, discussing about possible reasons of misdiagnosis. Sample and Results: We have collected 12 case reports (2 from Bologna center, 3 from Torino center, 3 from Pavia center, 2 from Verona center and 2 from Catania center) of adult HF ASD previously misdiagnosed. These cases shows important similarity across centers and highlight that if are taken into account only problems or symptoms that conduct patients to ask help, cases can easily suggest other psychiatric or personality disorders. Diagnosis becomes clear only after considering all the clinical features and a detailed developmental history. Conclusion: Psychiatrists who have insufficient experience of ASD may overlook some symptoms of the overall clinical picture and misdiagnose ASD as personality disorders, schizophrenia, phobia or even as a non-psychiatric condition, so is hopeful for future increased knowledge about HF ASD in adulthood.