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Objective: The objective was to describe the methodology used to develop new response criteria for adult DM/PM and JDM.Methods: Patient profiles from prospective natural history data and clinical trials were rated by myositis specialists to develop consensus gold-standard ratings of minimal, moderate and major improvement. Experts completed a survey regarding clinically meaningful improvement in the core set measures (CSM) and a conjoint-analysis survey (using 1000Minds software) to derive relative weights of CSM and candidate definitions. Six types of candidate definitions for response criteria were derived using survey results, logistic regression, conjoint analysis, application of conjoint-analysis weights to CSM and published definitions. Sensitivity, specificity and area under the curve were defined for candidate criteria using consensus patient profile data, and selected definitions were validated using clinical trial data.Results: Myositis specialists defined the degree of clinically meaningful improvement in CSM for minimal, moderate and major improvement. The conjoint-analysis survey established the relative weights of CSM, with muscle strength and Physician Global Activity as most important. Many candidate definitions showed excellent sensitivity, specificity and area under the curve in the consensus profiles. Trial validation showed that a number of candidate criteria differentiated between treatment groups. Top candidate criteria definitions were presented at the consensus conference.Conclusion: Consensus methodology, with definitions tested on patient profiles and validated using clinical trials, led to 18 definitions for adult PM/DM and 14 for JDM as excellent candidates for consideration in the final consensus on new response criteria for myositis.

Alcohol use disorder (AUD) is one of the most common psychiatric disease in the general population, characterized by having a pattern of excessive drinking despite the negative effects of alcohol on the individual's work, medical, legal, educational, and/or social life. Currently, the bio-psycho-social model describes properly AUD as a multidimensional phenomenon including biological, psychological, and socio-cultural variables affecting the nature, maintenance, and expression of the disorder. The AUD diagnostic process is crucial since the treatment success depends heavily on the accuracy and the adequacy of the diagnosis. The diagnosis is based on a comprehensive assessment of the patient's characteristics and uses interviews and psychometric instruments for collecting information. This paper will provide insights into the most important psychological dimensions of AUD and on the best psychometric instruments for proposing AUD diagnosis.

Pharmacological treatment of alcohol use disorder represents an essential core of the therapeutic project in a multidisciplinary approach. While non-drug treatment is evolving, from a medical perspective few pharmacotherapies are available; in particular acamprosate, naltrexone and more recently nalmefene among anticraving drugs, disulfiram as an antidipsotropic medication. New studies are focusing on off-label drugs. Moreover, scientific evidence has to support any therapeutic indication which should be tailored on patient needs and comorbidity by considering the individual bio-psycho-social profile. Follow-up is essential in order to assess patient compliance to treatment and monitoring outcomes.

Background. Clinical practice of mental health services changed in 1978 after the Basaglia Law was passed, and it is now characterized by usually voluntary treatments offered by community-based services. That broadened the interventions' focus from the single subject to their environment. Dual diagnosis is defined by WHO as «the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder». It is considered to be a "border territory" since entails networking between different medical services. Materials and methods. A literature search was performed in PubMed, Web of Science, Scopus and Google Scholar. Search terms were: "guidelines", "treatment", "comorbidity", "substance abuse", "alcohol", "dual-diagnosis", "psychiatric illness", "outpatient", "inpatient", "health care service", "clinical practice". National and regional regulations about health and addiction were screened too. Out of 598 titles, 31 studies were included in this article for their relevance on treatments and networking between services for dual diagnosis cases. Results. There are not any guidelines for clinical practice in the literature, neither there are any shared treatment strategies on a national level. Considering the autonomy that every regional health service has, several different courses of action are possible. Here there are reported the ones available. Conclusions. After discussing the weak points of the treatment options, we suggest the "Multidisciplinary Healthcare" model to best address the difficulties represented by dual diagnosis cases.

The phenomenon of homeless people is eliciting a devastating social impact with an estimated prevalence in the USA and in Europe between 5.6% and 13.9%. These persons have a poor quality of life, a limited or no social life. They are often unemployed or work only occasionally. They are at risk for problems with the law and often suffering from addiction to other drugs, psychiatric and other medical diseases. Alcohol is often not the cause of their social status, but only the result of other discomforts thus contributing to their bio-psycho-social degradation. In 2009 the US Department of Housing and Urban Development’s Homelessness Assistance Programs and in 2010 the European Consensus Conference on Homelessness discussed about the social rehabilitation of these people, using the concept of case management. In particular, the Standard Case Management was able to improve the housing stability, to reduce the use of drugs and to remove the working barriers. The Assertive Community Treatment was able to improve the housing stability and had a better efficacy for patients suffering from double diagnosis.

Alcohol withdrawal syndrome (AWS) is a medical emergency, rare in the general population, but very common among alcoholic individuals, which can lead to severe complications when unrecognized or late treated. It represents a clinical condition which can evolve in few hours or days following an abrupt cessation or reduction of alcohol intake and is characterized by hyperactivity of the autonomic nervous system resulting in the development of typical symptoms. According to DSM-5 criteria, the alcohol withdrawal syndrome is defined as such: if patients present at least two of typical signs and symptoms. The Clinical Institute Withdrawal Assessment of Alcohol Scale, revised version (CIWA-Ar), is the tool for assessing the severity of AWS. The support to patient with AWS includes pharmacological intervention as well as general support, restoration of biochemical imbalances and specific therapy. Regarding the pharmacological treatment, benzodiazepines represent the gold standard, in particular long-acting benzodiazepines, administered with a gradual reduction up to cessation.

Adolescents are the most vulnerable group for alcohol-related diseases, as starting to drink at a young age is associated with an increased risk of alcohol dependence in adulthood. Young people tend to drink large amounts of alcohol to seek out strong emotions and for reaching fun at all costs through the psychotropic properties of alcohol. The behavioural motivations of this kind of drinking (binge drinking) depend on the lack of awareness of the harmful effects of alcohol, in the rite of social conviviality (a condition for which alcohol is attributed to the function of facilitating the aggregation among young people), in the absence of personal interests, lack of controls and family habits. Actions to be taken to limit or stop harmful alcohol consumption in young people should be based on interventions aimed at delaying the age of first contact with alcoholic beverages through the implementation of educational campaigns aimed at young people, their families and the whole society.

The development of a treatment for alcohol use disorder (AUD) is a crucial and complex moment. Indeed, the information gathered by a team of professionals (physicians, psychologists and social workers) (bio-psycho-social model of AUD) interact to choose the most appropriate cure. As for AUD psychological treatment, it is of considerable importance to avoid clinical treatments leading to drop-out for improving the patients quality of life. Psychoanalytic and behavioral techniques were early utilized as psychological treatment of AUD, however, evidence-based approaches as motivational interviewing (MI) and cognitive behavioral therapy (CBT) are recently used in AUD. In this work we review the more effective and appropriate AUD psychological treatments.

Background. It has long been appreciated that alcohol use disorder (AUD) is associated with increased risk of psychiatric disorder. As well, people with history of mental disorder are more likely to develop lifetime AUD. Nevertheless, the treatment of dual diagnosis (DD) in alcohol addiction still remains a challenge. The efficacy of pharmacological treatment for these patients has been widely investigated with controversial results. Patients with untreated psychiatric disorder are at higher risk to return to drinking and tend to do so more quickly. The aim of this review was to collect clinical data for developing guidelines for the pharmacological treatment of psychiatric diseases in a population with AUD. Materials and methods. A literature review was conducted using the following databases: PubMed-NCBI, Cochrane database, Embase Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: "guideline", "treatment", "comorbidity", "substance abuse", "alcohol", "dual-diagnosis", "antidepressant", "antipsychotic", "mood-stabilizer". Out of 1521 titles, 84 studies were included for their relevance on pharmacological treatment of psychiatric disorders in people with AUD. Results. Different drugs were collected in major pharmacological classes (antidepressant, mood-stabilizer, antipsychotic), in order to identify their proved efficacy for treating specific psychiatric disorder in the AUD population. Data were selected and verified for publications from randomized clinical trials, open-label trials and case reports. Conclusions. DD in alcohol dependence is a complex clinical entity, and its high prevalence is supported by epidemiological data. Pharmacological management of psychiatric disorders in patients with AUD remains partially anecdotal. Based on reviewed articles, we propose a classification of psychiatric medications for treatment of mental disorders comorbid with AUD, listed with evidence-based recommendations. More research is needed to obtain and collect clinical data, in order to organize and share evidence-based guidelines.

Background. The term "dual diagnosis" (DD) has been used in clinical practice for years. However, there is confusion about these medical cases, which consist in the presence of both a psychiatric disorder and a substance abuse disorder (in this case, alcohol). There are evidences that in the alcohol use disorder (AUD) population, 50.3% of patients had a psychiatric comorbidity during their lifetime. Nevertheless, to these days there are not any thorough guidelines for the management of these patients. A precise nosography would prevent delay in diagnosis and treatment and all the self-evident negative outcomes of those delays. Materials and methods. A literature search was performed in PubMed, Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: "guidelines", "treatment", "comorbidity", "substance abuse", "alcohol", "dual-diagnosis", "etiopathogenesis", "outpatient", "inpatient", "unit", "diagnosis". Out of 1045 titles, 43 studies were included in this article for their relevance on definition and nosography of DD. Results. Taking into account the state of art available in the literature, we contributed to clarify the definition of DD in the alcohol addiction field. Clinical data confirm high prevalence of DD, and allow to better describe and understand the complex relationship between alcohol dependence and other psychiatric diseases. Conclusions.We believe that a clear nosographic framework and a precise diagnostic process are essential for a timely management of every case, using specific guidelines to standardize and improve clinical practice. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which introduces dimensional approach, could be a useful tool to improve diagnostic accuracy.

Objective: Group norms and drinking motives are crucial predictors of adolescents’ alcohol intake. The current study examined the role of drinking motives in the association between descriptive group norms and alcohol intake. Method: A sample of 525 Italian adolescents (56% men) was surveyed. Participants completed measures of group norms, drinking motives, and personal drinking. Results: Hierarchical multiple regression analysis revealed that stronger group norms were positively related to increased alcohol intake. Drinking for enhancement and social motives also were related to increased alcohol intake. Mediation analysis showed that group norms were related to alcohol intake through social and enhancement drinking motives. Conclusions: Drinking motives provide fruitful insights into the relationship between descriptive group norms and excessive alcohol use among adolescents. Implications for future research are discussed.

Negli ultimi anni, un tema che ha riscosso un interesse crescente è lo studio del consumatore socialmente responsabile, definito da Webster (1975) come “un consumatore che tiene conto delle conseguenze pubbliche del suo consumo privato e che tenta di usare il suo potere di acquisto per portare un cambiamento sociale” (p. 188). In questo lavoro si indagano come variabili antecedenti il consumo atteggiamenti e valori. Rispetto a quest’ultimi si è utilizzata la teoria di Schwartz (1992), che identifica dieci valori di base, in relazione fra loro lungo due dimensioni: self-enhancement/self-trascendence e openess to change/conservation. L’obiettivo è verificare se le variabili considerate determinino scelte comportamentali diverse fra un prodotto convenzionale ed un prodotto socialmente responsabile, quando gli aspetti di etica del lavoro legati alle aziende produttrici sono messi in evidenza e tracciare quindi il profilo del consumatore socialmente responsabile e del consumatore che sceglie prodotti convenzionali. La letteratura prima d’ora aveva considerato come determinanti del comportamento responsabile solo il self-enhancement. Qui si ipotizza l’effetto anche di altre dimensioni valoriali. Allo studio hanno partecipato 245 persone (M = 60, F = 178, sette persone non indicano il genere; età media = 20.23). I rispondenti leggevano la presentazione di un prodotto facilmente reperibile sul mercato, il cioccolato. I partecipanti erano assegnati casualmente alla presentazione di un prodotto convenzionale (n = 110) e di un prodotto socialmente responsabile (n = 109) . Per aumentare la credibilità della manipolazione sperimentale, si sono scelti prodotti realmente esistenti. Il questionario rilevava misure di atteggiamenti (differenziale semantico), valori e intenzioni comportamentali, in particolare word of mouth positivo e negativo (Carroll & Ahuvia, 2006; Romani, Grappi & Dalli, 2010) e intenzioni di acquisto future. Analisi di regressione svolte separatamente per le due condizioni, mostrano che contrariamente alla letteratura corrente, per quanto riguarda i valori, la dimensione self-enhancement è risultata ininfluente nel determinare le intenzioni comportamentali in risposta ad entrambi i prodotti. Emerge quindi una maggiore complessità del profilo valoriale dei diversi tipi di consumatori. Quando si considera il prodotto convenzionale, tanto più si è conformisti, si ha come valore la sicurezza e la stimolazione e non si è universalisti, tanto più si intende attuare comportamenti a favore di tale prodotto e tanto meno si intende attuarne di negativi. Rispetto al prodotto socialmente responsabile, tanto più non si è edonisti, non si ha come valore la sicurezza e si è universalisti, tanto più si intende attuare comportamenti a favore del prodotto e tanto meno si intende attuarne di negativi. Per quanto riguarda gli atteggiamenti, dai risultati emerge che, in entrambe le condizioni, è la componente affettiva e non la componente valutativa a determinare l’intenzione comportamentale futura. I partecipanti attribuiscono un’importanza maggiore alla loro esperienza affettiva, all’impatto con il prodotto e non ad una valutazione razionale del prodotto e delle sue caratteristiche, neppure quando l’etica del lavoro è resa saliente.