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Rosaria Di Lorenzo,1 Anita Iorio,2 Margherita Pinelli,3 Federica Magarini,3 Mattia Marchi,3 Andrea Sacchetti,3 Chiara Calogero,4 Gian Maria Galeazzi,5 Paola Ferri,5 Sergio Rovesti,5 Alessandro Minarini6 1Service of Psychiatric Diagnosis and Care, Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy; 2Psychiatric Rehabilitation Technique Programme, University of Modena and Reggio Emilia, Reggio Emilia, Italy; 3School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy; 4Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy; 5Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 6Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, MO, ItalyCorrespondence: Rosaria Di Lorenzo, Department of Mental Health and Pathological Addictions, AUSL-Modena, Service of Psychiatric Diagnosis and Care, via P. Giardini n. 1355, Baggiovara (MO), 41126, Italy, Email r.dilorenzo@ausl.mo.itPurpose: Antipsychotic long-acting injections (AP-LAIs) are indicated for patients affected by schizophrenia especially those with poor treatment adherence.Patients and Methods: To compare paliperidone palmitate 3-monthly (PP3M), paliperidone palmitate one-monthly (PP1M) and haloperidol decanoate (HAL-D) treatment, we enrolled 90 patients with schizophrenia treated in Mental Health Center with one of the three AP-LAIs for at least six months and followed them for another 6 months. At 6 and 12 months of treatment we administered Clinical Global Impression-Severity, Global Assessment of Functioning and World Health Organization Quality of Life-26 items (WHOQOL-BREF). At 1-year treatment, we evaluated relapses (psychiatric hospitalizations and urgent consultations), side effects and drop-outs.Results: We did not highlight any statistically significant difference among the three treatments in relapses and scale scores. Weight increase was significantly higher in PP1M and PP3M groups. Twelve patients (13.3%) discontinued AP-LAI. At 1-year AP-LAI treatment, 69% of patients rated quality of life as “good” or “very good” and 71% declared themselves to be “satisfied” or “very satisfied”.Conclusion: HAL-D, PP1M and PP3M 1-year treatments were similarly effective in preventing relapses and improving quality of life and health satisfaction. All discontinuations in the new 3-monthly antipsychotic treatment were caused by patient refusal to continue it.Keywords: antipsychotic long-acting injections, schizophrenia spectrum disorders, relapses, quality of life, health satisfaction

Introduction: According to the WHO, detainees attempt suicide ten times more than the general population. Objectives: To investigate the impact of migration traumas on suicide behaviours of migrants in jail and to explore how substance use and other psychiatric features affect this relation. Methods: Prospective cohort study, conducted at "Sant'Anna" jail in Modena (Italy). Socio-demographic, psychiatric features and previous suicide attempts were collected, and traumas assessed with the LiMEs (List of Migration Experiences) checklist. Every participant was followed-up until an episode of suicide behaviour or to September 2019 (end of study). Survival analysis was performed. Cox's Hazard Ratios were used as a measure of association for the comparison between groups. Results: We recruited 113 subject, 96% male, median age 33. Prevalence of mental disorders was 26% and substance abuse 59%. History of self-harm was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (8 self-harm and 3 suicide attempts); cumulative survival probability was 85% (Figure 1). Having experienced traumas related to wars was significantly associated with suicide behaviours, HR: 5.168 (Figure 2, Figure 3). Interestingly, no subject without substance abuse presented the outcome. Conclusions: Migrants in custody who experienced traumas in the post-migration periods, attempt suicide 5 timesmore frequently than those without traumas at any time. War traumas seem to be more strongly associated with suicide attempts, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties. [ABSTRACT FROM AUTHOR]

Background: Caregivers of patients load different kinds of burdens, including emotional distress. Aims of this study were to evaluate both burden and empathy of caregivers who assist patients with schizophrenia spectrum disorders., Methods: We selected a sample of 60 caregivers (34 women and 26 men), who assisted patients with schizophrenia spectrum disorders treated in our local Community Mental Health Center for a 1-year minimum period. We administered two scales to our sample, Zarit Burden Interview (ZBI) and Balanced Emotional Empathy Scale (BEES), and collected data of caregivers and their assisted patients in a 3-month period. Data were statistically analyzed., Results: We reported a mean ZBI score of 49.68 (±15.03 SD) and a mean BEES score of 14.35 (±9.05 SD), indicating the perception of moderate-severe burden and low level of empathy, respectively. The analysis of internal consistency confirmed the good reliability of both ZBI (Cronbach's alpha = 0.90) and BEES (Cronbach's alpha = 0.77). The correlation between the two scales was not statistically significant at Spearman test. At our multiple linear regression, many variables of both caregiver and patient showed a significant correlation with the ZBI score. In particular, not living with the assisted patient and female gender of caregiver potentially decreased the burden, whereas clinical severity of assisted patient and two caregiver conditions, middle school education and spouse relationship with patient, could worsen the burden. We highlighted two positive statistically significant correlations between the total score of BEES and caregiver characteristics: being spouse and not living with assisted patient., Conclusions: Our study highlights that the caregiver burden of patients with severe psychiatric disorders is high and is associated with low emotional empathy experienced by caregivers, probably due to a defensive psychological mechanism. The conditions of spouse and cohabitation can concomitantly increase both empathy and burden in caregivers.

This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery., (Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd.. All rights reserved.)