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Objectives People with schizophrenia (SCZ) present serious and generalised deficits in social cognition (SC), which affect negatively patients' functioning and treatment outcomes. The genetic background of SC has been investigated in disorders other than SCZ providing weak and sparse results. Thus, our aim was to explore possible genetic correlates of SC dysfunctions in SCZ patients with a genome-wide study (GWAS) approach. Methods We performed a GWAS meta-analysis of data coming from two cohorts made of 242 and 160 SCZ patients, respectively. SC was assessed with different tools in order to cover its different domains. Results We found GWAS significant association between the TMEM74 gene and the patients' ability in social inference as assessed by The Awareness of Social Inference Test; this association was confirmed by both SNP-based analysis (lead SNP rs3019332 p-value = 5.24 × 10-9) and gene-based analysis (p-value = 1.09 × 10-7). Moreover, suggestive associations of other genes with different dimensions of SC were also found. Conclusions Our study shows for the first time GWAS significant or suggestive associations of some gene variants with SC domains in people with SCZ. These findings should stimulate further studies to characterise the genetic underpinning of SC dysfunctions in SCZ.

We aimed at investigating the gender and/or ultradian pattern of serum levels of the Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF). Blood samples were collected at the 8.00, 13.00 and 20.00 hours of the day in healthy men and women, and the neurotrophins concentration was measured in the serum by ELISA. A further aim of the study was to evaluate whether or not the NGF/BDNF variations might be related to specific physiological or psychological traits as mood, feeling good and feeling rested, sexual desire and energy. Heart rate and blood pressure were also monitored at the same hours in each enrolled subject. The anxiety (STAI-T and STAI-S score) and sleeping quality were once evaluated in the morning too. We found that serum BDNF increases in men and decreases in women from morning to evening, while NGF shows a similar ultradian profile between men and women, but with higher concentrations in women. Both neurotrophins also show gender-related associations with psychophysiological variables. High NGF levels correlated with a high score for all the psychological variables in men, but with a low score in women. An inverse correlation was found between BDNF and energy and sexual desire in women, while no correlations were found in men. These data disclose that the condition of well-being (or activity/arousal status) is featured by an increasing NGF profile in men and a negative BDNF/NGF trend in women. The clinical relevance of the present data is discussed.

The aim of this study was to provide an Italian validation of the Premenstrual Symptoms Screening Tool (PSST). The PSST is a retrospective questionnaire, originally developed in English language, used for the screening of Premenstrual Syndrome (PMS) and of Premenstrual Dysphoric Disorder (PMDD). PMDD and PMS are common, but are often not adequately recognized and treated, although they can heavily interfere on women's quality of life.An Italian version of the PSST from English was prepared using the "forward-backward" procedure, and submitted to a sample of 520 women over 18 years of age (mean age of 23.6; DS=±3.1). The content validity, the internal consistency, the test-retest reliability, and the convergent validity were evaluated. The factorial structure underlying the questionnaire was assessed with the use of both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).Among the 520 participants to the study, 337 experienced no or mild premenstrual symptoms (64.8%), while 158 women evidenced a positive screening for moderate or severe PMS (30.4%), and 23 for PMDD (4.4%). The Italian PSST displayed adequate content validity and a very good internal consistency, with a Cronbach's alpha of 0.89. The test-retest reliability showed satisfactory results, with a Spearman's ρ for the overall score of 0.80, and the intra-class correlation coefficient (ICC) of 0.810 (95% CI=0.761-0.862; p0.001). The EFA was performed using the principal component analysis, followed by varimax rotation. The CFA was conducted on EFA results and supported a four-factor model, yielding the best fit indices [χ2/df=1.76; CFI=0.920; TLI=0.904; RMSEA=0.054 (0.043-0.065)]. The convergent validity, evaluated using the Spearman's correlation coefficient between the overall score of the Italian version of PSST and the Beck Depression Inventory (BDI) score showed a good value (ρ=0.647 p0.001).Our results support the cross-cultural validity of the questionnaire, suggesting that the Italian version is a reliable and valid tool, as well as easy to use, to screen women in need of treatment for their premenstrual symptoms.

Background Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals. Aims To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia. Methods The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures. Results Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p p Conclusions These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD.

Importance: The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs. Objective: To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up. Design, Setting, and Participants: This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020. Main Outcomes and Measures: Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains. Results: In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P

Background Electroconvulsive Therapy (ECT) has been widely applied to treat schizophrenia (SCZ) in the presence of resistance to pharmacotherapy. The mechanism of action of ECT in schizophrenia has not been fully clarified, though its intrinsic mechanism presents analogies with some neurobiological processes mediated by nerve growth factor (NGF). Objectives. The aim of this study was to investigate in patients with treatment-resistant schizophrenia (TRS) the effect of ECT on acute and long-term NGF serum levels and the association with the clinical outcomes. Methods. Twelve male inpatients with TRS underwent eight sessions of ECT. Blood samples were collected during the first and the eighth ECT at the following time points: 5 minutes before the induction of seizure and then at 0, 5, 15 and 30 minutes after seizure. Results. Following ECT treatment, a substantial clinical improvement in symptom severity was indicated by a significant reduction in the Positive and Negative Syndrome Scale (PANSS) total and subscales scores. Even though the baseline NGF levels showed an increase over time, there were no statistical differences in NGF at time 0 at the first and the eighth ECT session. Furthermore, no correlation was observed between the severity of schizophrenic symptoms and NGF levels. Conclusions. This is the first study addressing peripheral NGF during ECT treatment in TRS, as well as the first study in which NGF has been evaluated in different ECT sessions at various time points. These findings may potentiate the knowledge about the neurotrophic effects of ECT and the role of NGF in synaptic plasticity related to possible mechanisms of schizophrenia treatment.

First generation antipsychotics (FGAs) are more likely to induce extrapyramidal side-effects (EPS) than second generation antipsychotics (SGAs), and EPS have been shown associated to cognitive deficits in schizophrenia. So far, no study has explored the relationships between EPS and social cognition (SC) in people with schizophrenia. Therefore, we assessed the prevalence of EPS in a large sample of drug-treated community-dwelling persons with schizophrenia and explored their relationships with patients' neurocognitive and SC abilities. 875 patients underwent EPS, psychopathological, neurocognitive and SC assessments by means of standardized measures. Relationships between EPS, psychopathology and neurocognitive and SC measures were investigated by correlation tests. Moreover, a partial correlation network was computed by means of a network analysis. 256 patients were treated with FGAs alone or in combination with SGA and 619 with SGAs. EPS were significantly more frequent in FGA-treated group than in the SGA-treated one. Patients with EPS disclosed a more severe psychopathology and were more impaired in neurocognitive and SC measures compared to those without EPS. Disorganization, expressive deficit, and duration of illness were significantly associated to both neurocognitive and SC measures while EPS were associated to neurocognitive measures only. The network analysis showed that parkinsonism was the sole EPS directly connected to both psychopathological and neurocognitive indices whereas no direct connection emerged between EPS and SC measures. Present findings confirm that EPS are still present in the era of SGAs and contribute, together with other clinical variables, to the neurocognitive but not to the SC impairment of patients with schizophrenia.

The Resilience Scale for Adults (RSA) is a self-administered 7-point Likert scale of 33 items, structured in 6 factors measuring personal and interpersonal resources. We aimed to develop and validate a brief form of the RSA, in order to produce a short, fast and handy tool for assessing resilience.A non-clinical sample of 500 university students was recruited using a research website. Reduction of the RSA-33 was performed using an item response theory (IRT) analysis by means of a Graded Response Model (GRM) protocol on the 6 RSA factors separately. After the IRT reduction process, a Pearson's correlation matrix of the original RSA-33 and the reduced version was estimated. Finally, a CFA was estimated to assess factorial validity. The estimation of item discrimination from the GRM ranged from 0.69 and 5.94 and allowed to retain 11 items.For both the original RSA-33 and the brief RSA-11, the strongest correlations were between Family Cohesion and Social Resources factors. CFA was estimated to assess factorial validity in a simplified model with two latent first-order factors, i.e., Personal and Contextual resources.The availability of short and psychometrically robust measures is needed to improve evaluation and monitoring in mental health programs. For this reason, we provided a brief and effective tool to assess resilience resources in both research and clinical settings.

Objective The study aimed to explore premorbid academic and social functioning in patients with schizophrenia, and its associations with the severity of negative symptoms and neurocognitive impairment. Method Premorbid adjustment (PA) in patients with schizophrenia was compared to early adjustment in unaffected first-degree relatives and healthy controls. Its associations with psychopathology, cognition, and real-life functioning were investigated. The associations of PA with primary negative symptoms and their two factors were explored. Results We found an impairment of academic and social PA in patients (P ≤ 0.000001) and an impairment of academic aspects of early adjustment in relatives (P ≤ 0.01). Patients with poor PA showed greater severity of negative symptoms (limited to avolition after excluding the effect of depression/parkinsonism), working memory, social cognition, and real-life functioning (P ≤ 0.01 to ≤0.000001). Worse academic and social PA were associated with greater severity of psychopathology, cognitive impairment, and real-life functioning impairment (P ≤ 0.000001). Regression analyses showed that worse PA in the academic domain was mainly associated to the impairment of working memory, whereas worse PA in the social domain to avolition (P ≤ 0.000001). Conclusion Our findings suggest that poor early adjustment may represent a marker of vulnerability to schizophrenia and highlight the need for preventive/early interventions based on psychosocial and/or cognitive programs.

The aim of the current study was to evaluate the construct validity and the internal consistence of the Italian version of the Psychological Maltreatment Review (PMR), and to assess the concurrent validity to provide adequate and reliable instruments to measure retrospectively child psychological maltreatment in the Italian population.The participants to our study were 209 patients and 217 nonclinical subjects. The first group consisted in 209 adult patients, 106 males and 103 females (mean age of 41.43 years; SD=12.34) consecutively admitted at the psychiatric unit of the L'Aquila San Salvatore Hospital. The second group consisted in 217 non-clinical subjects, 96 males and 121 females (mean age of 36.38; SD=10.38) that completed an online survey, including the self-report version of the PMR and the Risky Families Questionnaire (RFQ). All subjects were invited to answer to Sociodemographic Information Form and to take a self-report battery composed by two instruments: the Psychological Maltreatment Review (PMR) and the RFQ.Internal consistency reliability analyses were performed separately for the two samples, all the scales had very good internal consistency in both samples, with Cronbach's alpha coefficients equal or greater than .88. An EFA was performed, using exploratory principal axis factoring, on the data of individuals from the non-clinical sample, separately for paternal and maternal scales, followed by varimax rotation and scree testing. The CFA was performed on the data of the patients' sample, separately for paternal and maternal scales, supported a three factor model yielding the best fit indexes, both for paternal scales, χ 2 =725, p.001; df=402, CFI=0.92; TLI=0.91, SRMR=0.053, RMSEA=0.063, 90% CI [0.056, 0.07]; and maternal scales, χ 2 =758, p.001; df=374, CFI=0.89; TLI=0.88, SRMR=0.064, RMSEA=0.07, 90% CI [0.06, 0.07]. The CFA performed on the patient' sample supported a three factor model yielding the best fit indexes. The convergence of the EFA and the CFA in different samples supported the structural validity of the PMR and replicated its factorial structure, for both maternal and paternal ratings.This study provides evidence on the appropriateness of the Italian version of the PMR to retrospectively measure childhood psychological maltreatment. The three PMR scales (psychological abuse, psychological neglect and psychological support) demonstrated good internal consistency with average alpha coefficients, equal or greater than .88. The findings provide evidence of the construct validity, according to the literature, suggesting that psychological abuse, psychological neglect and parental support are dimensionally separated constructs, as defined in the literature.

Suicide is a leading cause of death worldwide, with several risk factors, including a family history of mental disorders (FHMD) and interpersonal violence. The relationship between these risk factors needs further investigation.Addressing the impact of interpersonal violence on suicide attempts, and its interaction with FHMD.192 participants completed an online questionnaire, including the Psychological Maltreatment Review and the Karolinska Interpersonal Violence Scale (putative mediating variables variables), questions about previous suicide attempts and FHMD. Logistic regression and mediation analysis were performed.FHMD (OR=7.09, 95%CI [2.20,22.81]), expressed violence in childhood (OR=2.55, 95%CI [1.26,5.18]) and exposure to violence in childhood (OR=2.80, 95%CI [1.80,4.34]) predicted attempted suicide. Exposure to, and expression of violence in childhood mediated 15.23% and 9.63% respectively of the total effect of FHPD on attempted suicide.Small sample size, reporting bias on FHMD an attempted suicide, self-selection bias due to sampling technique.The familial load on adult suicidal behavior is partially mediated by exposure to violence in childhood, suggesting that the presence of a relative affected by any psychiatric condition may contribute to exposure to violence in childhood, which eventually enhances the risk of suicide in adulthood.

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem., Highlights Better insight seems associated with depressive symptoms in schizophrenia.Network analyses were used to explore this association in a large sample.Insight was associated with self-depreciation, guilt, and suicidal ideation.Although cross-sectional, data suggest causal direction from insight to depression.

Our manuscript aims to: 1) assess physical health in a sample of patients with severe mental disorders; and 2) identify the psychopathological and psychosocial characteristics associated with an increased likelihood of having a poor physical health. The study, funded by the Italian Ministry of Education, has been carried out in psychiatric outpatient units of six Italian University sites. All recruited patients have been assessed through standardized assessment instruments. Moreover, anthropometric parameters have been obtained at recruitment and a blood samples have been collected to assess cardiometabolic parameters. Four-hundred and two patients with a primary diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were recruited. Internalized stigma, psychosocial functioning, quality of life, psychiatric hospitalizations, depressive/anxiety and manic symptoms and cognition were those domains more strongly associated with poor metabolic parameters, including high body mass index, HOMA and Framingham indexes and waist circumference. There were no statistically significant differences among the three diagnostic groups. Our findings highlight the importance of perceived stigma and quality of life on patients’ physical health. This should be taken into account when developing plans for reducing the mortality rate in patients with severe mental disorders.

The metabolic syndrome (MS) is an area of interest for mental health research because individuals with mental illnesses have an increased risk of medical morbidity and mortality compared with the general population. This cross-sectional study is aimed to estimate the prevalence of metabolic syndrome in an Italian psychiatric sample, treated with different types of antipsychotics.The data were derived from medical records of patient with affective and non-affective psychosis, admitted to the Hospital of L'Aquila psychiatric ward, from January 2012 to July 2014. The sample refers to consecutive admissions of subjects of both sexes, aged over 18 years, receiving one or more antipsychotic treatment. The diagnosis of MS was established when the clinical subject at least three of the five diagnostic criteria of the Adult Treatment Panel (NCEP-ATP III) were met.389 subjects were evaluated. We report a MS prevalence of 27.5%. This figure is very close to the metabolic syndrome prevalence in the Italian general population quoted around 26%. The BMI values also are very similar in these two populations, despite a higher obesity rate in the clinical sample. The MS prevalence rates in subject with schizophrenia, bipolar disorders and depressive disorders were respectively 30.6%, 36.4% and 36.8%. No significant differences in MS, diabetes or dyslipidemia rates were found among the three diagnostic groups. We did not find differences in metabolic syndrome prevalence either in relation to psychotropic polypharmacy or in relation to typical or atypical antipsychotics. However the psychiatric females in the clinical sample tend to have higher obesity rate, with a sort of all or none distribution (i.e. more obesity, more normal weight, but less overweight) compared to the general population.These findings could be explained by the interaction of some sort of liability due to drug treatment, illness related lifestyles, gender and other interacting factors (e.g. genetic) with metabolic issues.

In April 2009 there was an earthquake in L'Aquila city. Several studies have shown that the citizens ability to react to a stressful situation is related to the satisfaction level of services during the reconstruction process of the city. The general aim of the present study is to investigate if the knowledge of information about the reconstruction phase has an influence on the satisfaction of the citizens, regarding the lifestyles and the capacity to adapt and respond to changes.Five hundred and three residents in L'Aquila city were interviewed using a questionnaire that examines the satisfaction level, understanding of political issues and the resiliency skills of individuals. Results: The data show that the lack of information about the work of the facilities of by the Government has caused dissatisfaction among the citizens who feel that they have not been well informed about the rebuilding on the city.The study can represent an indication concerning the facilities and assistance provided by politicians and be understood as an input in order to improve the administrative system and public welfare.

Seizure threshold (ST) is a parameter that differs in each person and can be modified both spontaneously and because of drug intake and/or other exogenous factors. A rise in ST during a course of electroconvulsive therapy (ECT) has been demonstrated in patients with depression and mania, but little information has been available as to whether the same result occurs in schizophrenia (SCZ). 11 male patients underwent estimation of the seizure threshold over a bilateral ECT course. Mean ST changed not significantly. No correlations were found between baseline ST and Positive and Negative Syndrome Scale (PANSS) scores. A significant positive correlation emerged between baseline ST and the variation of Hamilton Depression Rating Scale (HDRS) total and cognitive scores. The results suggest that ST in SCZ patients is not related to baseline psychopathological features, it is not related to clinical improvements of negative or positive SCZ symptoms and it does not change during the ECT course but it appears predictive of the improvement of affective and cognitive symptmos.

Familial Atypical Multiple Mole-Melanoma Syndrome (FAMMM) is an autosomal dominant genodermatosis characterized by the presence of a high number of dysplastic nevi and family history of melanoma or pancreatic cancer. Melanomas in FAMMM patients tend to occur at a younger age, although they are clinically similar to sporadic melanomas in terms of overall survival.A 45 year-old woman with a family history of melanoma, a type II phototype and numerous (100) nevi was admitted to our Department of Dermatology and Plastic Surgery. Over the past years, the patient underwent several surgical operations to remove pigmented lesions and two are dysplastic nevi. Since 1995, she underwent surgery to remove four melanomas. She is followed for skin examinations including dermoscopy.Identifying high-risk patients for melanoma represents a primary objective for the specialists that are involved in the management of this disease, especially in order to enact all the necessary surveillance and follow-up strategies.

The Night Eating Syndrome (NES) is a disorder characterized by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. The diagnosis and early treatment of NES may represent an important means of prevention for obesity. Aims. The aim of the present study was to determine the vulnerability to develop NES between a clinical sample of patients with psychiatric disorders and a non clinical sample. We investigated a possible relation between stress and a dysfunctional eating behaviors as NES. Methods. The Night Eating Questionnaire (NEQ) has been administered to 147 psychiatric outpatients and to 531 subjects attending the University of L'Aquila. The NEQ is a questionnaire used to evaluate the prevalence of NES. The sample has been also evaluated through the Stress-related Vulnerability Scale (SVS) to measure both perceived stress and social support. Results. The 8.2% of patients scored above the diagnostic cut-off of the NEQ, compared to the 2.1% in the sample of healthy subjects. The majority of patients who had shown NEQ25 had a diagnosis of major depressive disorder (MDD). The total scores on the NEQ were strongly associated with the SVS total score and especially with the "lack of social support" subscale. Conclusions. This study shows the increased vulnerability of NES in the sample of psychiatric patients compared to the sample of healthy subjects. The study further confirms the strong association between perceived stress, social support, altered eating behaviors and obesity.