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The study of the effects of the COVID-19 pandemic on individuals who attended mental health services is needed to identify the specific vulnerabilities associated to this challenging period. Despite several analyses reporting the worsening of eating disorders symptomatology after the beginning of the pandemic, characterizations of adult inpatients with eating disorders are still lacking. We conducted a retrospective analysis to assess whether adult individuals who underwent hospitalization in a specialized eating disorders unit in the two years after the beginning of the COVID-19 pandemic differed in clinical presentation, psychopathological measures, and treatment outcomes from inpatients hospitalized in the two years before. In the comparison between the two groups, the individuals who began treatment after the start of the pandemic presented with more physical hyperactivity and more severe psychopathological scores in most of the areas investigated, with differences in eating symptoms still evident at discharge. Notably, body-related symptoms (i.e., body shape concerns, body checking, body avoidance) were associated with the pandemic, and also for inpatients with extreme anorexia nervosa. This retrospective analysis does not allow us to separate the impact of COVID-19 from other potentially relevant co-occurring factors; however, these findings help in understanding how the pandemic could have affected individuals that needed specialized intensive treatment.

Dissociation in anorexia nervosa (AN) is common (literature reported 29% of dissociative disorders in eating disorders) and higher in patients with binge-purging AN (BP-AN) than in those with restricter AN (R-AN). However, the distinction between somatoform (SomD) and psychoform dissociation (PsyD) is understudied. We aimed to assess the differences in PsyD and SomD, eating-related, general, and body-related psychopathology, and childhood trauma between subtypes of AN. Then, we attempted to describe a subgroup of patients with AN with marked SomD comparing them to patients without SomD, also controlling the results for PsyD and AN subtypes. Inpatients with AN (n = 111; 109 women and 2 men) completed self-reported questionnaires evaluating dissociation, eating-related, body-related, and general psychopathology, and childhood abuses. Patients with BP-AN reported higher SomD and PsyD and a more severe clinical picture than those with R-AN. The SomD-group (n = 41) showed higher eating concerns, trait-anxiety, body-related variables, and sexual/physical abuse compared to the no-SomD group (n = 70), independently of AN subtype and PsyD symptoms. Results described particular features of patients with AN and SomD. Data, clinically, suggest a careful assessment, for both SomD and PsyD, especially when a history of bodily-impacting trauma is present, potentially fostering dissociation-informed interventions.

The literature has reported poor concordance in the assessment of psychiatric conditions, and inhomogeneity in the prevalence of psychiatric comorbidities in Anorexia Nervosa (AN). We aimed to investigate concordance level between clinicians’ and researchers’ diagnoses of psychiatric comorbidity in AN and differences in eating and general psychopathology between patients with and without psychiatric comorbidity assessed by clinicians versus researchers. A clinical psychiatrist interviewed 122 patients with AN; then a researcher administered the Structured and Clinical Interview for DSM-5 (SCID-5). Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). The agreement between clinicians and researchers was poor for all diagnoses but obsessive-compulsive disorder and substance use disorder. Patients with comorbid disorders diagnosed by researchers reported more severe eating and general psychopathology than those without SCID-comorbidity. The differences between patients with and without comorbidities assessed by a clinician were smaller. Two approaches to psychiatry comorbidity assessment emerged: SCID-5 diagnoses yield a precise and rigorous assessment, while clinicians tend to consider some symptoms as secondary to the eating disorder rather than as part of another psychiatric condition, seeing the clinical picture as a whole. Overall, the study highlights the importance of carefully assessing comorbidity in AN.

The validity of body mass index (BMI) specifiers for anorexia nervosa (AN) has been questioned, but their applicability to inpatients with extremely low BMIs and their prognostic validity are currently unknown. Therefore, we designed this study: (a) to test current BMI specifiers in severe inpatients; (b) to explore a “very extreme” specifier (VE-AN; BMI ≤ 13.5); and (c) to verify inpatients’ hospitalization outcome according to BMI severity. We enrolled 168 inpatients with AN completing the following: Eating disorder Examination-Questionnaire, Eating Disorder Inventory-2, State-Trait Anxiety Inventory, Beck Depression Inventory, Body Shape Questionnaire, and EQ-5D-VAS. According to the current BMI classification, those with a BMI < 15 versus those with non-extreme AN (NE-AN, BMI ≥ 15) differed on all measures but the quality of life with those with NE-AN reporting more impaired scores on all measures. Adopting an exploratory classification comparing VE-AN, extreme AN (E-AN, BMI = 13.6–14.99), and NE-AN, no differences emerged between VE-AN and E-AN, while those with NE-AN reported significantly more impaired scores on all variables while the quality of life again did not differ across groups. Hospitalization outcome improved for all groups, independently of BMI. Groups differed concerning the length of stay that mirrored BMI severity and impacted also hospitalization outcomes. Taken together, our data support the lack of validity of current BMI specifiers in AN, even in the acute setting. Moreover, the exploratory subgroup of patients with BMI ≤ 13.5 did not delineate a clinically different group.

Purpose This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions. Methods The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired. Results Cronbach’s alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965–0.976) in patients and 0.960 (0.944–0.974) in controls. Test–retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983–0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff’s delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2–90.7). Conclusion The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes. Level of evidence Level III, Evidence obtained from well-designed cohort or case–control analytic studies.

Background: the role of self-conscious emotions (SCE) such as shame and guilt in eating disorders (ED) has been systematically studied only in recent years, but it is still debated. This study aims to investigate the role of SCE in anorexia nervosa (AN), evaluating the role of self-consciousness. Methods: fifty-five individuals with AN and seventy-four healthy controls (HC) were enrolled and completed a battery of tests evaluating the proneness to feel shame and guilt, as well as comparing self-consciousness, eating, and general psychopathology. Results: individuals with AN showed a higher proneness to shame. Shame was correlated with body dissatisfaction and drive for thinness, which are core symptoms in AN, after controlling for scores of depression and anxiety. Proneness to guilt seemed to be less correlated with eating and body symptomatology, but it appeared to have a negative correlation with binge-purging symptoms. Furthermore, proneness to shame was independent of guilt or self-consciousness and the two groups did not differ regarding public and private self-consciousness. Conclusions: shame is an important and independent factor in AN. Future research may offer progress in the development of shame-focused therapies.

O funcionalismo sobre a natureza de estados mentais postula que um estado ou propriedade mental é um estado ou propriedade funcional. Isto é, estados funcionais existem apenas a partir de uma rede causal na qual executam uma função, e de acordo com o funcionalismo esta rede é composta por entradas sensoriais, saídas comportamentais e outros estados mentais. A teoria funcionalista abrangente oferece uma compreensão mais inclusiva sobre os estados mentais de modo a atribuir mentalidade a casos como movimentos sociais ou grupos de pessoas, o que pode ser considerado contraintuitivo. Neste contexto, (1) apresentamos a tese funcionalista abrangente, (2) defendemos que a noção de intuição subjacente às principais críticas ao funcionalismo não é suficiente para acusar a teoria de ser contraintuitiva e, por fim, (3) sugerimos que nossa resistência em atribuir estados mentais a casos de agência de grupos se deve principalmente a características da psicologia do senso comum, segundo a qual atribuímos mentalidade mais facilmente a entidades que possuam ou (i) traços antropomórficos ou (ii) proximidade afetiva conosco.

Perfectionism is a risk and maintaining factor for anorexia nervosa (AN) but studies on its classification are lacking. This study aimed to classify patients with AN and healthy controls (HCs) according to their perfectionism; to evaluate the association between perfectionism clusters and severity of general and eating psychopathology for both groups; to investigate the relationship between baseline perfectionism and hospitalization outcome for patients. A sample of 207 inpatients with AN and 292 HCs completed: Eating Disorders Inventory-2, Frost Multidimensional Perfectionism Scale, Beck Depression Inventory, and State- Trait Anxiety Inventory. Cluster analyses were run to classify participants according to their perfectionism scores. Three clusters (i.e., high, medium, low perfectionism) emerged for both patients with AN and HCs. The high perfectionism cluster was over-represented among patients. Both groups reported significant differences across clusters in eating-related difficulties. In AN, anxiety and depression severity varied across clusters according to perfectionism, but patients' baseline perfectionism was unrelated to hospitalization outcome. Inpatients with AN and HCs could be grouped in clusters of high, medium, and low perfectionism which also mirrored their eating psychopathology severity. Finally, hospitalization outcome was unrelated to inpatients' baseline perfectionism.

Dissociation is a debilitating condition often present as comorbidity in patients with eating disorders, but to date only sparse findings are available on this topic. Additionally, very little data exist on the classification of dissociation, namely, psychoform and somatoform, in anorexia nervosa (AN). This review aimed to provide an updated view on the literature about dissociation in AN, with a focus on AN subtypes (i.e., restricter and binge-purging) as well as dissociation type (i.e., psychoform and somatoform), when available. We screened 304 studies, and after title and abstract selection and full-text reading, 29 of them were included in this review. Most of the studies investigated psychoform dissociation, whereas just four publications considered somatoform dissociation. Dissociation resulted to be present in AN more than in healthy controls and in individuals with other psychiatric disorders, and it was related mostly to the binge-purging subtype of AN. Moreover, dissociation was linked to traumatic events, self-harm and negative treatment outcomes, especially in patients affected by the binge-purging subtype of AN. However, results on these matters are scarce and partially discordant. The methodological assessment we performed revealed an overall fair quality of the included studies, although several flaws emerged as well. The present review reported on one hand the relevance of dissociation in AN, but on the other hand the need to stimulate the scientific debate on (a) a deeper investigation of somatoform dissociation in AN and (b) the relationship between dissociation and both clinical severity and treatment response/resistance in AN.

Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty-seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine-lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed.

Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty‐seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine‐lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed.

Ibuprofen is a non-selective cyclo-oxygenase (COX)-1/COX-2 inhibitor used to treat pain conditions and inflammation. Limited data have been published concerning the pharmacokinetic profile and clinical effects of ibuprofen in patients with osteoarthritis (OA). In this paper we compared the pharmacokinetic and clinical profile of ibuprofen (at a dosage of from 800 mg/day to 1800 mg/day) administered in patients affected by severe knee OA.Ibuprofen was administered for 7 days to patients who were scheduled to undergo knee arthroplasty due to OA. After 7 days, the ibuprofen concentration in plasma and synovial fluid was measured through both high-performance liquid chromatography (HPLC)-UV and gas chromatography-mass spectroscopy (GC/MS), while clinical effects were evaluated through both visual analogue scale (VAS) and Western Ontario and McMaster Universities (WOMAC) scores. The Naranjo scale and the WHO causality assessment scale were used for estimating the probability of adverse drug reactions (ADRs). The severity of ADRs was assessed by the modified Hartwig and Siegel scale.Ibuprofen showed a dose-dependent diffusion in both plasma and synovial fluid, which was related to the reduction of pain intensity and improvement of health status, without the development of ADRs.Ibuprofen at higher dosages can be expected to provide better control of OA symptoms as a result of higher tissue distribution.

Generic formulations represent a way to reduce the costs of brand compounds when their patent is expired. While, the bio-equivalence in generic drugs is guaranteed, some excipients as well as dyes could be different and this could reduce the drug safety. Herein, we report the development of Adverse Drug Reactions (ADRs) in two patients after the switch from brand to generic formulations. We have tested cytochrome P450 enzymes expression as well as drug serum levels. None of these markers were altered. Checking deeply into both patient's medical history, they harbored poly-sensitivity or allergy to pollen and graminacea and used different active ingredients for different health problems coming from the same generic company Almus(®). This company used different dyes and excipients compared to the branded drugs made by distinguished companies. In conclusion, we strongly suggest to both pharmacists and physicians to be careful in giving the advice to change the drug, thinking to reduce health sanitary costs without considering the personal clinical history of each one. Paradoxically this behavior is causing other health issues, bringing to an increase of the overall costs for patients as well as for National Health System.

Questo volume, ultimo della serie di libri dedicata a riflessioni teoriche e proposte operative per una didattica speciale e inclusiva della matematica, intende offrire un approfondimento rispetto all’educazione matematica nella Scuola dell’infanzia, sulla base di ricerche nazionali e internazionali e di esperienze didattiche significative. Si riflette sulla Matematica non come disciplina a sé stante, avulsa da un contesto reale, ma come campo di esperienza e su come possano essere costruite le conoscenze dal bambino, anche se con disabilità, mediante il gioco e la metacognizione.