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Background: Major depressive disorder (MDD) is prevalent and disabling among older adults. Standing on its tolerability profile, vortioxetine might be a promising alternative to selective serotonin reuptake inhibitors (SSRIs) in such a vulnerable population. Methods: We conducted a randomised, assessor- and statistician-blinded, superiority trial including older adults with MDD. The study was conducted between 02/02/2019 and 02/22/2023 in 11 Italian Psychiatric Services. Participants were randomised to vortioxetine or one of the SSRIs, selected according to common practice. Treatment discontinuation due to adverse events after six months was the primary outcome, for which we aimed to detect a 12% difference in favour of vortioxetine. The study was registered in the online repository clinicaltrials.gov (NCT03779789). Findings: The intention-to-treat population included 179 individuals randomised to vortioxetine and 178 to SSRIs. Mean age was 73.7 years (standard deviation 6.1), and 264 participants (69%) were female. Of those on vortioxetine, 78 (44%) discontinued the treatment due to adverse events at six months, compared to 59 (33%) of those on SSRIs (odds ratio 1.56; 95% confidence interval 1.01–2.39). Adjusted and per-protocol analyses confirmed point estimates in favour of SSRIs, but without a significant difference. With the exception of the unadjusted survival analysis showing SSRIs to outperform vortioxetine, secondary outcomes provided results consistent with a lack of substantial safety and tolerability differences between the two arms. Overall, no significant differences emerged in terms of response rates, depressive symptoms and quality of life, while SSRIs outperformed vortioxetine in terms of cognitive performance. Interpretation: As opposed to what was previously hypothesised, vortioxetine did not show a better tolerability profile compared to SSRIs in older adults with MDD in this study. Additionally, hypothetical advantages of vortioxetine on depress

Background: There is growing support for considering Dance Movement Therapy (DMT) as an effective approach to improving physical and psychological symptoms in eating disorders (ED), but additional evidence is needed. The current study aims to investigate the effectiveness of a DMT intervention for inpatients with ED during an in-hospital rehabilitation program for ED in reducing emotion dysregulation and alexithymia and improving interoceptive awareness. Methods: Forty-nine consecutive inpatient young women with ED (aged between 18 and 34 years) recruited from a clinical center for the rehabilitation of obesity and ED received four group sessions of DMT intervention. All participants completed the Difficulties in Emotion Regulation Scale (DERS), the Toronto Alexithymia Scale (TAS), and the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA) before (Time 0) and after the intervention (Time 1). Paired-sample t-tests were run to assess differences between Time 0 to Time 1. Results: From pre-to-post interventions, there was a significant reduction in the means of all of the subscales of DERS, suggesting an improvement in emotion regulation competencies, with the only exception for difficulties in awareness that increased (p = 0.016). We also found a significant reduction in alexithymia, as proved by significant differences in all of the subscales and the total score of TAS (p < 0.001), and significant improvements in interoceptive awareness as suggested by increased scores of the noticing (p = 0.043), emotional awareness (p < 0.001), body listening (p < 0.001), and trusting (p < 0.001) subscales of MAIA. Conclusion: Overall, our results point towards the efficacy of dance/movement in reducing symptoms of eating disorders. Our findings also suggest that dancing can be considered a useful intervention to increase emotional regulation, reduce alexithymia, and enhance interoceptive awareness.

Introduction Long-acting injectable (LAI) antipsychotics are prescribed to people with severe psychiatric disorders who show poor adherence to oral medication. The present paper examined factors potentially associated with medication adherence to LAI treatment. Methods The STAR (Servizi Territoriali Associati per la Ricerca) Network Depot Study was a multicenter, observational, prospective study that enrolled 461 subjects initiating a LAI from 32 Italian centers. After 6 and 12 months of treatment, we evaluated differences between participants with high (≥5 points) and low (<5 points) medication adherence using Kemp's 7-point scale in sociodemographic, clinical, psychopathological, and drug-related variables. Factors that differed significantly between the two groups were entered for multivariate logistic regression. Results Six months after enrollment, participants with high medication adherence were younger, living with other people, had lower Brief Psychiatric Rating Scale (BPRS) total scores, lower adverse events, and a more positive attitude toward medication than participants with low adherence. Multivariate regression confirmed lower BPRS resistance and activation scores, absence of adverse events, and positive attitude toward medication as factors significantly associated with good adherence. After 12 months, all BPRS subscales were significantly lower in the high adherence group, which also showed a more positive attitude toward medication. BPRS resistance and attitude toward medication were confirmed as factors associated with medication adherence. Discussion Our findings suggest that adherence to LAI is principally related to attitude toward medication and traits of suspiciousness/hostility. Quality of patient-clinician relationship and tailored psychoeducational strategies may positively affect adherence in people undergoing psychopharmacological treatment, including LAI.

Background: The pleasantness of a gentle and slow, namely affective, touch experienced in interpersonal interactions motivates social closeness. In anorexia nervosa (AN), independent evidence suggests lower pleasantness of affective touch, as well as social withdrawal. We aim to probe both the experience of affective touch and its possible association with social anhedonia and lifespan experiences of affective bodily contacts in AN. Methods: The pleasantness of affective and non-affective touch was compared between fourteen women with AN and fourteen healthy women. Stimuli were traditionally delivered with a brush, with the experimenter's hand, as novelty, and with a stick, as control. The pleasantness of imagined and real touch was probed. Self-report questionnaires assessed social anhedonia and lifespan experiences of affective touch. Results: A preserved pleasantness of affective touch emerged in AN in both the imagery and real task, despite higher social anhedonia and less lifespan experience of affective touch than healthy women. Limitations: Affective touch involves loved ones; thus, the experimenter's touch may not resemble real-life interactions. Future research may take advantage of imagery procedures to solve this issue. Conclusions: Body-oriented therapy for AN recognizes touch as a therapeutic tool: ascertaining how touch is experienced is crucial to maximize rehabilitative outcomes. Furthermore, clarifying the possible interplay between interpersonal difficulties in AN and affective touch is especially relevant considering the possible role of the attachment style, which is intensively debated in AN, on affective touch.

Background: The evidence about facial emotion recognition in anorexia nervosa as the role of alexithymic traits on this emotional ability is conflicting and heterogeneous. Objective: We assessed the capability of recognizing facial expressions of two primary emotions, fear, and anger, in the context of anorexia nervosa. Methods: Women affected by anorexia nervosa were compared with healthy weight women in a well-established implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the individual levels of alexithymia were assessed through a standard self-report questionnaire. Results: Participants with anorexia nervosa reported a significantly lower performance in terms of reaction time and accuracy when the emotion of fear—but not anger—was the target. Notably, such an alteration was linked to the levels of alexithymia reported in the self-report questionnaire. Conclusion: In anorexia nervosa, difficulties in processing facial fearful (but not angry) expressions may be observed as linked to higher expressions of alexithymic traits. We suggested future research in which emotional processing will be investigated taking into account the role of the bodily dimensions of emotional awareness.

Uncovering the underdrawings (UDs), the preliminary sketch made by the painter on the grounded preparatory support, is a keystone for understanding the painting's history including the original project of the artist, the pentimenti (an underlying image in a painting providing evidence of revision by the artist) or the possible presence of co-workers’ contributions. The application of infrared reflectography (IRR) has made the dream of discovering the UDs come true: since its introduction, there has been a growing interest in the technology, which therefore has evolved leading to advanced instruments. Most of the literature either report on the technological advances in IRR devices or present case studies, but a straightforward method to improve the visibility of the UDs has not been presented yet. Most of the data handling methods are devoted to a specific painting or they are not user-friendly enough to be applied by non-specialized users, hampering, thus, their widespread application in areas other than the scientific one, e.g., in the art history field. We developed a computer-assisted method, based on principal component analysis (PCA) and image processing, to enhance the visibility of UDs and to support the art-historians and curators’ work. Based on ImageJ/Fiji, one of the most widespread image analysis software, the algorithm is very easy to use and, in principle, can be applied to any multi- or hyper-spectral image data set. In the present paper, after describing the method, we accurately present the extraction of the UD for the panel “The Holy Family with St. Anne and the Young St. John” and for other four paintings by Luini and his workshop paying particular attention to the painting known as “The Child with the Lamb”.

Obesity is the underlying constant for the development of the most common modern diseases such as insulin resistance, high blood pressure, lipid metabolism disorders, non-alcoholic steatohepatitis (fatty liver), joint problems and various malignancies. The role of endoscopic diagnostic and therapy in obese patients is highlighted in this chapter. In this chapter all devices and methods used in flexible endoscopy for diagnostic and treatment in obese patients are introduced. Role of endoscopy is presented in three parts: in preoperative setting, in post-operative complication management and instead of surgery as endoscopic bariatric therapy. If possible presentation of the effectiveness is compiled with study data. Finally, the interaction between endoscopy and surgery in the treatment of obesity is complex, essential and promising. Endoscopy is indispensable in preoperative preparation, as a primary therapeutic approach, and also in the detection and treatment of acute complications and long-term complications of obesity surgery.

Girl with flowers (Bambina coi fiori) is a painting by Giacomo Balla, one of the key proponents of Futurism, an Italian artistic and social movement of the beginning of the 20th century. Property of Musei Civici of Varese (Italy) since 1965, it was restored for an exhibition held in 2020. On this occasion, an extensive campaign to detect painting materials was carried out preliminarily to the restoration. Imaging and spectroscopic techniques were applied with the specific aim to individuate pigments, binders and preparation layers, in order to better understand the chemical phenomena linked to the current degradation and bad conservation state. Quite interestingly, classical materials were detected, with the only exception of cobalt violet and green, testifying a first introduction of modern industrial materials, one of the focuses in the Futurist program.

Il mare è considerato semplicemente o come uno spazio ludico o come uno spazio vuoto, eppure la sua orizzontalità e la sua vastità ne fanno uno spazio affascinante, caricato di valori ed emozioni. Il mare inoltre è uno degli ultimi spazi in cui l'essere umano si può confrontare con la natura. Per questo motivo il mare può essere considerato come uno spazio educativo, come confermano le testimonianze di letterati e navigatori che fanno risalire alla loro esperienza del mare gran parte della loro educazione.

La memoria di una città di Belforte, di fondazione antichissima, contenuta in diverse cronache tardomedievali milanesi si spiega con le vicende occorse al castello omonimo nel XII secolo. Durante lo scontro tra Federico I e Milano l’aristocrazia del Seprio (che esprimeva la magistratura consolare sepriese) si schierò con l’imperatore ed elesse il castello di Belforte a sua sede principale trasferendo in esso nel quinquennio 1162-1166 tutte le attività politiche ed economiche che precedentemente avevano avuto sede nella vicina Varese, con l’intenzione di colpire quest’ultima località in quanto appartenente alla giurisdizione temporale dell’arcivescovado ambrosiano fieramente antifedericiano. Il tentativo di costruire un’alternativa a Varese fallì a causa del cambiamento del quadro politico che portò alla sconfitta finale dell’imperatore e al ripristino dell’egemonia milanese nel territorio sepriese, a cui seguirono il progressivo abbandono della fortificazione, la trasformazione in abitazione rurale e la nascita del mito alimentato dei ruderi rimasti sul terreno.