Perceived Burdensomeness, Thwarted Belongingness and Fearlessness About Death in Italian university students: validation of the INQ-15 and the ACSS-FAD

Introduction

The Interpersonal Needs Questionnaire (INQ-15) and the Acquired Capability for Suicide Scale - Fearlessness About Death (ACSS-FAD) have been introduced to evaluate the theoretical constructs posit by Joiner’s Interpersonal Psychological Theory of Suicide (IPTS).

Objectives

The present study aimed to evaluate the psychometric properties of the INQ-15 (which measures Thwarted Belongingness, TB, and Perceived Burdensomeness, PB) and the ACSS-FAD (measurement of Fearlessness About Death, FAD, dimension of the acquired capability) in a population of Italian university students.

Methods

Since there was no Italian version of the ACSS-FAD, we have translated it through an accurate multistage procedure. ACSS-FAD and INQ-15 have been administered to a sample of 1,665 Italian university students. We analyzed the factorial structure of the INQ-15 and the ACSS-FAD, their reliability, criterion, convergent and discriminant validity.

Results

Principal Component Analysis confirmed a two-dimensional structure for INQ-15 and a one-factor structure for ACSS-FAD. Internal consistency reliability of the scales was good, respectively TB: α = .85; PB: α = .90; and FAD: α = .85. The INQ-15 demonstrated concurrent associations with suicidal ideation, while the ACSS-FAD with a history of suicidal planning/suicide attempt. Convergent and discriminant validity were also in line with previous studies.

Conclusions

Both INQ-15 and ACSS-FAD appropriately capture the respective constructs, proving to be valid measures for the assessment of suicide risk factors among Italian university students according to the IPTS. The valuable psychometric properties of the two scales established with this study in the Italian context encourages their use to advance the clinical understanding and prevention of suicide.

Disclosure

No significant relationships.

Homicide and Suicide in the Elderly

Homicide and suicide are complex phenomena raising questions and interest which go far beyond the medical and psychiatric field, as they represent a challenge for an understanding which is, first of all, human. In older adults, homicide and suicide may present together in the homicide-suicide phenomenon. The most common motive underlying this behavior in intimate partner relationships is the so-called “mercy killing”, where the perpetrator kills the partner to eventually allow relief from declining health conditions, and then commits suicide. Actually, older adults account for a disproportionately high number of suicide deaths and approximately 55% of late-life suicides are associated with physical illness, notwithstanding psychiatric comorbidity. Physical illness is more likely to eventually lead to suicidal behaviour when it represents a threaten for the individual’s independence, autonomy, self-esteem and dignity, and when it impacts on quality of and pleasure with life, sense of meaning, usefulness and purpose in life. As the current historical period is one marked by opportunities which have allowed a rapid increase of life expectancy and longevity, it clearly emerges the need to balance benefits and harms of curative and palliative therapies, especially for painful, terminal illnesses. The expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” or indirect suicidal attitudes, should be carefully investigated and clinicians should try to decode the possible communicative role of suicidal behaviour while avoiding premature conclusions about the “rationality” of patients’ decision to die.

COVID-19 pandemic and eating disorders: What impact on specific and general psychopathology?

Introduction

The coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measures, such as “lockdown” and “social distancing”, have had important consequences on people’s mental and physical health.

Objectives

We aimed to study the effect of social isolation and subsequent re- exposure and eventual changes in general and ED-specific psychopathology in people with Eating Disorders (EDs).

Methods

Three-hundred twelve Italian people with EDs (179 Anorexia Nervosa, 83 Bulimia Nervosa, 48 Binge Eating Disorder and 22 Other Specific Feeding Eating Disorder) were asked to fill-in an online survey to explore several dimensions such as: anxiety, depression, panic, insomnia, suicide ideation, stress, post-traumatic stress and obsessive-compulsive symptoms. Differences in ED specific and general symptoms among the 3 investigated time periods (before, during and after the end of lockdown) were assessed with a one-way ANOVA with repeated measures. Subsequently, ED diagnosis was introduced as covariate in the analysis in order to investigate the possible contribution on psychopathological changes.

Results

ED core symptoms increased during the lockdown but most of them returned to pre-COVID19 levels at re-opening. The severity of general psychopathology also increased during the lockdown and persisted high in the following phase, except for depression and suicide ideation. None of this symptoms was affected by ED diagnosis, participants’age and illness duration.

Conclusions

People with EDs showed worsening of both general and specific psychopathology; moreover, changes in general psychopathology persisted in the re-opening period suggesting a higher stress vulnerability in this kind of patients.

Disclosure

No significant relationships.

Keyword

COVID19 and Eating Disorders

Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition

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.

Familial aggregation of MATRICS Consensus Cognitive Battery scores in a large sample of outpatients with schizophrenia and their unaffected relatives

BACKGROUND

The increased use of the MATRICS Consensus Cognitive Battery (MCCB) to investigate cognitive dysfunctions in schizophrenia fostered interest in its sensitivity in the context of family studies. As various measures of the same cognitive domains may have different power to distinguish between unaffected relatives of patients and controls, the relative sensitivity of MCCB tests for relative-control differences has to be established. We compared MCCB scores of 852 outpatients with schizophrenia (SCZ) with those of 342 unaffected relatives (REL) and a normative Italian sample of 774 healthy subjects (HCS). We examined familial aggregation of cognitive impairment by investigating within-family prediction of MCCB scores based on probands' scores.

METHODS

Multivariate analysis of variance was used to analyze group differences in adjusted MCCB scores. Weighted least-squares analysis was used to investigate whether probands' MCCB scores predicted REL neurocognitive performance.

RESULTS

SCZ were significantly impaired on all MCCB domains. REL had intermediate scores between SCZ and HCS, showing a similar pattern of impairment, except for social cognition. Proband's scores significantly predicted REL MCCB scores on all domains except for visual learning.

CONCLUSIONS

In a large sample of stable patients with schizophrenia, living in the community, and in their unaffected relatives, MCCB demonstrated sensitivity to cognitive deficits in both groups. Our findings of significant within-family prediction of MCCB scores might reflect disease-related genetic or environmental factors.

The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials

OBJECTIVE

Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy.

METHODS

After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool.

RESULTS

Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3months to 3years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results.

CONCLUSION

Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.

Alexithymia, recognition of facial emotion and inference in patients with Eating Disorders (ED) or Substance Abuse Disorders (SAD)

Alexythimia is a psychological construct characterized by difficulty describing emotions and distinguishing them from somatic components of the emotional activation. Patients with eating disorders (ED) or substance use disorders (SAD) commonly present also impairment of recognition of facial expressions and deficits in social inference. Patients with ED and SAD may present impulsiveness, difficulty in emotion-focused coping skills, and search for a concrete relief from psychological suffering. The purpose of study is to compare the ED, SAD and healthy controls (HC), in several variables, including Alexythimia, empathy, and ability to recognize emotions, social inference. Thirty-two patients with ED, 27 patients with SAD and 31 HC were recruited between September 2016 and April 2016 at the psychiatric ward of Novara Hospital, nursing home of Nebbiuno and the nursing home of Viverone. We administrated to patients the same battery of tests, composed by Toronto Alexithymia Scale-20 (TAS-20), Facial Emotion Identification Test (FEIT), the awareness of Social Inference Test (TASIT), temperament and Character Inventory (TCI), Interpersonal Reactivity Index (IRI), Symptoms Checklist-90 (SCL-90). The two clinical groups showed differences in TAS, FEIT and TASIT, highlighting Alexythimic tracts, difficulty in recognizing emotions and deficit of social inference, compared to HCs. The TCI and SCL-90 have also highlighted the common psychopathological characteristics and temperamental in patients with ED and SAD. Alexythimia is particularly represented in patients with ED and SAD, and could represent a maintenance factor, together with deficits in emotions recognition and social inference. The similarities between ED and TD seem to suggest the possibility of shared core features.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Motivations behind suicide attempts: A study in the ER of Maggiore hospital – Novara

Introduction

A previous study, conducted in the province of Novara stated that, from an epidemiological and clinical point of view, being a female, being a migrant, as well as being in the warmer months of the year, or suffering from an untreated psychiatric disease are associated with suicide attempts. Literature suggests there is a positive relation between negative life events and suicidal behaviours. In this study, we intend to deepen knowledge, individuating motivations and meanings underlying suicidal behaviours. This appears a meaningful approach to integrate studies and initiatives in order to prevent suicide and suicidal behaviours.

Aim

To examine possible correlation between socio-demographic and clinical characteristics and motivations underlying suicide attempts.

Methods

Patients aged > 16 years admitted for attempted suicide in the Emergency Room of the AOU Maggiore della Carità Hospital, Novara, Italy, were studied retrospectively from the 1st January 2015 to the 31st December 2016. Each patient was assessed by an experienced psychiatrist with a clinical interview; socio-demographic and clinical features were gathered. Analysis were performed with SPSS.

Results and discussion

Data collection are still ongoing; results and implications will be discussed. We expect to find different motivations in relation to socio-demographic and clinical characteristics [1,2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Outcome of A Counseling Intervention. The Experience of the Counseling Service UPO

Background.

Counseling addresses the emotional social, work, school and physical health concerns that people may have at different stages in their lives. It focuses on typical life stresses and more severe issues. It may be addressed to individuals, groups, organisations.

Aim and methods.

The objective of our study was to assess the outcome of a counseling intervention offered to students of the University of Piemonte Orientale, aged between 18 and 20 years. Baseline features and reasons for consultation will be described and the outcome will be assessed with CGI (Clinical Global Impression) and HONOS (Health of the Nation Outcome Scales) at T0 (time 0), T1 (4 weeks) and T2 (8 months). We will present the data of the period between 1st January 2014 to 31st December 2016.

Results/discussion.

Data analysis is ongoing. The results will be discussed in the light of the current literature about counseling services for university student.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Resilience and Psychological Correlates in a Group of Patients Affected by Dual Diagnosis

Introduction

Although several authors found a strong association between childhood trauma and substance abuse disorder, many other suggest that specific personological aspects and resilience may contribute to the development of this disease.

Objectives

To compare the characteristics of psychiatric patients with and without dual diagnosis assessing differences in psychological correlates, such as resilience, coping strategies, self-esteem, temperament, character traits and childhood trauma.

Methods

From November 2015 to May 2016, we recruited all patients aged between 18 to 65 years referred to the Psychiatry Ward of “Maggiore della Carità” Hospital in Novara, Italy. Diagnosis of psychiatric disorder was made according to DSM-5 diagnostic criteria. Exclusion criteria were: inability to express a valid inform consent, a personality disorder or mental retardation diagnosis. We administered to each patient: Resilience Scale for Adult (RSA), Brief Cope, Rosenberg Self-esteem Scale (RSES), Childhood Trauma Questionnaire (CTQ), Temperament and Character Inventory (TCI). Patients were subdivided for the analysis into two groups: dual diagnosis and no dual diagnosis (or single diagnosis) group.

Results

Data show that dual-diagnosis patients (n = 40) had lower global levels of resilience (RSA) and cooperativeness (TCI). Higher novelty seeking and reward dependence traits (TCI) were found as well. Moreover, the lower Cope-Avoidance (Brief Cope) was statistically different among patients with dual diagnosis compared to single diagnosis ones.

Conclusions

Identified differences between these two groups could suggest targets to manage during the treatments in order to optimise dual diagnosis patients’ outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Socio-Demographic and Clinical Features of Patients Referred to Emergency Room Psychiatric Consultation Between 2006 and 2015. A Comparison Between Migrants and Natives

In recent decades, Italy has become a desirable destination for immigrants. It should be noted that the organization of mental health services in Italy strongly relies on outpatient services, while the psychiatric wards usually accommodate patients in acute phases of their disorder. Nonetheless, migrants’ first contact often happen in a psychiatry ward when they are in a severe and acute psychopathological condition. The research was performed in the Emergency Department (ED) of the Maggiore della Carità Hospital, Novara, Italy. We collected data about 3781 consecutive patients, 3247 Italian natives and 421 migrants, assessed in the ER of the Maggiore della Carità Hospital, and referred to psychiatric assessment after ER triage. From 1st January 2006 to 31st December 2007, only data for migrant patients were available. From 1st January 2008 to 31st December 2015, data were available for all consecutive patients assessed in the ER. An experienced psychiatrist assessed patients with a clinical interview, including the assessment of suicidal intent, suicidal behaviors and attempts. The psychiatrist filled in for each patient a data sheet, reporting demographic data and clinical features. The high frequency of substance use disorders was higher in the migrant population than in the native one. The request for psychiatric consultation for self-injury behaviors was more frequent in migrants and also suicide attempts were more common. Nonetheless, being a migrant was not a predictor of suicide attempt in our sample.

Several differences were found between migrants and natives in socio-demographic, clinical and treatment variables. Clinical implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison between patients with depressive disorders and healthy controls in resilience and coping skills

Introduction

Resilience in the psychiatric field, it is defined as the ability to recover from perceived adverse or changing situations through a dynamic process of adaptation. This process is influenced by personal characteristics, family and social resources and is expressed by positive coping skills. It is well known that resilience has an inverse relation with depression, however, the specific role of resilience in disorders like depression, personality disorders and psychosis is not fully understood.

Objectives

Compare differences in resilience and coping skills in a sample of patients with depressive disorder in acute phase versus healthy controls.

Methods

We are conducting a cohort study to the date we recruited 82 inpatients admitted in our psychiatric ward. The data have been gathered from the 1st December 2014 and they will continue to be collected until the 1st December 2016, the healthy controls are represented by 67 subjects with similar socio-demographic features.

Inclusion criteria are: diagnosis of depressive disorders or dysthymia according to DSM-IV-TR diagnostic criteria, age > 18 years, proper understanding of Italian language, willingness to give written informed consent. We compared them with healthy controls with similar socio-demographic features.

Patients’ assessment includes the following tests:

– Resilience Scale for Adults (RSA);

– Brief-COPE Scale (Brief-COPE);

– Statistical analysis will be performed using SPSS for Windows, 21.0 (Armonk, NY: IBM Corporation).

Results

Data collection is still ongoing.

Conclusions

From a preliminary analysis of data, we assume that the levels of resilience and coping of our patients is reduced compared with controls, however the recruitment during the acute phase could significantly influence final results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Resilience and attempted suicide in depressed patients

Introduction

Among the patients, 6.6% with past-year major depressive disorders attempt suicide in their life. Resilience (the ability to respond positively to adversity) and coping strategies (the ability to manage living stresses) may be protective factors against suicide ideation and behavior. A study conducted on 100 abstinent substance dependent patients suggested that suicide attempters had significantly lower resilience scale scores. Other authors demonstrated that intrinsic religiosity, resilience, quality of life were associated with previous suicide attempts in depressed patients.

Aim

To examine the correlation among resilience, coping strategies and sociodemographic and clinical characteristics in depressed patients.

Methods

From December 1st 2014 to December 31st 2015 we recruited inpatients and outpatients aged > 18 years with a diagnosis of depression (current or past). At baseline, patients were assessed with Montgomery Asberg Depression Rating Scale, Resilience Scale for Adult and Brief-COping with problems experienced; sociodemographic and clinical characteristics were gathered. Follow-up was conducted after 1 year in order to assess the possible presence of further depressive episodes and suicide attempts. Analysis was performed with SPSS.

Results and discussion

Data collection are still ongoing; results and implications will be discussed. We expect to find higher attempted suicide rates in patients with lower resilience and less coping strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Psycho-geriatric Patient in the Emergency Room (ER) of the Maggiore della Carità Hospital in Novara

Introduction

Due to population aging, the health system will face increasing challenges in the next years. Concerning mental disorders, they are major public health issues in late life, with mood and anxiety disorders being some of the most common mental disorder among the elderly. For this reason, increasing attention has to be paid to the evaluation of the elderly in psychiatry emergency settings.

Objectives

To evaluate the socio-demographic and clinical features of over 65 patients referred to psychiatric consultations in the ER of “Maggiore della Carità” Hospital in Novara, in a 7 years period.

Aims

The analysis of the characteristics of the study sample could be potentially useful in resource planning in order to better serve this important segment of the general population.

Methods

Determinants of ER visits for over 65 patients referred to psychiatric evaluation were studied retrospectively from 2008 to 2015.

Results

Elderly patients made up 14,7% (n = 458) of all psychiatric evaluation in the ER (n = 3124). About two thirds (65,9%) were females and one third were males (34,1%). The mean age of patients recruited was 75.11 years. The majority of subjects (68.6%) presented without a diagnosis of Axis I according to DSM-IV. The other most frequent diagnosis was “cognitive disorders” (11.4%) and “mood disorders” (10.9%).

Conclusions

The large proportion of patients without a diagnosis of Axis I, could be related to the misunderstanding of the psychosocial aspects of aging. Preliminary results highlight the importance of research on this topic, considering population aging and the impact of mental disorders in late-life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Vortioxetine versus citalopram in treating major depressive disorder (MDD)

Introduction

Citalopram is a widely used antidepressant (AD), indicated for the treatment of Major Depressive Disorder (MDD), with a high and Selective Serotonin Reuptake Inhibitory action (SSRI), good efficacy and safety profile. Vortioxetine is a novel multimodal antidepressant compound, with a mixed action on Serotonin (both 5-HT agonism and antagonism). Its clinical efficacy has been established in several short and long term trials; furthermore it proved effective at mitigating cognitive dysfunction, which is addressed to as one of the main causes of social impairment in MMD patients.

Objectives

To evaluate the relative efficacy and safety of Vortioxetine versus Citalopram, in patients suffering from MDD.

Aims

To assess whether Vortioxetine effectiveness and tolerability are comparable to those observed for previous antidepressants.

Methods

The main outcomes were efficacy (variance from baseline to 1 month) in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D) and tolerability (adverse events). Changes in cognitive performance were assessed using the following specifics tools: Digit symbol substitution test (DSST), Trail Making Test A (TMT-A) and Hopkins Verbal Learning Test-Revised (HVLT-R).

Results

Data collection is ongoing. According to Literature we expect to find a significant number of MDD patients on Vortioxetine to achieve a reduction in depressive symptoms from baseline, to report poor adverse events and to increase their cognitive performance.

Conclusion

As shown by recent literature, Vortioxetine might be an effective option in treating MMD with particular focus on cognitive dysfunction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples

BACKGROUND

Orthorexia nervosa (ON) is defined as pathological healthful eating. The aim of this study was to investigate whether there is any difference in orthorexic behaviours between clinical and non-clinical groups, and in different cultural contexts. .

METHODS

Recruitment involved both female patients with anorexia nervosa (AN) and healthy controls (HC) from Italy and Poland (N = 23 and N = 35 AN patients; and N = 39 and N = 39 HCs, in Italy and Poland, respectively). Assessment of orthorexic behaviours was performed with the ORTO-15 test.

RESULTS

Statistically significant differences were found between Italian women in the AN and HC group, whereas no difference between Polish women in the AN and HC group was found. Both Italian groups scored significantly higher than the Polish ones on the ORTO-15.

CONCLUSIONS

Differences have been found between the Italian and Polish samples, both in the percentage of individuals with orthorexic behaviours as suggested by an ORTO 15 score below the cutoff, and in the mean ORTO 15 scores in the AN and HC groups, suggesting cross-cultural differences in orthorexic behaviours, whose meaning is currently difficult to understand.

Social cognition in people with schizophrenia: a cluster-analytic approach

BACKGROUND

The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses.

METHOD

A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters.

RESULTS

We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC.

CONCLUSIONS

If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person.

Suicide attempters: Clinical characteristics and management

Background

Suicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.

Aim

The aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.

Material and methods

We collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.

Results

Data collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychiatric consultations in the emergency room: Focus on suicide attempters with and without longitudinal psychiatric disorders

Introduction

The role of mental illness in the pathway leading to suicide is widely discussed in the literature. Nonetheless, the debate about this issue is open, both from a clinical and philosophical point of view.

Aims

The purpose of the present study was to compare suicide attempters with and without a history of psychiatric disorder, in order to highlight the possible differences between the two groups, with a specific focus on intent to die and methods of the attempt.

Methods

Data from all ER referrals undergoing a psychiatric consultation in the period 2008–2015 at the Maggiore della Carità Hospital, Novara, Italy, were gathered. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.

Results

We have already gathered data from more than 2000 ER psychiatric consultations, including 495 suicide attempters. Preliminary results suggest that these kinds of behaviours are more common in subjects without psychiatric disorders but with clinical history of previous contact with mental health services and in psychopharmacological therapy. Reasons for self-harming are associated with relational problems rather than psychiatric symptoms. Among Axis II diagnoses, almost half of cases are affected by histrionic personality disorder.

Conclusions

The results described above should be considered as preliminary, as data collection and statistical analyses are still ongoing. Anyway, the observed correlation between previous contact with mental health services, socio-relational issues and suicide attempt, and the significant frequency of attempts in histrionic personality disorders seem to be particularly interesting. Implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

In a period of economical crisis who is at risk for attempted suicide?

Introduction

According to Durkheim's theory, suicide attempts increase during periods of rapid economic changes and decrease again when stability is achieved, due to the social integration in the community guaranteed by occupational status. Since 2009 in Europe, it was observed an increase in the suicide rates, in line with the increase of unemployment. Although unemployment is considered a risk factor for suicide, it was observed a noticeable increase in suicide rates among Italian employed men during the last years, probably related to the specific economic scenario and to emerging difficulties in keeping an income to adequately maintain one's own family standard of living.

Aim

To study attempted suicides with a specific focus and attention on the current Italian economic scenario.

Methods

Determinants of emergency room visits for psychiatric reasons in patients aged > 16 years were studied prospectively from 2008 to 2015 at the AOU Maggiore della Carità Hospital, Novara, Italy. Each patient was assessed by an experienced psychiatrist with a clinical interview and socio-demographic and clinical features were gathered. Statistical significance was set at P ≤ 0.05.

Results

Preliminary results suggest an increase in suicide attempts according to the rise of the unemployment rate in Novara. Although in absolute figures most attempters are unemployed, it seems that suicide attempts are more frequent in the group of employed subjects, which includes also people under redundancy fund. This subgroup may be considered halfway between employed and unemployed attempters.

Conclusions

Data collection and statistical analyses are still ongoing. Implications for clinical practice will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Alcohol and substances acute intoxication in a population of suicide attempters

Introduction

The effects of psychotropic drugs and alcohol acute intoxication are important risk factors for attempted suicide among individuals with and without substance use disorder (SUD).

Aims

The first aim of this study is describing the socio-demographic features and clinical history of subjects who were acutely intoxicated when attempting suicide. The second aim is to compare their features with those of subjects without acute alcohol and substances intoxication at suicide attempt time.

Methods

Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2014 at the “Maggiore della Carità” Hospital in Novara, Italy. For each patient, a data sheet was filled in by experienced psychiatrists, in order to gather demographic features, psychiatric history and present clinical issues like blood and urine dosage of amphetamine and methamphetamine, cannabinoid, cocaine and alcohol. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.

Results

We collected a sample of 495 suicide attempters who referred to our ER. Statistical analysis of demographic and clinical data is still ongoing.

Conclusions

Preliminary results point out that acute alcohol and drugs intoxication at suicide attempt time is much more frequent in subjects without a SUD. Implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Surgery-first or orthognathic surgery approach: Psychosocial and physical changes

Introduction

Two surgical approaches exist for malocclusion: in the surgery-first approach the orthognathic surgery precedes the orthodontic treatment, treating facial esthetics first and then occlusion, whereas in the conventional approach (the orthodontics-first approach) the orthodontic treatment precedes the orthognathic surgery, treating occlusion first and then facial esthetics. The advantages of the surgery-first approach include the fact that patient's dental function, and facial esthetics are restored and improved soon after the beginning of treatment. Moreover, the entire treatment lasts only 1 to 1.5 years or less and orthodontic management is easier to achieve.

Aims

Our study aims to compare patients undergoing surgery-first or orthognathic surgery approach as for as self-esteem, satisfaction with their appearance in the pre- and postoperative care, quality of life and psychosocial changes, are concerned.

Methods

We recruited 50 patients undergoing surgery-first or orthognathic surgery approach at SC Maxillo-Facciale of Novara between October 2014 and December 2017. Assessment were performed at baseline (T0) and at follow-up (T1: 5 weeks; T2: 5–6 months), with Rosenberg Self-Esteem Scale (RSES), Temperament and Character Inventory (TCI: only at T0), Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI-II), Resilience Scale for Adult (RSA), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile (OHIP-14).

Results

Data collection is still ongoing. We expect to find a better quality of life and higher self-esteem in patients undergoing surgery first approach.

Conclusion

Satisfaction is crucial for patients’ adherence to treatment and to avoid revolving door. Clinical implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychiatric Disturbances in a Patient with Melas Syndrome: a Case Report

Introduction

Mitochondrial disorders of energetic metabolism (MD) represent a heterogeneous group of diseases manifesting at any age and its one of a number of mitochondria syndromes that share the common characteristics of encephalopathy and myopathy. The clinical expression of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like episodes) is highly variable and ppsychiatric symptoms are rarely reported in literature even if are more common in MELAS syndrome than in the general population.

Objective

The first aim of the study is describing the clinically observed primary psychiatric symptoms in a patient affected by MELAS syndrome admitted to the Psychiatric ward. The second aim is to go back over the diagnostic process, which led, from the uncommon psychiatric symptoms and signs to the final genetic diagnosis of MD.

Methods and results

We report the case of a 44-year-old male with MELAS in whom psychiatric symptoms preceded the establishment of the clinical diagnosis for several months. Diagnosis was initially based on the neuroimaging and metabolic findings and subsequently confirmed with genetic analysis.

Conclusions

In case of aggressive and paranoid behaviour with delusions of persecution and disorganised behaviour mmitochondrial disorders deserve consideration as part of the differential diagnosis, especially if there is suspected involvement of other organ groups or positive family history of MD. There is no specific consensus approach for treating MELAS syndrome. Management is largely symptomatic and should involve a multidisciplinary team.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Who is a survivor of suicide loss? A systematic review

Introduction

Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss. The underlying structure of grief for survivors of suicide loss appears complicated.

Aims

The purpose of this study consists in reviewing literature data about survivors of suicide, especially exploring the few informations emerged by researches on the role of psychiatrist as “survivor”.

Methods

A PubMed search was conducted using combinations of the following keywords: survivors suicide or bereavement suicide or suicide psychiatrists and randomized.

The search was conducted through September 10, 2015, and no conference proceedings were included.

Results

Bereavement following suicide is complicated by the psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention.

Conclusions

Suicide bereavement seems to be different from natural loss. Clinicians may react to a patient's suicide both on a personal and professional level, with emotions such as loss of self-esteem or blame. This grief somehow nullifies the core of a helping relationship and may imply a more conservative management of future patients or even avoiding to accept suicidal patients for treatment. Support interventions have been proposed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Dual diagnosis patients at first admission in an acute psychiatric ward. Trend over a decade

Introduction

Dual diagnosis (DD) is the coexistence of a Psychiatric Disorder (PD), and Substance Use Disorder (SUD). The increase of DD observed in recent years has caused serious problems to both public and private services organization.

Aims

Our aim is to assess the prevalence and features (including clinical and sociodemographic ones) of DD over a decade, comparing the period 2003–2004 and 2013–2014.

Methods

We performed a retrospective study retrieving the medical records of DD patients at their first admission to the Psychiatry Ward AOU “Maggiore della Carità”, Novara, Italy. Sociodemographic and clinical features were recorded. The two groups of patients (2003–2004 vs. 2013–2014) were compared.

Results

In both periods DD patients are usually Italian male, aged 19–40, single. They have usually attended middle school, live with parents, have two or more brothers and/or sisters but no kids. DD patients in 2003–2004 and 2013–2014 showed differences as far as employment and diagnosis are concerned. The first were more frequently employed than the latter: moreover the 2003–2004 patients were more frequently diagnosed with a personality disorder while the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods, as well.

Conclusions

The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors which may be the target of prevention and treatment approaches.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Anger Expression, Impulsivity And Expressed Emotion: a Comparison Between Patients With Eating Disorder And Schizophrenia

Introduction

The level of express emotion (EE) is a measure of the attitude of close relatives towards a patient and include dimensions as critical comments, hostility and emotional over-involvement. Anger and impulsivity may lead to self-injurious and aggressive behaviours, and often represent an obstacle to treatment.

Aims

To compare anger expression, impulsivity and expressed emotion in ED and SCHZ, and to explore the different level of caregivers’ EE in the two groups.

Methods

Twenty-five female with ED diagnosis and 25 patients with schizophrenia, were recruited at the Psychiatry Ward and outpatient Service of AOU – Novara, during one year period. Patient's assessment included Global Assessment of Functioning (GAF), Structured Clinical Interview (SCID 1-2), Level of Expressed Emotion Scale (LEE), Paykel scale, State and Trait Anxiety Inventory (STAY 1-2), State-Trait Anger Expression Inventory (STAXY), Barratt Impulsiveness Scale (BIS-11).

Results

Levels of anxiety (both state and trait) are higher in the ED group than in SCHZ. As far as the STAXY is concerned, SCHZ patients score higher than ED ones on control over anger, while general index of anger expression was higher in ED patients. We did not find significant differences in EE between two groups, except for the patient's emotional response of the patient to the disease, which was greater among SCHZ. Both SCHZ and ED patients scored higher on the LEE, Paykel and STAY than their caregivers.

Conclusions

SCHZ and ED patients show different patterns of anxiety and anger, but similar profile as far as EE is concerned. Implications for treatment will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Dermal reactivity and resilience in a sample of depressed patients

Background

Mental disorders are considered a risk factor for suicide: for example, the lifetime risk of suicide is estimated to be 4%–8% in people with mood disorders. The literature suggests that a history of suicide attempts is significantly related to electrodermal hyporeactivity and that patients with violent suicide attempters exhibit faster habituation of the electrodermal response to repeated neutral tones than patients with non-violent attempts. The impact of depressive symptoms on suicidal ideation may be moderated by resilience. Resilience refers to the ability to maintain o regain mental health despite experiencing adversity. In bipolar and depressive disorders, resilience may influence severity of episodes, frequency of relapse and response to treatment.

Aim

The objective of our study was to assess the possible correlation among attempted suicide, resilience and dermal reactivity in a sample of depressed patients.

Methods

We recruited patients with depressive disorders and bipolar depression; data about socio-demographic, clinical features, severity of attempted suicide and suicidal risk were gathered. Patients filled in the Resilience Scale for Adult (RSA). Moreover, for each patient we performed the Edor test in order to assess dermal reactivity.

Results

Data collection is still ongoing. We expect to find lower levels of resilience in those patients who are hyporeactive and attempted suicide. Moreover, we hypothesize that suicide attempts in the group of hyporeactive patients would be characterized by planning and greater severity. Clinical implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Analysis of correlations among theory of mind, symptoms and personologic traits in university students

Introduction

Theory of mind represents the ability to attribute mental states to oneself and others and to use these mental representations to decide one's own and predict others’ behavior. In our study, ToM is investigated in a non-psychiatric setting: a university students sample.

Objectives

The aim of this study is to evaluate the presence of subthreshold alterations in our sample and, on the other hand, if altered cognitive functioning can worsen study performance. Moreover it investigates a possible correlation between the faculty chosen and cognitive functioning. We considered 228 students attending the Faculty of: Economy (n = 26), Dental hygienists(n = 7), Law(n = 16), Medicine (n = 54), Pharmaceutics(n = 27), Physiotherapy(n = 15), Mathematics, Physics and Biology (n = 12), Midwifery (n = 14), Chemistry and Pharmaceutical techniques (n = 17), Liberal Arts (n = 3), Nursing (n = 37).

Methods

We administered the following tests to 228 university students: EYSENCK PERSONALITY QUESTIONNAIRE (EPQ-R): evaluating some personality dimensions including psychoticism, neuroticism, introversion, extroversion;SCL-90-R: self-evaluation scale of some symptom dimensions as somatization, obsessive-compulsiveness, depression, anxiety, anger, hostility, sensitivity, phobic anxiety, paranoid ideation and psychoticism; TEST OF EMOTION ATTRIBUTION: composed of 58 short scenes concerning seven emotions (sadness, fear, shame, disgust, happiness, anger, envy) that the student must identify.

TEST OF ToM: consists of 13 short stories describing social and family situations; the student must identify why the protagonist behaved in a certain manner.

Results

The statistical analysis is still in progress. Preliminary data suggest that people with subthreshold symptoms belonging to the depression, obsessive-compulsiveness, anxiety and phobic-anxiety clusters show deficits of theory of mind. Data concerning the correlation between cognitive functioning and faculty chosen and between cognitive functioning and poor study performance will be examined in a further work.

Conclusions

Our results together with data from literature suggest the chance to apply this set of tests to screen deficit of Theory of Mind in a non mentally ill population.

Venlafaxine and CYP2D6 in clinical practice: An observational study

Introduction

Venlafaxine is a serotonin-norepinephrine inhibitor, mainly metabolized by CYP2D6 to its active metabolite ODV. Depending on CYP2D6 activity, patients may be identified as Poor, Intermediate, Extensive or Ultrarapid Metabolizers. There is some evidence that a PM phenotype is associated with poor tolerance more often than an EM; while a UM patient would only respond to a greater dose of Venlafaxine1.

Objectives

To evaluate the impact of CYP2D6 phenotype on the efficacy of Venlafaxine XR in depressed patients.

Methods

This observational study evaluated 27 Caucasian adult patients (F = 18, M = 9), satisfying DSM-IV criteria for Major Depressive, Bipolar Disorder or Personality Disorder receiving treatment with Venlafaxine 75–300 mg/die.

CYP2D6 alleles were evaluated with INFINITI CYP2D6 assay, which employs AutoGenomics proprietary film-based microarray technology.

Results

Most patients were identified as EMs, 4 as PMs, while only one was identified as UM. The only statistically significant difference between Extensive and Poor Metabolizers was, in contrast with current literature, the need of a greater mean dose of Venlafaxine in the second group (225 mg/die vs 159.38 mg/die, t student: p = 0.01).

Likewise, in contrast with literature, the UM patient was responsive to average doses of Venlafaxine.

On the contrary, we found no statistically significant differences as far as efficacy, adverse events or duration of treatment are concerned.

Conclusions

In our sample, CYP2D6 metabolizer status does not seem to affect treatment response nor adverse events related to Venlafaxine.

SWN (subjective well-being under neuroleptics) in clinical practice

Objectives

To assess the use of SWN in the acute phase of psychiatric disease as a predictor of clinical outcome.

Methods

This study started in June 2009 and at the moment we have recruited 150 patients. The patients were divided into 4 groups according to their psychiatric diagnosis (schizophrenic psychosis, mood disorders, personality disorders, acute stress reaction) and each diagnostic group into three subgroups according to length of stay (T1< 7 days, T2 = 7–14 days, T3> 14 days). The subjective well-being indicators (subscales SWN: emotional regulation; self-control; mental functioning; social integration and physical functioning) and the severity of illness (CGI-S) were evaluated at admission and discharge.

Results

At discharge there is a statistically significant difference in the SWN subgroups among the four diagnostic groups except for social integration and total score with equal CGI-S scores. Schizophrenic patients and personality disorders show a subjective improvement at T2; mood disorders at T3; acute stress reactions T1 = T2. CGI shows a statistically improvement regardless of the length of stay.

Conclusions

Preliminary data suggest that SWN represents a predictor of clinical outcome and remission and together with the clinical evaluation it can help clinician to settle therapeutic programs.

Creutzfeldt-jacob disease with psychiatric presentation (CJD) : A case report

Introduction

CJD is a neurodegenerative disease with a rapid onset characterized by progressive dementia, myoclonus and also cerebellar, pyramidal and extrapyramidal signs. It is caused by an increased loss of neurons due to the abnormal conformation of a membrane protein.

Case report

A 69 year-old woman was admitted to Psychiatry with a clinical picture characterized by psychomotor agitation, disorientation, confusion, confabulation, false ricognition, circumstantiality, perseveration, logorrhea and dysphoria. She presented no alterations of sense-perception. Her psychiatric history was silent. The neurological examination showed no focal neurological deficits and the first EEG was nonspecific. She became progressively more confused, with subsequent drowsiness with psychomotor agitation, aimless buste, disorganization and visual hallucinations. She started treatment with quetiapine (200 mg/die) and lorazepam (4 mg/die) without benefit. The second EEG was characterized by triphasic waves with diffuse projection. MRI angiography revealed the presence of diffuse cortical ribbon hyperintensity of gray matter. CSF examination showed positivity of 14/3/3 protein and a TAU protein value greater than 16000 pq/ml allowing diagnosis of CJD.

Conclusions

We emphasize the importance of a correct differential diagnosis in patients with psychiatric symptoms and rapidly progressive dementia unresponsive to therapy.

A New Proposed Protocol to Evaluate Anxiety, Depression and the Needs of Cancer Patients

Aims:

To examine the perceived needs by patients and radiotherapists using a modified by us version of the Camberwell Assessment of Need (CAN).

Methods:

We eliminated 4/22 areas of the CAN scale -ideated for psychotic patients- in order to adapt it to oncological subjects (naming it CANo). Each of the scale areas values: the existence of a specific need; the help received from care-givers; the help coming from social services; the completeness of the help received. CANo was administrated to 30 solid cancer subjects consecutively admitted in 2007 to the Radiotherapy Department of Novara Hospital (Italy), and to their respective treating radiotherapists. Patients with cognitive impairment were excluded. Patients were also administrated the following protocol: HADS (Hospital anxiety and depression scale); Paykel's list of stressful events; MBTI (Mayer-Briggs Type Indicator); EORTC QLQ-C30.

Results:

Anxiety and depression occurred at any level in 15/30 of cases. There was a significant correlation (Spearman coefficient: SC) between the numbers of needs on CANo scale and anxiety (SC:0.4; p=0.002) or depression (SC:0.48; p=0.006) levels. Higher scores in all functional EORTC scales corresponded to lower needs detected by CANo. Patient needs were perceived less important by patients themselves than their physicians (mean satisfied need scores: 1.87 vs. 3; unsatisfied need scores: 0.63 vs. 1.03). The staff overestimated patient physical health needs (7/30 vs 3/30), psychological distress (20/30 vs 5/30), relationship difficulties (9/30 vs 2/30), received information correctness (7/30 vs 2/30).

Conclusions:

The CANo scale may be useful to detect oncological patient needs and to improve the quality of care.