1
|
Pelizza L, Leuci E, Leucci AC, Quattrone E, Azzali S, Pupo S, Plazzi E, Paulillo G, Pellegrini P, Menchetti M. Diagnostic shift in first episode psychosis: Results from the 2-year follow-up of the "Parma Early Psychosis" program. Schizophr Res 2024; 267:99-106. [PMID: 38531162 DOI: 10.1016/j.schres.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Although the stability of current diagnostic criteria for people with First Episode Psychosis (FEP) is essential for treatment, it still remains poorly investigated. As its examination necessarily requires a prospective evaluation of diagnostic trajectories, the aims of the current longitudinal investigation were: (a) to assess diagnostic changes in an Italian FEP population treated within an "Early Intervention in Psychosis" service during a 2-year follow-up period, and (b) to identify potential sociodemographic and clinical moderators of diagnostic instability at entry. METHODS All participants were FEP individuals, aged 12-35 years. Their primary diagnosis was formulated both at baseline and at the end of the follow-up. At entry, they also completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. As measure of diagnostic stability, the Kappa statistic was first calculated. The associations of diagnostic shift with baseline sociodemographic and clinical characteristics were then analyzed using a logistic model with the diagnostic change as dependent variable. Finally, a propensity score was calculated, based on logistic analysis results. RESULTS 221 (50.1 %) FEP participants changed their initial diagnosis. The highest prospective diagnostic stability was found for initial diagnosis of schizophrenia (93.9 %) and affective spectrum psychoses (92.4 %). Diagnostic instability was high for initial diagnosis of brief psychotic disorder (100 %), schizophreniform disorder (100 %) and psychotic disorder not otherwise specified (92.1 %). The best predictors of diagnostic change were previous contact with neuropsychiatry services, shorter duration of untreated psychosis and higher baseline levels of disorganization. CONCLUSIONS Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses and detecting its moderators at entry are important challenges for future diagnostic development of early psychosis.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy; Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Anna Caterina Leucci
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Enrico Plazzi
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
| | - Giuseppina Paulillo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
| |
Collapse
|
2
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Gammino L, Biancalani A, Menchetti M. Borderline personality disorder vs. schizophrenia spectrum disorders in young people recruited within an "Early Intervention in Psychosis" service: clinical and outcome comparisons. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01772-5. [PMID: 38472469 DOI: 10.1007/s00406-024-01772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
Borderline Personality Disorder (BPD) is under-recognized in First-Episode Psychosis (FEP) and its psychotic manifestations are difficult to differentiate from Schizophrenia Spectrum Disorders (SSD). The aim of this investigation was to compare clinical, sociodemographic, and outcome characteristics between FEP patients with BPD vs. FEP subjects with SSD both at baseline and across a 2-year follow-up period. Participants completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale both at entry and every 12 months during the follow-up. A mixed-design ANOVA model was conducted to investigate the temporal stability of clinical scores within and between the two subgroups. Among 356 FEP participants, 49 had a BPD diagnosis. Compared to FEP/SSD (n = 307), FEP/BPD patients showed higher prevalence of employment, current substance use, and past attempted suicide. They had a lower equivalent dose of antipsychotic medication at entry and lower levels of negative symptoms. Finally, they had a higher 2-year drop-out rate and a significant improvement in psychopathological scores limited to the first year of treatment. BPD as categorical entity represents a FEP subgroup with specific clinical challenges. Appropriate treatment guidelines for this FEP subgroup are thus needed.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 43100, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Lorenzo Gammino
- Department of Mental Health and Pathological Addictions, Azienda USL di Bologna, Via Castiglione 29, 40124, Bologna, Italy
| | - Arianna Biancalani
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
| |
Collapse
|
3
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Poletti M, Raballo A, Pellegrini P, Menchetti M. Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from the Parma At-Risk Mental States (PARMS) program. Early Interv Psychiatry 2024; 18:71-81. [PMID: 37194411 DOI: 10.1111/eip.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
AIM The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period. METHODS This research was settled within the 'Parma At-Risk Mental States' program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. RESULTS Hundred and seventy-eight CHR-P individuals (aged 12-25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals. CONCLUSIONS In agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in risk calculators.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" - University of Bologna, Bologna, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Department of Medicine, Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
- Center for Translational, Phenomenological and Developmental Psychopathology, Perugia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" - University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Menchetti M. Longitudinal evaluation on negative symptoms in young people at Ultra-High Risk (UHR) of psychosis: results from a 2-year follow-up study in a real-world care setting. Eur Arch Psychiatry Clin Neurosci 2023; 273:1761-1771. [PMID: 37029806 DOI: 10.1007/s00406-023-01600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Negative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis. However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal stability of NS levels in young UHR subjects treated within a specialized "Early Intervention in Psychosis" (EIP) program across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment components offered within the EIP program. One hundred UHR individuals (aged 12-25 years) completed the Positive And Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the clinical severity of NS at least during the first year of treatment.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42100, Reggio Emilia, RE, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Simona Pupo
- Division of Pain Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
| |
Collapse
|
5
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Pupo S, Paulillo G, Pellegrini P, Menchetti M. Short-term disengagement from early intervention service for first-episode psychosis: findings from the "Parma Early Psychosis" program. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02564-3. [PMID: 37831081 DOI: 10.1007/s00127-023-02564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Service disengagement is a major concern for "Early Intervention in Psychosis" (EIP). Indeed, identifying predictors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment. METHODS All participants were young FEP help-seeking patients, aged 12-35 years, enrolled within the "Parma Early Psychosis" (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used. RESULTS 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry. CONCLUSION About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum", Università di Bologna, Viale Pepoli, 5, 40126, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Giuseppina Paulillo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum", Università di Bologna, Viale Pepoli, 5, 40126, Bologna, BO, Italy
| |
Collapse
|
6
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Pupo S, Paulillo G, Pellegrini P, Menchetti M. Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2-year follow-up of the Pr-EP program. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02306-5. [PMID: 37812244 DOI: 10.1007/s00787-023-02306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
Service disengagement is a major concern for "Early Intervention in Psychosis" (EIP). Indeed, understanding predictors of engagement is important for the effectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with first episode psychosis (FEP). No specific European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12-18 years) enrolled in the "Parma Early Psychosis" (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS "Disorganization" factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the first 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Istituto di Psichiatria "Paolo Ottonello", viale Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, 43100, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, 43100, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, 43100, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, viale Amendola 2, 42100, Reggio Emilia, RE, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, viale Gramsci 14, 43100, Parma, PR, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, 43100, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, 43100, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, Istituto di Psichiatria "Paolo Ottonello", viale Pepoli 5, 40123, Bologna, BO, Italy
| |
Collapse
|
7
|
Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Disorganization in first episode affective psychosis: Treatment response and clinical considerations from a 2-year follow-up study in a "real world" setting. Span J Psychiatry Ment Health 2023; 16:151-158. [PMID: 38520114 DOI: 10.1016/j.rpsm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period. MATERIALS AND METHODS Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated. RESULTS During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment. CONCLUSIONS Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| |
Collapse
|
8
|
Poletti M, Pelizza L, Loas G, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A. Anhedonia and suicidal ideation in young people with early psychosis: Further findings from the 2-year follow-up of the ReARMS program. Psychiatry Res 2023; 323:115177. [PMID: 37003168 DOI: 10.1016/j.psychres.2023.115177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Ninty-six UHR and 146 FEP, aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II "Anhedonia" subscale score to assess anhedonia and the CAARMS "Depression" item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime.
Collapse
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna (BO), Italy.
| | - Gwenole Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques Universitaires de Bruxelles, Universitè Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | | | - Simona Pupo
- Pain Therapy Unit, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci n.14, 43100 Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, PG, Italy; Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, PG, Italy
| |
Collapse
|
9
|
Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P. Depressive Features in Individuals with First Episode Psychosis: Psychopathological and Treatment Considerations from A 2-Year Follow-Up Study. Clin Neuropsychiatry 2023; 20:39-47. [PMID: 36936626 PMCID: PMC10016103 DOI: 10.36131/cnfioritieditore20230105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective Comorbid depression is quite common in early psychosis and specifically related to suicidal behavior and poor long-term outcomes. However, Depressive Symptoms (DS) are often neglected in both research and treatment, especially at the psychosis onset. The goals of this investigation were: (a) to longitudinally explore DS levels in patients with First Episode Psychosis (FEP) during 24 months of follow-up, and (b) to investigate the associations of DS with psychopathology and intervention components of an "Early Intervention in Psychosis" (EIP) program across the follow-up period. Method The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 266 FEP subjects. A linear regression analysis with DS as the dependent parameter and psychopathological and treatment characteristics as independent variables was performed (both at baseline and across the follow-up period). Results DS had enduring associations with PANSS "Positive Symptoms" and "Negative Symptoms" subscores. During the investigation, FEP subjects significantly improved their DS severity levels. This was related to the number of individual psychotherapy meetings supplied within the EIP protocol, as well as to a higher antidepressant dose and a lower antipsychotic dose prescribed during the follow-up. Conclusions DS are quite prominent in FEP, even at the recruitment time in EIP services. Nevertheless, DS severity tends to diminish overtime, especially with the provision of specialized EIP treatments.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
- Department of Biomedical and NeuroMotor Sciences, Università di Bologna, via Pepoli n. 5, 40126 Bologna, Italy
- Corresponding author Lorenzo Pelizza c/o Istituto di Psichiatria “Paolo Ottonello” via Pepoli n. 5 40126 Bologna (BO) – Italy Phone: +39 – 051/396502 E-mail:
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, via Gramsci n.14, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| |
Collapse
|
10
|
Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Association between case management and longitudinal decrease in negative symptoms in patients with first episode psychosis: A 2-year follow-up. Early Interv Psychiatry 2022; 16:1185-1191. [PMID: 35086160 DOI: 10.1111/eip.13267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/19/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023]
Abstract
AIM Negative symptoms (NS) severely affect daily functioning already at the psychosis onset. However, most studies investigating beneficial effects of specific treatments for NS mainly included individuals with prolonged psychotic disorders. Furthermore, evidence on psychosocial rehabilitation for NS in early psychosis is still relatively poor. The aims of this study therefore were (A) to longitudinally examine NS stability in people with first episode psychosis (FEP) along a 2-year follow-up period, and (B) to overtime explore any relevant association of NS levels with the specific intervention components of an 'early intervention in psychosis' (EIP) protocol during the follow-up. METHODS At baseline, 266 FEP subjects (aged 12-35 years) completed the positive and negative syndrome scale (PANSS). Multiple linear regression analyses were then performed. RESULTS Along the follow-up, FEP participants had a relevant improvement in NS levels. This was specifically predicted by the total number of case management sessions offered within our 2-year EIP protocol, as well as by shorter duration of untreated psychosis at entry and by longitudinal reduction in PANSS depressive and positive symptom dimension levels. No association with antipsychotic medication was found. CONCLUSIONS NS are clinically relevant in FEP, already at the recruitment time in specialized EIP services. However, their severity appears to improve over time together with the delivery of patient-tailored, integrated EIP case management.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
11
|
Pelizza L, Quattrone E, Leuci E, Paulillo G, Azzali S, Pupo S, Pellegrini P. Anxious-depressive symptoms after a first episode of schizophrenia: Response to treatment and psychopathological considerations from the 2-year "Parma Early Psychosis" program. Psychiatry Res 2022; 317:114887. [PMID: 36219900 DOI: 10.1016/j.psychres.2022.114887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 01/05/2023]
Abstract
Depression is common in schizophrenia and is correlated with suicide risk and poor long-term outcomes. However, the presence of depressive symptoms is often underestimated in both research and treatment, particularly at the illness onset. The goals of this study were: (a) to longitudinally observe anxious-depressive symptom levels in patients with First Episode Schizophrenia (FES) during a 24 months of follow-up period, and (b) to examine their associations with other psychopathology and the intervention patients received in an "Early Intervention in Psychosis" (EIP) program during the follow-up period. The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 159 FES patients both at baseline and across the follow-up. Data were analyzed by linear regression analysis and Spearman's coefficients. Anxious-depressive symptoms had significant longitudinal associations with GAF deterioration and PANSS "Positive Symptoms", "Negative Symptoms" and "Disorganization" subscores. During the follow-up period, FES participants significantly improved the level of anxious-depressive symptoms. This was significantly associated with the number of case management and individual psychotherapy meetings the patient engaged in, as well as with lower antipsychotic doses prescribed during the follow-up period. In conclusion, anxious-depressive symptoms are prominent in FES and at the initial entry into EIP programs. Anxious-depressive symptom severity tends to diminish overtime, especially with the provision of specialized EIP treatments. However, since we did not have a control population studied in parallel, we cannot say whether these results are specific to the protocols of EIP programs or just to the intensity of engagement in care.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, Parma 43100, Italy; Department of Biomedical and Neuromotor Sciences, Università degli Studi di Bologna, Via Zamboni n. 33, Bologna, Italy.
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, Parma 43100, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, Parma 43100, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, Parma 43100, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, Reggio, Emilia 43100, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci n.14, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, Parma 43100, Italy
| |
Collapse
|
12
|
Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Longitudinal persistence of negative symptoms in young individuals with first episode schizophrenia: a 24-month multi-modal program follow-up. Nord J Psychiatry 2022; 76:530-538. [PMID: 34936855 DOI: 10.1080/08039488.2021.2015431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Persistent Negative Symptoms (PNS) affect real-world functioning already at the onset of schizophrenia. Longitudinal studies on beneficial effects of psychosocial treatments for PNS in First Episode Schizophrenia (FES) are still relatively scarce. The aim of the current study was to evaluate the longitudinal persistence of PNS in young FES individuals treated according to the multimodal "Early Intervention in Psychosis" (EIP) program over a 2-year follow-up period. MATERIALS AND METHODS 133 FES subjects (aged 12-35 years) were recruited within the Italian EIP program and completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). In accordance with the PNS criteria, we dichotomized FES individuals with and without PNS. In the FES group with PNS, a multiple linear regression analysis was conducted to examine relevant associations between longitudinal PNS levels and the specialized treatment components of our EIP protocol. RESULTS Twenty (15%) FES participants met the PNS criteria. At baseline, PNS levels had relevant positive correlations with functioning decline and PANSS total score. At the end, the 2-years follow-up period, FES subjects with PNS showed a significant decrease in PNS levels. In our linear regression analysis, this reduction was associated with a higher number of individual psychotherapy and case management sessions delivered during our follow-up (together with a shorter DUP [Duration of Untreated Psychosis]). CONCLUSIONS PNS are clinically relevant in a minority of FES individuals. Our results suggest that patient-tailored psychosocial interventions can reduce clinical severity of PNS over a 2-year period.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
13
|
Pelizza L, Leuci E, Quattrone E, Paulillo G, Azzali S, Pupo S, Pellegrini P. Depressed Mood in First Episode Schizophrenia: Findings From a 1-Year Follow-Up in an Italian Real-World Care Setting. Psychiatry 2022; 86:164-166. [PMID: 36149804 DOI: 10.1080/00332747.2022.2120308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Introduction: Depression in schizophrenia is associated with poor outcomes and suicide risk. However, it is overlooked in both research and clinical practice, especially in First Episode Schizophrenia (FES). Methods: In this letter to the editor, we reported relevant findings on relevant comorbid depressed mood in an Italian sample of FES patients during a 1-year follow-up period within an "Early Intervention in Psychosis" (EIP) program. The Positive And Negative Syndrome Scale (PANSS) was completed by 159 participant. Results: At baseline, 53 (33.3%) participants showed a relevant depressed mood (as measured with a PANSS "Depression" G6 item subscore of ≥ 5). At entry, a relevant depressed mood was associated with a greater percentage of females and a higher PANSS "Positive Symptoms" score. Across the follow-up, FES individuals improved their depression severity levels. This reduction was significantly related to improvments in positive symptoms levels. Conclusions: Depression is relatively common in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs.
Collapse
|
14
|
Scazza I, Pelizza L, Azzali S, Garlassi S, Paterlini F, Chiri LR, Poletti M, Pupo S, Raballo A. Aberrant salience in first-episode psychosis: Longitudinal stability and treatment-response. Early Interv Psychiatry 2022; 16:912-919. [PMID: 34786863 DOI: 10.1111/eip.13243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/02/2021] [Accepted: 11/07/2021] [Indexed: 01/24/2023]
Abstract
AIM Aberrant salience (AS) is considered a putative predisposing factor for the onset of psychosis. However, despite several studies conducted in the general population, research in early psychosis is still relatively scarce. The main purposes of this study were to investigate any relevant correlation of AS with functioning and psychopathology in young patients with first episode psychosis (FEP), and to analyse the longitudinal stability of AS across a 1 year follow-up period. METHODS All the participants (139 FEP), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS), and the Positive And Negative Syndrome Scale (PANSS). Spearman correlation analysis among psychopathological parameters were performed both at baseline and after the 1 year of follow-up. RESULTS Across the follow-up, FEP patients showed a significant decrease in the ASI total score. This reduction was specifically associated with the number of individual cognitive-behavioural therapy sessions offered to FEP individuals in the same time period (and not with antipsychotic dose at baseline). CONCLUSIONS AS is clinically significant in FEP patients. However, it tends to ameliorate over time together with the delivery of specialized, person-tailored FEP treatments within a specific "Early Intervention in Psychosis" protocol.
Collapse
Affiliation(s)
- Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Second Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
15
|
Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Examining disorganization in patients with first episode psychosis: Findings from a 1-year follow-up of the 'Parma early psychosis' program. Early Interv Psychiatry 2022; 16:552-560. [PMID: 34279049 DOI: 10.1111/eip.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/09/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022]
Abstract
AIM Disorganization has been considered as a clinical domain close to the core of psychosis. However, it has received poor attention, especially at the illness onset. Moreover, most of the studies examining disorganized symptoms have been conducted in patients with chronic psychosis and research in the early stages of illness is still relatively scarce. Thus, the aims of this study were (a) to longitudinally monitor the stability of disorganization in patients with first episode psychosis (FEP) across a 1-year follow-up period, and (b) to investigate any relevant association of disorganized symptoms with functioning, psychopathology and the specific treatment components of an 'early intervention in psychosis' (EIP) program along the 1 year of follow-up. METHODS At baseline, 312 FEP participants (aged 12-35 years) completed the positive and negative syndrome scale (PANSS) and the global assessment of functioning (GAF). Spearman's correlations and multiple linear regression analysis were used. RESULTS At baseline, disorganization showed significant associations with all PANSS subscores, and a relevant negative correlation with GAF score. Across the follow-up, FEP individuals showed a significant improvement in disorganization severity. This decrease was specifically related to both baseline antipsychotic dosage and the number of individual cognitive-behavioural therapy sessions offered across the 1-year follow-up period. CONCLUSIONS Disorganization is clinically relevant in FEP patients, already ate the enrollment in an EIP program. However, it tends to improve over time together with the delivery of specialized, person-tailored FEP interventions within a specific EIP protocol.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
16
|
Pelizza L, Pellegrini C, Quattrone E, Azzali S, Landi G, Pellegrini P, Leuci E. Suicidal Thinking and Behavior in First Episode Schizophrenia: Findings from the 24-Month Follow-Up of the "Parma Early Psychosis" Program. Arch Suicide Res 2022; 26:656-676. [PMID: 32970972 DOI: 10.1080/13811118.2020.1820411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although suicide risk is relevant in First Episode Schizophrenia (FES), little data are reported on suicidal ideation and its longitudinal stability. Aim of this study was: (1) to evaluate incidence rates of suicide attempts, completed suicide and suicidal thinking in FES patients at baseline and along a 24-month follow-up period, (2) to investigate any relevant association of baseline suicidal ideation with psychopathology, and (3) to longitudinally monitor suicidal thinking during the 2-years of follow-up. Participants (n = 149; age = 12-35 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale. FES participants showed a 40.8% percentage of baseline suicidal ideation (i.e., BPRS item 4 cutoff score of ≥3) and a 2-year cumulative incidence rate of attempted suicide of 6.1%. One completed suicide (0.7%) was also found during the follow-up. Baseline suicidal ideation was positively correlated with depression and negatively correlated with younger age. These results support a routine monitoring of suicide risk in this young population at the point of entry into early intervention services.
Collapse
|
17
|
Poletti M, Pelizza L, Azzali S, Scazza I, Paterlini F, Garlassi S, Chiri LR, Pupo S, Raballo A. Association between psychosocial interventions and aberrant salience in adolescents with early psychosis: A follow-up study. Scand J Psychol 2022; 63:290-296. [PMID: 35285026 DOI: 10.1111/sjop.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Pupo
- Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
18
|
Leuci E, Pelizza L, Landi G, Quattrone E, Maestri D, Azzali S, Pelosi A, Ceroni P, Soncini C, Daolio MC, Paulillo G, Raballo A, Pellegrini P. Personal health budget in patients with first episode psychosis: A new rehabilitation model based on a community care system in Italy. Early Interv Psychiatry 2022; 16:221-230. [PMID: 33754490 DOI: 10.1111/eip.13145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Abstract
AIM Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first-episode psychosis (FEP) across a 2-year follow-up period. METHODS Participants (n = 104; 18-50 years) were recruited within the 'Parma-Early Psychosis' program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed-design analysis of variance (ANOVA) and Kaplan-Maier survival analysis (as drop-out measure) were performed. RESULTS A significant effect of time on all BPRS, HoNOS and GAF scores along the follow-up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed-design ANOVA results showed a significant 'time x group' interaction effects on BPRS 'Disorganization', HoNOS 'Psychiatric Symptoms' and GAF scores in FEP participants with PHB. Kaplan-Meyer survival analysis showed a longer survival mean for FEP patients with PHB. CONCLUSIONS Our results support the applicability of a PHB model within an 'Early Intervention in Psychosis' program in public community mental health services.
Collapse
Affiliation(s)
- Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Modena, Modena, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Pelosi
- Department of Medicine and Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Patrizia Ceroni
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Caterina Soncini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Maria Cristina Daolio
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
19
|
Azzali S, Pelizza L, Scazza I, Paterlini F, Garlassi S, Chiri LR, Poletti M, Pupo S, Raballo A. Examining subjective experience of aberrant salience in young individuals at ultra-high risk (UHR) of psychosis: A 1-year longitudinal study. Schizophr Res 2022; 241:52-58. [PMID: 35086058 DOI: 10.1016/j.schres.2021.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022]
Abstract
Aberrant salience (AS) is considered as a predisposing factor in early psychosis. Although it has been frequently examined in the general population as a measure of vulnerability to psychotic disorder, empirical evidence on AS in prodromal phases of psychosis is still relatively scarce. Thus, the aims of this research were (1) to investigate any significant association of AS with functioning, psychopathology and treatment components of an "early intervention in psychosis" program in a sample of young community help-seekers at Ultra-High Risk (UHR) of psychosis along a 1-year follow-up period, and (2) to longitudinally monitor the stability of AS across the 1 year of follow-up. Participants (87 UHR), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B) at baseline and after the 1 year of follow-up. Spearman correlation analyses among psychopathological parameters and specialized treatment components were performed. A multiple linear regression analysis was also carried out. After a 1-year follow-up period, UHR subjects had a statistically relevant decrease in ASI total scores. This was significantly related to the number of individual cognitive-behavioral therapy (CBT) sessions and the number of family psychoeducational sessions offered to UHR participants and their family members during the same 12-month period. In conclusion, AS is clinically relevant in UHR individuals. However, it seems to improve over time along with the delivery of tailored, specialized psychosocial interventions for early psychosis.
Collapse
Affiliation(s)
- Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy; Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1, 43100 Parma (PR), Italy.
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n. 2, 43100 Parma (PR), Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy; Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Via Gramsci n. 14, 43100 Parma (PR), Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Sant'Andrea delle Fratte, 06156 Perugia (PG), Italy; Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Sant'Andrea delle Fratte, 06156 Perugia (PG), Italy
| |
Collapse
|
20
|
Poletti M, Pelizza L, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Pupo S, Raballo A. Subjective experience of aberrant salience in young people at Ultra-High Risk (UHR) for psychosis: a cross-sectional study. Nord J Psychiatry 2022; 76:129-137. [PMID: 34185607 DOI: 10.1080/08039488.2021.1942547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Aberrant salience (AS) is conceptualized as a potential predisposing factor for psychotic states of mind. Despite several studies in the general population, research on AS in the early phases of psychosis is still relatively scarce. The aim of this cross-sectional study is (1) to evaluate the AS subjective experience in Ultra-High Risk (UHR) adolescents and young adults compared to help-seeking peers with First Episode Psychosis (FEP) and (2) to assess any significant association of baseline AS with psychopathology and functioning in UHR participants. MATERIALS AND METHODS Participants (87 UHR and 139 FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Aberrant Salience Inventory (ASI) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B). Within the UHR subgroup, Spearman correlation and multiple linear regression analyses among psychopathological parameters were performed. RESULTS No difference in baseline AS subjective levels was found between UHR and FEP participants (median [interquartile range]: 14.50 [7-19] vs 14 [9-21]; z = -1.576; p = 0.115). In UHR individuals, the ASI total score was significantly associated with attenuated positive symptoms (ρ = 0.284, p = 0.008), depression (ρ = 0.256; p = 0.018) and specific schizotypal personality traits (i.e. cognitive-perceptual deficits and disorganization [respectively, ρ = 0.487, p = 0.001, and ρ = 0.295, p = 0.008]). CONCLUSIONS AS is clinically relevant in UHR subjects, comparable to FEP patients. Moreover, it seems to mutually interact with schizotypy in the clinical manifestation of attenuated positive psychopathology.
Collapse
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
21
|
Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A. Overcoming the gap between child and adult mental health services: The Reggio Emilia experience in an early intervention in psychosis program. Early Interv Psychiatry 2021; 15:1749-1758. [PMID: 33264817 DOI: 10.1111/eip.13097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
AIM Early intervention in psychosis (EIP) can reduce severity and persistence of illness. From September 2012, the Reggio Emilia Department of Mental Health developed the 'Reggio Emilia At-Risk Mental States' (ReARMS) protocol as a specific EIP infrastructure in all its adult and child/adolescent mental health services. Aims of this study were (a) to describe the ReARMS macroscopic organization and (b) to analyse some specific process indicators (i.e., the amount of individuals referred to the ReARMS program, the number of subjects who met defined diagnostic criteria of early psychosis and accepted the intervention, and the 1-year drop-out rate) during the first 5 years of its clinical activity, in order to examine feasibility and quality of its procedures on the adolescent help-seeking subgroup. METHODS Adolescent participants (n = 125), aged 13-18 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) to investigate the clinical status. Descriptive quantitative analyses were then used. RESULTS Fifty (40%) individuals did not meet early psychosis-defined criteria, while 75 (60%: i.e., 44 Ultra-High Risk [UHR] and 31 First Episode Psychosis [FEP] subjects) were offered an EIP dedicated care protocol: of them, 66 (88%) were enrolled in the program and 9 (12%) dropped out during the first year of treatment). Adolescents enrolled in the ReARMS protocol were mainly referred by general practitioners (32%), family members (16%), or school/social services (15.2%). Seventy (56%) participants had a history of previous specialist contact (especially for learning and anxiety disorders). CONCLUSIONS An EIP program for adolescents with early psychosis in Italian child/adolescent mental health services are feasible, clinically relevant and recommended, specifically in this age group with a high risk of falling through the child/adult service gap.
Collapse
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma (PR), Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia (RE), Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma (PR), Italy
| | - Simona Pupo
- Intensive Care Unit, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy.,Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma (PR), Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia (PG), Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia (PG), Italy
| |
Collapse
|
22
|
Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Negative symptom dimensions in first episode psychosis: Is there a difference between schizophrenia and non-schizophrenia spectrum disorders? Early Interv Psychiatry 2021; 15:1513-1521. [PMID: 33238327 DOI: 10.1111/eip.13088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/27/2020] [Accepted: 11/14/2020] [Indexed: 01/24/2023]
Abstract
AIM Identifying discrete dimensions that underline negative symptoms in First Episode Psychosis (FEP) could improve the understanding and the treatment of such invalidating symptomatology. The aim of this study is to examine the negative symptom structure in FEP individuals and to compare the resulting factor configurations between FEP subjects with and without Schizophrenia Spectrum Disorders (SSD vs non-SSD). METHODS One hundred and seventy participants (88 SSD and 82 non-SSD), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Positive and Negative Syndrome Scale (PANSS). A principal component analysis was then performed to investigate PANSS negative symptom structure in both non-SSD and SSD groups. RESULTS Whereas in the SSD sample a 3-factor model solution (i.e., "Socio-Emotional Disengagement", "Motor/Thought Poverty", and "Avolition/Apathy" dimensions) was identified, a 2-factor model solution (with a mixed alogia/avolition domain in addition to a mixed socio-emotional disengagement/expressive deficits dimension) appeared more appropriate in the non-SSD group. CONCLUSIONS Our results show a relevant difference in the negative symptom factor structure between SSD and non-SSD individuals. In particular, a different specificity and significance of negative symptom models in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered. Notably, a "Motor/Thought Poverty" domain, which specifically includes alogia and motor retardation separately from the other PANSS negative items, appears to specifically characterize FEP young patients with the schizophrenia spectrum.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
23
|
Pelizza L, Chiri LR, Azzali S, Garlassi S, Scazza I, Paterlini F, Poletti M, Pupo S, Raballo A. Identifying adolescents in the early stage of psychosis: A screening checklist for referrers. J Clin Psychol 2021; 78:1184-1200. [PMID: 34797917 DOI: 10.1002/jclp.23280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The early identification of adolescents at the onset of psychosis is crucial to provide effective interventions. The aim of this study is to examine the validity of the "early detection Primary Care Checklist" (PCC) in an Italian adolescent population. The PCC is a 20-item tool designed to assist primary care practitioners in identifying young people with early psychosis. METHODS The checklist was completed by the referring practitioners of 129 adolescents. The validity of this instrument was established by comparing screen results with the "Comprehensive Assessment of At-Risk Mental States." RESULTS The simple checklist had excellent 98% sensitivity, but low specificity (58%). Using only a PCC total score of ≥20 as cutoff, there was a substantial improvement in specificity (87%). CONCLUSION The Italian version of the PCC performed well to identify adolescents in the early stage of psychosis and may be used in primary care settings.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Luigi R Chiri
- Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Division of Psychiatry, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
24
|
Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2-year follow-up of the 'Parma Early Psychosis' programme. Clin Psychol Psychother 2021; 29:982-989. [PMID: 34704336 DOI: 10.1002/cpp.2678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings. The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an 'Early Intervention in Psychosis' (EIP) protocol along the 2 years of follow-up. METHODS At entry, 232 FEP participants (aged 12-35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a 'Suicidality' item subscore. Multiple linear regression analysis was then performed. RESULTS Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention). CONCLUSION Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
25
|
Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Negative symptom configuration in patients with first episode affective psychosis: findings from the 1-year follow-up of the "Parma Early Psychosis" program. Acta Biomed 2021; 92:e2021224. [PMID: 34487088 PMCID: PMC8477119 DOI: 10.23750/abm.v92i4.11115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: Evidence on discrete dimensions underlining negative symptoms in First Episode Affective Psychosis (FEAP) may be useful for their treatment strategy, but is still relatively scarce. Aim of this study was to examine the negative symptom configuration in patients with FEAP using both exploratory and confirmatory factor analysis methods on the Positive And Negative Syndrome Scale (PANSS). Methods: Seventy-eight participants, aged 13-35 years, completed the PANSS within the “Parma Early Psychosis” (Pr-EP) program, a specialized protocol of early detection and intervention in psychosis implemented since January 2013 in all public adolescent and adult mental health services of the Parma Department of Mental Health (Northern Italy). Results: A 3-factor model (i.e. “Alogia”, “Social Withdrawal” and “Motor/Affective Expression Poverty” domains) was identified. As an alternative, a 2-factor solution previously proposed in patients with first episode schizophrenia (always within the Pr-EP program) also showed good fit indices in our FEAP sample. Conclusions: Our results suggest the crucial importance of identifying discrete negative symptom domains already at the onset of affective psychosis in order to implement specific early intervention strategies aiming to improve prognosis and long-term outcomes also in this young FEAP help-seeking population.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Parma Department of Mental Health and Pathological Addiction, Azienda USL di Parma.
| | | | | | | | | | | | | |
Collapse
|
26
|
Pelizza L, Pompili M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Suicidal thinking and behaviours in First Episode Psychosis: Findings from a 3-year longitudinal study. Early Interv Psychiatry 2021; 15:624-633. [PMID: 32462776 DOI: 10.1111/eip.12994] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 01/24/2023]
Abstract
AIM Suicide risk is greater at the beginning of the course of psychosis. Purpose of this research was: (a) to investigate prevalence and incidence rates of suicide attempts, suicidal thinking and completed suicide in First Episode Psychosis (FEP) help-seekers as compared with non-FEP help-seeking peers, and (b) to examine any correlation of suicidal ideation with other baseline psychopathological predictors. METHODS Two hundred and forty-one young people (13-35 years) were assessed with the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF), the Beck Depression Inventory - II Edition (BDI-II) and the Comprehensive Assessment of At-Risk Mental States (CAARMS) at the enrollment and over a 36-month follow-up period. A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was used. RESULTS FEP patients showed more severe levels of CAARMS "Suicidality/Self-Harm" item than non-FEP peers. They also had higher 3-year incidence rates of attempted suicide (11%) and completed suicide (13%). Within the FEP total group, suicidal ideation was positively correlated with BDI-II and CAARMS "Perceptual Abnormalities" item scores, and showed negative associations with younger age and WHOQOL-BREF "Social Relationships" factor sub-score. CONCLUSIONS Suicidal ideation is relevant in FEP patents, supporting the routine monitoring of suicide risk in baseline assessment of adolescents and young adults with early psychosis. Suicidal thinking seems to be correlated to younger age, perceptual aberrations and depression severity, as well as to poorer quality of social relationships.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma (PR), Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy
| | | | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia (RE), Italy
| | - Simona Pupo
- Service of Anhesthesia and Resuscitation, Azienda Ospedaliero-Univeristaria di Parma, Parma (PR), Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia (PG), Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia (PG), Italy
| |
Collapse
|
27
|
Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Anhedonia in the Psychosis Risk Syndrome: State and Trait Characteristics. Psychiatr Danub 2021; 33:36-47. [PMID: 33857038 DOI: 10.24869/psyd.2021.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. SUBJECTS AND METHODS All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. RESULTS In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow-up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. CONCLUSIONS In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Pelizza L, Leuci E, Maestri D, Quattrone E, Paulillo G, Pellegrini P, Azzali S. Negative symptoms in first episode schizophrenia: Results from the “parma early psychosis” program. Eur Psychiatry 2021. [PMCID: PMC9470993 DOI: 10.1192/j.eurpsy.2021.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology. Objectives Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS). Methods All 147 participants, aged 12–35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptom structure in the FES total sample. Results A 2-factor model (i.e. “Expressive Deficits” and “Asociality” dimensions) was identified. Only “Expressive Deficits” domain had a significant negative correlation with baseline GAF score. Conclusions This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services. Disclosure No significant relationships.
Collapse
|
29
|
Pelizza L, Azzali S, Garlasdi S, Scazza I, Paterlini F, Poletti M, Pupo S, Raballo A. Social cognition in adolescents at risk for psychosis: A 2-year follow-up study. Eur Psychiatry 2021. [PMCID: PMC9528519 DOI: 10.1192/j.eurpsy.2021.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionDeficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population.Objectives
Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period.MethodsParticipants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13–18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis.Results
In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE “Social Cognition” subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms.ConclusionsSocial cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.
Collapse
|
30
|
Landi G, Leuci E, Quattrone E, Azzali S, Pellegrini C, Pellegrini P, Pelizza L. The 'Parma-Early Psychosis' programme: Characterization of help-seekers with first episode psychosis. Early Interv Psychiatry 2021; 15:380-390. [PMID: 32307896 DOI: 10.1111/eip.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
AIM Research on early psychosis paradigm has demonstrated the importance of early intervention (EI) in reducing illness severity and persistence. From January 2013, the Parma Department of Mental Health developed a specific care pathway [the 'Parma-Early Psychosis' (Pr-EP) programme] as a diffused EI infrastructure aimed to offer an evidence-based protocol of care to help-seekers with a first episode psychosis (FEP). Aim of this study was to investigate sources of referral, drop-out rate, sociodemographic and clinical characteristics of patients enrolled in the Pr-EP programme during the first 6 years of activity. METHODS Participants (n = 279) were individuals (aged 12-54 years) completing an ad-hoc socio-demographic/clinical schedule. RESULTS At baseline, the most frequent diagnoses were schizophreniform disorder (30.5%) and schizophrenia (29.4%). Only 31 (11.1%) subjects dropped out during the first year of treatment. FEP participants were mainly referred by general practitioners (36.9%) and emergency room/general hospital (28.7%). FEP individuals who were referred by emergency room/general hospital showed a higher percentage of current suicidal ideation compared to those entering the Pr-EP protocol through other sources of referrals. CONCLUSIONS EI in FEP help-seekers within Italian public mental health services is feasible and desirable, also in adolescence, where the risk of falling through the child-adult service gap is high.
Collapse
Affiliation(s)
- Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Clara Pellegrini
- Psychiatric Unit, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
31
|
Pelizza L, Poletti M, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Pupo S, Raballo A. Subjective experience of social cognition in young people at Ultra-High Risk of psychosis: a 2-year longitudinal study. Nord J Psychiatry 2021; 75:97-108. [PMID: 32762506 DOI: 10.1080/08039488.2020.1799430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Impairments in SC have been reported in people at Ultra-High Risk (UHR) of psychosis exclusively using neurocognitive tasks. The aims of this study are (1) to assess subjective experience of SC in adolescent and young adult community help-seekers identified through UHR criteria, (2) to explore significant associations of SC with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally the SC stability after a 2-year follow-up period. Methods: Participants (97 UHR, 141 First-Episode Psychosis [FEP], and 98 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the GEOPTE scale of social cognition for psychosis. Within the UHR group, a multiple linear regression analysis (with GEOPTE scores as independent variables and CAARMS dimension subscores and treatment measures as dependent variables) was also performed across the 2-year longitudinal design. Results: In comparison with non-UHR/FEP, both UHR and FEP subjects showed significantly higher GEOPTE scores. Both after 12 and 24 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE SC subscore. In the UHR group, GEOPTE scores showed significant positive correlations with general psychopathology, positive and negative symptoms. Regression analysis showed a significant contribution of SC in predicting baseline social isolation, impaired role functioning, and general psychopathology. After 1 year of follow-up, improvement in SC was predicted by the number of psychotherapy sessions and lower doses of antipsychotics. Conclusions: SC deficits are prominent in UHR individuals and are similar in severity to those of FEP patients. However, they tend to decrease over time along with the delivery of targeted, specialized interventions for early psychosis.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Pupo
- Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
32
|
Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Negative symptom configuration within and outside schizophrenia spectrum disorders: results from the "Parma Early Psychosis" program. Psychiatry Res 2020; 294:113519. [PMID: 33130513 DOI: 10.1016/j.psychres.2020.113519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/19/2020] [Indexed: 01/24/2023]
Abstract
The identification of discrete dimensions underlining negative symptoms in First Episode Psychosis (FEP) may be useful in the treatment strategy for such severe symptomatology. Aim of this research was to investigate the negative symptom configuration in FEP patients and to compare the emerging factor solutions between individuals with and without Schizophrenia Spectrum Disorders (non-SSD vs SSD). Two-hundred-seventy-four participants (144 non-SSD and 130 SSD), aged 13-35 years, completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Confirmatory and exploratory factor analyses were then performed to examine PANSS negative symptom configuration in both SSD and non-SSD samples. In SSD, a 3-factor model solution (i.e. "Experiential Deficits", "Volition/Empathy Deficits" and "Motor/Affective Expression Deficits" domains) was identified. A different 2-factor configuration (with "Social/Communicative Withdrawal" and "Motor/Affective/Motivational Deficits" dimensions) was more appropriate in non-SSD. In conclusion, our results show differences in negative symptom factor models between non-SSD and SSD. Thus, a different specificity and significance of negative symptom solutions in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy.
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy; Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| |
Collapse
|
33
|
Pelizza L, Poletti M, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Pupo S, Raballo A. Subjective experience of social cognition in adolescents at ultra-high risk of psychosis: findings from a 24-month follow-up study. Eur Child Adolesc Psychiatry 2020; 29:1645-1657. [PMID: 32016572 DOI: 10.1007/s00787-020-01482-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period. Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13-18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE "Social Cognition" subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy. .,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Strada del Quartiere n.2, 43100, Parma, PR, Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy.,Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n.2, 43100, Parma, PR, Italy
| | - Simona Pupo
- Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera-Universitaria di Parma, Via Gramsci n.1, 43100, Parma, PR, Italy.,Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazzale Lucio Severi n.1, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
34
|
Pelizza L, Azzali S, Garlassi S, Scazza I, Paterlini F, Rocco LC, Poletti M, Pupo S, Raballo A. A 2-year longitudinal study on subjective experience of social cognition in young people with first episode psychosis. Actas Esp Psiquiatr 2020; 48:287-301. [PMID: 33398858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Impairments in Social Cognition (SC) in First Episode Psychosis (FEP) were reported exclusively using neurocognitive tests. Aim of this study is (1) to assess subjective experience of SC in FEP adolescent and young adults compared to non-FEP help-seeking peers, (2) to investigate any significant association of SC with psychopathology and functioning in FEP individuals; and (3) to monitor longitudinally the stability of SC after a 2-year follow-up period.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy. Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Strada del Quartiere n.2, 43100 Parma (PR), Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Chiri Rocco
- Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n.2, 43100 Parma (PR), Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Simona Pupo
- Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Via Gramsci n.14, 43100 Parma (PR), Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Piazza dell’Università n.1, 06121 Perugia (PG), Italy. Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, S. Andrea delle Fratte, 06156 Perugia (PG), Italy
| |
Collapse
|
35
|
Pelizza L, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Poletti M, Pupo S, Cicero DC, Preti A, Raballo A. Assessing aberrant salience in young community help‐seekers with early psychosis: The approved Italian version of the Aberrant Salience Inventory. J Clin Psychol 2020; 77:782-803. [DOI: 10.1002/jclp.23059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/29/2020] [Accepted: 09/05/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
- Department of Mental Health and Pathological Addiction Azienda USL di Parma Parma Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Luigi R. Chiri
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
- Department of Primary Care Azienda USL di Parma Parma Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
- Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera‐Universitaria di Parma Parma Italy
| | - David C. Cicero
- Department of Psychology University of North Texas Denton Texas USA
| | - Antonio Preti
- Center for Consultation‐Liason Psychiatry and Psychosomatics University Hospital of Cagliari Cagliari Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry Clinical Psychology and Rehabilitation University of Perugia Perugia Italy
- Center for Translational, Phenomenological and Developmental Psychopathology Perugia University Hospital Perugia Italy
| |
Collapse
|
36
|
Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Characterization of young people with first episode psychosis or at ultra-high risk: the Reggio Emilia At-Risk Mental States (ReARMS) program. Riv Psichiatr 2020; 54:254-263. [PMID: 31909752 DOI: 10.1708/3281.32544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM Twenty years of research on the Ultra-High Risk (UHR) paradigm have shown the importance of early intervention in psychosis (EIP) in reducing its severity and persistence. From September 2012, the Reggio Emilia Department of Mental Health developed a specific care pathway (the Reggio Emilia At-Risk Mental States [ReARMS] protocol) as an diffused, "liquid" EIP infrastructure branched within the network of all its adult and child/adolescent mental health service, aimed to offer an evidence-based, expertise-driven protocol of care to young people with a First Episode Psychosis (FEP) or an UHR mental state. Aim of the current study was to investigate patterns of referral to the ReARMS protocol during the first five years of clinical activity. METHODS All participants (n=300) were help-seeking adolescents and young adults, aged 13-35 years, who completed an ad-hoc socio-demographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States (CAARMS). RESULTS Among individuals who completed the baseline assessment, 95 (31.7%) did not comply with UHR/FEP defined criteria (UHR- subgroup), while 205 (68.3%) were offered the ReARMS protocol: of them, 154 (75.1%) accepted and were enrolled in the program, 19 (9.3%) refused, and 32 (15.6%) dropped out during the first year of treatment. In comparison with UHR- and UHR, FEP patients showed higher percentages of history of substance abuse and previous hospitalization, as well as higher levels of psychopathology and functioning. Individuals entering the ReARMS protocol were mainly referred by emergency room/general hospital, general practitioners, or they were self-referred. CONCLUSIONS EIP on young subjects at UHR of psychosis (together with FEP patients) in Italian public mental health services is clinically relevant, feasible, and recommended, also in adolescence, where there is a specific high risk of falling through the child-adult service gap.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy - Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy
| | | | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Uniti, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Italy - Anhestesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Italy
| |
Collapse
|
37
|
Pelizza L, Garlassi S, Azzali S, Paterlini F, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Anhedonia in young people with first episode psychosis: a longitudinal study. Nord J Psychiatry 2020; 74:381-389. [PMID: 32108539 DOI: 10.1080/08039488.2020.1733661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: Previous research observed deficits in pleasure experience in chronic schizophrenia, but little is known about anhedonia in early psychosis. Aim of this study is: (1) to examine anhedonia in distinct help-seeking subgroups of young people identified through the First Episode Psychosis (FEP) criteria, (2) to investigate its correlations with psychopathology in the FEP sample, and (3) to monitor longitudinally its stability in the FEP group along 1-year follow-up period.Materials and methods: All participants (137 FEP and 95 nonpsychotic psychiatric controls [i.e. non-FEP]), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We used two different indexes of anhedonia: CAARMS 'Anhedonia' item 4.3 and BOL 'Introvertive Anhedonia' subscale scores.Results: In comparison with non-FEP, FEP patients showed higher baseline anhedonia scores. After 1-year follow-up period, FEP individuals had a significant decrease in severity of anhedonia scores. In the FEP group, anhedonia showed significant, enduring (over time) correlations with impaired role functioning, negative symptoms, comorbid depression, poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits).Conclusions: Anhedonia is relevant in the early phase of psychosis and its severity is associated with functioning deterioration and a bad quality of life.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Anestesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| |
Collapse
|
38
|
Pelizza L, Pellegrini C, Quattrone E, Azzali S, Landi G, Pellegrini P, Leuci E. Suicidal Ideation in Patients Experiencing a First-episode Psychosis: Findings From the 2-Year Follow-up of the "Parma Early Psychosis" Program. Suicide Life Threat Behav 2020; 50:838-855. [PMID: 32048352 DOI: 10.1111/sltb.12625] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although suicide behavior is relevant in first-episode psychosis (FEP), little is known about suicidal ideation and its longitudinal stability. The aim of this study was (1) to assess incidence rates of suicide attempts, completed suicide, and suicidal thinking in FEP individuals at baseline and over a 24-month follow-up period; (2) to explore any significant association of suicidal ideation with psychopathology at baseline; and (3) to monitor longitudinally suicidal thinking along the 2-year follow-up. METHODS Participants (134 FEP patients, aged 13-54 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was also performed. RESULTS FEP patients showed a 31.3% percentage of suicidal ideation (i.e., BPRS item 4 cutoff score of ≥ 3) and a 2-year cumulative incidence rate of attempted suicide of 11%. No completed suicide was found. In the FEP total sample, suicidal thinking was positively correlated with general psychopathology (especially depression) and negative symptoms. CONCLUSIONS Suicidal ideation is relevant in FEP patients, supporting a routine monitoring of suicide risk during the baseline assessment of adolescents and adults with early psychosis.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Clara Pellegrini
- Department of Medicine and Surgery, Psychiatric Unit, Università di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
39
|
Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Pompili M, Raballo A. Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study. Schizophr Res 2020; 220:98-105. [PMID: 32249122 DOI: 10.1016/j.schres.2020.03.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. METHODS 273 young people (13-35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory - II Edition (BDI), and the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. RESULTS UHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS "Anhedonia" scores, and showed a negative correlation with all WHOQOL-BREF scores. CONCLUSIONS Suicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Bologna, Via Castiglione n.29, 40124 Bologna (BO), Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa n.1035, 00189 Rome, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Piazza Università n.1, 06123 Perugia (PG), Italy
| |
Collapse
|
40
|
Pelizza L, Landi G, Pellegrini C, Quattrone E, Azzali S, Pellegrini P, Leuci E. Negative symptom configuration in first episode Schizophrenia: findings from the "Parma Early Psychosis" program. Nord J Psychiatry 2020; 74:251-258. [PMID: 31762390 DOI: 10.1080/08039488.2019.1695286] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology. Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS).Materials and Methods: All 147 participants, aged 12-35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptom structure in the FES total sample.Results: A 2-factor model (i.e. "Expressive Deficits" and "Asociality" dimensions) was identified. Only "Expressive Deficits" domain had a significant negative correlation with baseline GAF score.Conclusions: This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Clara Pellegrini
- Psychiatric Unit, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| |
Collapse
|
41
|
Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Gebhardt E, Raballo A. Anhedonia in adolescents at ultra-high risk (UHR) of psychosis: findings from a 1-year longitudinal study. Eur Arch Psychiatry Clin Neurosci 2020; 270:337-350. [PMID: 31055617 DOI: 10.1007/s00406-019-01018-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/26/2019] [Indexed: 12/19/2022]
Abstract
Previous findings suggested deficits in pleasure experience in schizophrenia, but little is known in psychosis risk prodrome, especially in adolescence. Aim of this study was (1) to assess anhedonia in distinct help-seeking subgroups of adolescents identified through the ultra-high risk (UHR) criteria, (2) to explore any association of anhedonia with other psychopathological aspects in the UHR group, and (3) to monitor longitudinally the stability of anhedonia in UHR individuals across 1-year follow-up period. 123 participants (13-18 years) completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II, the Schizotypal Personality Questionnaire-Brief version, the Brief-O-LIFE questionnaire (BOL), and the Brief version of the World Health Organization Quality of Life scale (WHOQOL-BREF). Two different indexes of anhedonia were used: CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia levels between UHR and First Episode Psychosis (FEP) groups was found. UHR adolescents showed higher CAARMS and BOL anhedonia scores than non-UHR/FEP. After 1-year follow-up period, UHR adolescents had a significant decrease in severity only in CAARMS anhedonia subscores. In UHR subgroup, CAARMS anhedonia measures showed significant correlations with impaired role functioning and negative symptoms, while BOL anhedonia was significantly correlated with specific schizotypal personality traits concerning interpersonal deficits. Anhedonia is prominent in the psychosis prodrome, also in adolescence. Its severity is not statistically different from that of FEP adolescents and is related to more severe functioning impairment and a worse quality of life.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy.
- Department of Mental Health and Pathological Addiciton, Azienda USL di Parma, Strada del Quartiere n.2, c/o Centro "Santi", Via Vasari n.13, 43100, Parma, PR, Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Luigi R Chiri
- Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n.2, 43100, Parma, PR, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci n.14, 43100, Parma, PR, Italy
| | - Eva Gebhardt
- Melograno Medical Psychotherapy Centre, Via Saturnia n.4/a, 00183, Rome, Italy
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazza Università n.1, 06123, Perugia, PG, Italy
| |
Collapse
|
42
|
Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A, Pelizza L. Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis. Front Psychiatry 2020; 11:552282. [PMID: 33488412 PMCID: PMC7819871 DOI: 10.3389/fpsyt.2020.552282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/27/2020] [Indexed: 01/24/2023] Open
Abstract
Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group. Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status. Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect). Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).
Collapse
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Primary Care, Azienda Unità Sanitaria Locale (USL) di Parma, Parma, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale (USL) di Parma, Parma, Italy
| |
Collapse
|
43
|
Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. The "Reggio Emilia At-Risk Mental States" program: A diffused, "liquid" model of early intervention in psychosis implemented in an Italian Department of Mental Health. Early Interv Psychiatry 2019; 13:1513-1524. [PMID: 31270956 DOI: 10.1111/eip.12851] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/25/2019] [Accepted: 06/09/2019] [Indexed: 12/26/2022]
Abstract
AIM From September 2012, the Reggio Emilia Department of Mental Health developed a specific program (the "Reggio Emilia At-Risk Mental States" [ReARMS] protocol) as a diffused, "liquid" infrastructure for early intervention in psychosis. Aims of the current study are (a) to describe the ReARMS macroscopic organization and (b) to examine specific process indicators during the first 5 years of clinical activity. METHODS All participants (n = 300) were young help-seekers, aged 13 to 35 years, who completed the Comprehensive Assessment of At-Risk Mental States (CAARMS). RESULTS At baseline, 95 (31.7%) participants did not meet CAARMS-defined criteria, while 205 (68.3%) were offered a dedicated protocol of care: 154 (75.1%) of them were enrolled in the program, 19 (9.3%) refused and 32 (15.6%) dropped out during the first year of treatment. Individuals enrolled in the ReARMS protocol were mainly referred by general practitioners (33.3%), emergency room/general hospital (24%) or they were self-referred (15%). In comparison with ultra-high risk individuals, patients with first episode psychosis showed significantly higher mean age at entry and preponderance of males, as well as higher percentages of history of substance abuse and previous hospitalization. CONCLUSIONS An early intervention in psychosis service in Italian child/adolescent and adult mental health services are feasible and clinically relevant, also in adolescents, who have a high risk of falling through the child-adult service gap as they cross the transition boundary between services.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi R Chiri
- Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Sant'Andrea University of Perugia, Perugia, Italy
| |
Collapse
|
44
|
Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A. Suicidal Thinking and Behavior in Adolescents at Ultra-High Risk of Psychosis: A Two-year Longitudinal Study. Suicide Life Threat Behav 2019; 49:1637-1652. [PMID: 30932235 DOI: 10.1111/sltb.12549] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Suicide risk in subjects at Ultra-High Risk of psychosis (UHR) has been rarely assessed in adolescence, but it is of obvious importance for prognostic and clinical care reasons. In this study, we aimed to prospectively assess suicide risk and behaviors in UHR adolescents. METHOD We examined 112 help-seeking adolescents (13-18 years, 50% males, 83.9% Caucasian) that were enrolled in the Reggio Emilia At-Risk Mental States (ReARMS) project and followed up for 2 years. Specific items derived from the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II) were used to assess suicide risk. Suicide attempts and completed suicides were also recorded. RESULTS Baseline assessment detected 40 UHR adolescents, 32 FEP (first-episode psychosis), and 40 non-UHR/FEP. We found that 67.5% of UHR adolescents had suicidal ideation, and 18.5% to severe degree. Attempted suicide before enrollment was higher in the UHR group than in non-UHR/FEP peers (17.5% vs. 2.5%). BDI-II suicidal ideation severity was stable at 12-month follow-up and decreased at 24-month follow-up. CONCLUSIONS A high prevalence of suicidal ideation among UHR adolescents was found and supports the routine monitoring of risk of self-injurious thinking and behavior in this at-risk population.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL di Bologna, Bologna, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
| |
Collapse
|
45
|
Pelizza L, Paterlini F, Azzali S, Garlassi S, Scazza I, Pupo S, Simmons M, Nelson B, Raballo A. The approved Italian version of the comprehensive assessment of at-risk mental states (CAARMS-ITA): Field test and psychometric features. Early Interv Psychiatry 2019; 13:810-817. [PMID: 29696795 DOI: 10.1111/eip.12669] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
AIM The Comprehensive Assessment of At-Risk Mental States (CAARMS) was specifically developed to assess and detect young people at ultra-high risk (UHR) of developing psychosis. The current study was undertaken to test the reliability and validity of the authorized Italian version of the CAARMS (CAARMS-ITA) in a help-seeking population. METHODS Psychometric properties of the CAARMS-ITA were established using a sample of 223 Italian adolescents and young adults aged between 13 and 35 years, who were divided into 3 groups according to the CAARMS criteria: UHR-negative individuals (UHR [-]; n = 64), UHR-positive (UHR [+]; n = 55) and individuals with a first-episode psychosis (FEP; n = 104). The CAARMS-ITA's reliability was tested measuring interrater reliability and internal consistency. Construct validity was tested comparing the Positive and Negative Syndrome Scale (PANSS) and CAARMS-ITA subscale scores across groups (ie, UHR [-], UHR [+] and FEP). For concurrent validity, we studied correlations between symptoms of the CAARMS-ITA and their equivalents in the PANSS. Finally, the predictive validity was examined by following up with UHR [+] individuals. The 12-month transition rate to psychosis was calculated. RESULTS The CAARMS-ITA showed good interrater reliability. The PANSS "Positive Symptoms" subscale scores in UHR [+] individuals were intermediate between FEP and UHR [-] groups. The positive and negative symptoms scores of the CAARMS-ITA significantly correlated with the corresponding scores of the PANSS. After 12 months, 4 of 41 (9.8%) UHR [+] individuals had transitioned to psychosis. CONCLUSIONS The CAARMS-ITA is a reliable and valid instrument for assessing and detecting at-risk mental states in Italian clinical settings. It also appears to be helpful in the prediction of psychosis transition.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Magenta Simmons
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Raballo
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
46
|
Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Screening for psychosis risk among help-seeking adolescents: Application of the Italian version of the 16-item prodromal questionnaire (iPQ-16) in child and adolescent neuropsychiatry services. Early Interv Psychiatry 2019. [PMID: 29537131 DOI: 10.1111/eip.12554] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM The 16-item Prodromal Questionnaire (PQ-16) is a versatile screen tool for routine screening of at-risk individuals. We wished to evaluate the psychometric properties of the Italian version of the PQ-16 (iPQ-16) in a sample of 72 help-seeking adolescents (age range 13-17 years) referred to child and adolescent neuropsychiatry services for diagnostic assessment. METHODS Participants who completed iPQ-16 were subsequently interviewed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) to confirm the psychosis high risk state. We then examined the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values [PPV e NPV]) and concurrent validity between iPQ-16 and CAARMS using Cronbach's alpha and Cohen's kappa. We also tested the validity of the adopted iPQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the 1-year predictive validity of the iPQ-16. RESULTS Overall, the psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 showed high internal consistency (Cronbach's alpha = .827) and acceptable diagnostic accuracy (77% sensitivity, 72% PPV) and concurrent validity (Cohen's k = 0.309). ROC analyses pointed to iPQ-16 total distress score of ≥10 as best cut-off. CONCLUSION The iPQ-16 is a reliable and valid instrument for routine screening of at-risk individuals in Italian neuropsychiatry services.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Bologna Public Health Centre, Bologna, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Andrea Raballo
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
47
|
Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Gebhardt E, Pupo S, Andrea R. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Eur Child Adolesc Psychiatry 2019; 28:957-971. [PMID: 30506419 DOI: 10.1007/s00787-018-1262-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2018] [Indexed: 12/25/2022]
Abstract
The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13-18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.
Collapse
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy.
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, AUSL di Bologna, Bologna, Italy
| | - Eva Gebhardt
- Cmed Polyspecialistic Diagnostic and Therapeutic Centre, Rome, Italy
| | - Simona Pupo
- Intensive Care Unit, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raballo Andrea
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
48
|
Pelizza L, Raballo A, Semrov E, Chiri LR, Azzali S, Scazza I, Garlassi S, Paterlini F, Fontana F, Favazzo R, Pensieri L, Fabiani M, Cioncolini L, Pupo S. Validation of the "early detection Primary Care Checklist" in an Italian community help-seeking sample: The "checklist per la Valutazione dell'Esordio Psicotico". Early Interv Psychiatry 2019; 13:86-94. [PMID: 28745012 DOI: 10.1111/eip.12455] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/07/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND To establish the concordant validity of the "Checklist per la Valutazione dell'Esordio Psicotico" (CVEP) in an Italian help-seeking population. The CVEP is the Italian adaptation of the "early detection Primary Care Checklist," a 20-item tool specifically designed to assist primary care practitioners in identifying young people in the early stages of psychosis. METHODS The checklist was completed by the referring practitioners of 168 young people referred to the "Reggio Emilia At Risk Mental States" Project, an early detection infrastructure developed under the aegis of the Regional Project on Early Detection of Psychosis in the Reggio Emilia Department of Mental Health. The concordant validity of the CVEP was established by comparing screen results with the outcome of the "Comprehensive Assessment of At Risk Mental States" (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis. RESULTS The simple checklist as originally conceived had excellent sensitivity (98%), but lower specificity (58%). Using only a CVEP total score of 20 or above as cut-off, the tool showed a slightly lower sensitivity (93%) with a substantial improvement in specificity (87%). Simple cross-tabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant item in terms of sensitivity and specificity were carried out. CONCLUSIONS In comparison to other, much longer, screening tools, the CVEP performed well to identify young people in the early stages of psychosis. Therefore, the CVEP is well suited to optimize appropriate referrals to specialist services, building on the skills and knowledge already available in primary care settings.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Andrea Raballo
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,NORMENT and Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Enrico Semrov
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Departmnent of Mental Health and Addiction, Bologna Public Health Centre, Bologna, Italy
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Francesca Fontana
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Rosanna Favazzo
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Luana Pensieri
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Michela Fabiani
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Leonardo Cioncolini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Simona Pupo
- Guastalla Civil Hospital, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| |
Collapse
|
49
|
Pelizza L, Azzali S, Garlassi S, Paterlini F, Scazza I, Chiri LR, Pupo S, Raballo A. Adolescents at ultra-high risk of psychosis in Italian neuropsychiatry services: prevalence, psychopathology and transition rate. Eur Child Adolesc Psychiatry 2018; 27:725-737. [PMID: 29058115 DOI: 10.1007/s00787-017-1070-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022]
Abstract
Studies in adolescents on ultra-high risk (UHR) and basic symptoms (BS) criteria for psychosis prediction are scarce. In Italy, early interventions in psychosis are less widespread than in other European countries. In the present study, we (1) assessed the clinical relevance of a UHR diagnosis [according to the comprehensive assessment of at-risk mental states (CAARMS) criteria] to promote the implementation of specific services for UHR adolescents into the Italian health care system; (2) described severity of positive, negative, general, and basic symptoms in UHR adolescents compared to adolescents with first-episode psychosis (FEP) and non-UHR adolescents (i.e., individuals who did not meet CAARMS criteria for UHR or FEP); and (3) investigated the predictive validity of UHR criteria in relation to BS criteria. Seventy-nine adolescents (aged 13-18 years) were assessed with the CAARMS, the positive and negative syndrome scale (PANSS), and the schizophrenia proneness instrument, child and youth version (SPI-CY). Both UHR (n = 25) and FEP (n = 11) had significantly higher PANSS subscale scores compared to non-UHR (n = 43). UHR had significantly lower PANSS-positive symptom scores than FEP, but similar global functioning and PANSS-negative symptoms and general psychopathology scores. Compared to non-UHR, both FEP and UHR had more severe thought and perception BS disturbances, and significantly more often met BS criteria. After 12 months, 2 of 20 (10%) UHR had transitioned to psychosis. They also met both BS criteria. Given the uncertain outcome of UHR adolescents, future research is needed to determine whether the combined assessment of BS with UHR symptoms can improve the accuracy of psychosis prediction in adolescence.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy.
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Addiction, Bologna Public Health Care Centre, Bologna, Italy
| | - Simona Pupo
- Reggio Emilia Public Health Care Centre, Guastalla Civil Hospital, Guastalla, RE, Italy
| | - Andrea Raballo
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
- Department of Psychology and Development, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
50
|
Pelizza L, Azzali S, Paterlini F, Scazza I, Garlassi S, Chiri LR, Poletti M, Pupo S, Raballo A. The Italian Version of the Brief 21-Item Prodromal Questionnaire: Field Test, Psychometric Properties and Age-Sensitive Cut-Offs. Psychopathology 2018; 51:234-244. [PMID: 30032134 DOI: 10.1159/000490708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Brief, 21-item version of the Prodromal Questionnaire (PQ-B) is a promising screener for psychosis-risk states that could be implemented in routine clinical practice. In this study, we assessed psychometric properties of the Italian version of the PQ-B (iPQ-B) in a sample of 243 help-seekers, aged 13-35 years. SAMPLING AND METHODS After completing the iPQ-B, participants were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS). Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values [PPV and NPV], positive and negative likelihood ratios) and concurrent validity between PQ-B and CAARMS were determined using Cronbach's alpha and Cohen's kappa. We also tested the validity of the adopted PQ-B cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the predictive validity of the iPQ-B at 1-year follow-up. RESULTS The iPQ-B showed high internal consistency (Cronbach's alpha = 0.868), acceptable diagnostic accuracy and concurrent validity (70% sensitivity, 67% specificity, 81% PPV, Cohen's kappa = 0.335). ROC analyses pointed to threshold of ≥20 on the PQ-B total distress score as best cut-off. After 12 months of follow-up, 11% of participants who scored ≥4 on the PQ-B distressing item total score and did not meet CAARMS psychosis criteria at baseline, developed a psychotic disorder. Interestingly, age had significant negative correlations with iPQ-B scores and adolescents (aged < 18 years) showed higher iPQ-B scores than young adults. CONCLUSIONS Overall, the psychometric properties of the iPQ-B were satisfactory. As iPQ-B scores appeared inversely associated to age, age-tailored cut-off scores are recommended for screening purposes in child-adolescent cohorts.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Bologna Public Health Care Centre, Bologna, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Reggio Emilia Public Health Care Centre, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Reggio Emilia Public Health Care Centre, Guastalla, Italy
| | - Andrea Raballo
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Bygg 12, 318, Dragvall, Trondheim, Norway.,Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Santa Maria della Misericordia, Edificio Ellisse, Sant'Andrea delle Fratte, Perugia, Italy
| |
Collapse
|