[Delirium in the "young" covid-19 patient (<65 years): preliminary clinical indications]

Delirium is a phenomenon classified within neuro-cognitive disorders in the DSM-5. It has several etiologies and it is often lethal. This contribute aims at analyzing clinical characteristics and diagnostic possibilities of delirium in patients affected by covid-19. Furthermore, some preliminary recommendations on the use of psychopharmacological treatment of delirium and their interactions with main drugs used to treat covid-19 are given, with a special attention to comorbidities like in immunocompromised patients, in those affected by diabetes and cancer, in pregnant women or in addicted clients.

Electroencephalographic (EEG) alterations in young women with high subclinical eating pathology levels: a quantitative EEG study

PURPOSE

To explore electroencephalographic (EEG) alterations in young women with different eating disorder (ED) psychopathology levels.

METHODS

Thirty-seven young women completed general and ED psychopathology (i.e., the ED Examination Questionnaire; EDE-Q) measures. EEG power spectra data were investigated in two conditions: (a) 5 min of resting state (RS) and (b) 5 min of RS after a single taste of a milkshake (ML-RS). EEG analyses were performed using exact Low-Resolution Electromagnetic Tomography software (eLORETA).

RESULTS

Cluster analysis performed on the EDE-Q responses revealed a group of 17 women with high levels of ED pathology falling into the subclinical (i.e., sub-threshold) EDs category and a group of 20 women with low levels of ED pathology (controls). In the RS conditions, no significant modifications were observed between groups. Compared to controls, women with subclinical EDs showed an increase in theta activity in the parieto-occipital areas in the ML-RS condition. After controlling for body mass index and general psychopathology, theta activity in these brain structures was positively associated with EDE-Q global and subscale (restraint, shape and weight concern) scores.

CONCLUSIONS

Our results may reflect the neurophysiological substrate of ED psychopathology core features like shape/weight concerns. Previous brain imaging and qEEG studies with full-syndrome ED patients also underscored the involvement of parieto-occipital areas in ED pathophysiology. These studies also found brain alterations in the RS condition, not observed here. This is notable given that full-syndrome and subclinical EDs are considered as different manifestations of the same disease along a severity spectrum.

LEVEL OF EVIDENCE

Level V, cross-sectional, electroencephalographic, descriptive study.

Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth

A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M _age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.

Agreement between DSM-IV and DSM-5 criteria for alcohol use disorder among outpatients suffering from depressive and anxiety disorders

BACKGROUND AND OBJECTIVES

Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD).

METHODS

We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders.

RESULTS

Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from -1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80).

DISCUSSION AND CONCLUSIONS

DSM-5 criteria did not inflate AUD rates.

SCIENTIFIC SIGNIFICANCE

Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53-56).

[Sexual abuse in adulthood: when psychic and somatic suffering merge]

Sexual abuse is a traumatic event with heavy consequences in terms of clinical implications and quality or quantity of life. The mediation of the development of post-traumatic stress disorder accounts for many of the presented symptoms, but not for the whole range of them, especially if violence is suffered during childhood. From the analysis of its epidemiology and consequences, it can be derived that this disorder is dramatically widespread and cannot be any longer ignored but preventive efforts and early intervention are required. Current therapeutic options that have been proven to be effective are discussed, though further research is warranted to improve treatment strategies.

[Child sexual abuse: an irremediable hurt?]

The aim of this review was to provide the state of art of child sexual abuse and its psychophysical consequences. We assessed the evidence-based literature derived from PubMed, Embase, Medline, PsychINFO databases, including a thorough analysis of what has been published in the last 5 years, not neglecting previous publications essential to the argument for their scientific validity (methodological accuracy, recruited survey). Child sexual abuse is ubiquitous both regarding victims' gender and socio-economic conditions. The important consequences linked to what they suffered--either immediately or with adolescent or adult onset--are mediated by age and family support to trauma reprocessing as well as by the frequency of repetition of the abuse or familiarity with the abuser. These factors appear to be of primary importance--both at a physical and psychic level--and may be expressed in multiple manifestations, hence it is of utmost importance to pay timely attention to possible alarm signals revealing suspected abuse suffered by any underage person. Special emphasis is addressed towards some of the consequences for which child sexual abuse is considered to be a primary cause (e.g. post-traumatic stress disorder) and the perpetuation of such abuse, both short-term as well as long-term. Poor training, regarding this field, of various professionals (pediatricians, teachers, etc.) who each day work with minors, as well as the paucity of available treatment options point to an urgent need for prevention (including in-depth diagnosis/therapy) and early intervention.

[Violence in psychiatric inpatients]

AIM

To evaluate knowledges about violence acted by psychiatric in-patients.

METHODS

We selected inherent articles classified as useful to our purpose encoded in PubMed in the last 5 years, not neglecting previous but equally valid for a more precise and complete reasoning EBM Literature.

RESULTS

Risk factors for violent acts are: previous acts history, male sex and young age, alcohol and drug abuse/dependence, lack of insight, anger management problems, impulsivity discontrol and ostility at admission. Most of the acts are classified as impulsive and so schizophrenic spectrum whether in presence of productive symptoms, personality disorders and manic episodes are the most involved psychiatric pathology. Clinical experience evaluating behaviour at risk as threatening or provoking acts towards patients or clinical staff and the identification of personal history features (in particular if detected at admission) should lead to the classification of patients into risk groups for acting violence during hospitalization.

CONCLUSIONS

Good clinical practice aimed at violent acts reduction and possible prevention into clinical environment couldn't leave aside a precise known risk factors identification and the observation and constant monitorization of patients behaviour predictive of a possible act.

[Stroke and psychiatric disorders]

AIMS

To define the prevalence of depression, anxiety, aggressiveness and personality disorders in a cohort of stroke survivors; to identify demographic and clinical factors associated with psychiatric disorders.

METHODS

The sample included patients admitted during the period 01.01.2000-31.12.2001 for a stroke and giving informed consent for a direct interview. The interview included an anamnestic and clinical evaluation, the Mini Mental State Examination, the Hamilton Rating Scale for Depression and Anxiety, the Modified Overt Aggression Scale and the Structured Clinical Interview for DSM-IV-TR.

RESULTS

Depression was present in 27% of cases (mild 14.6%, moderate 4.9%, severe 7.3%), anxiety in 12% and personality disorders in 10.2% (no cases reported aggressiveness). Patients with a positive psychopathology profile were at higher risk of depression and anxiety. No correlation was found between psychiatric disorders and other demographic and clinical variables, including stroke characteristics and severity. CONCLUSIONS; Psychiatric disorders, mostly depression, are fairly common in stroke survivors. Depression and anxiety are significantly correlated to the patient's psychopathological profile. There is no significant association between psychiatric disorders and stroke characteristics and severity.