Showing papers by "Andrea Fiorillo published in 2022"

COVID-19-Related Social Isolation Predispose to Problematic Internet and Online Video Gaming Use in Italy

Abstract: COVID-19 pandemic and its related containment measures have been associated with increased levels of stress, anxiety and depression in the general population. While the use of digital media has been greatly promoted by national governments and international authorities to maintain social contacts and healthy lifestyle behaviors, its increased access may also bear the risk of inappropriate or excessive use of internet-related resources. The present study, part of the COVID Mental hEalth Trial (COMET) study, aims at investigating the possible relationship between social isolation, the use of digital resources and the development of their problematic use. A cross sectional survey was carried out to explore the prevalence of internet addiction, excessive use of social media, problematic video gaming and binge watching, during Italian phase II (May–June 2020) and III (June–September 2020) of the pandemic in 1385 individuals (62.5% female, mean age 32.5 ± 12.9) mainly living in Central Italy (52.4%). Data were stratified according to phase II/III and three groups of Italian regions (northern, central and southern). Compared to the larger COMET study, most participants exhibited significant higher levels of severe-to-extremely-severe depressive symptoms (46.3% vs. 12.4%; p < 0.01) and extremely severe anxiety symptoms (77.8% vs. 7.5%; p < 0.01). We also observed a rise in problematic internet use and excessive gaming over time. Mediation analyses revealed that COVID-19-related general psychopathology, stress, anxiety, depression and social isolation play a significant role in the emergence of problematic internet use, social media addiction and problematic video gaming. Professional gamers and younger subjects emerged as sub-populations particularly at risk of developing digital addictions. If confirmed in larger and more homogenous samples, our findings may help in shedding light on possible preventive and treatment strategies for digital addictions.

The Relationship Between Mental Pain, Suicide Risk, and Childhood Traumatic Experiences: Results From a Multicenter Study.

Abstract: Objective: Mental pain and exposure to maltreatment are significant risk factors for suicidal behavior. This study aimed to investigate whether mental pain could be associated with a recent suicide attempt and whether it could mediate the relationship between childhood traumatic experiences and suicide risk in psychiatric patients. Methods: A multicenter observational study was organized as a joint project with representatives of numerous mixed Italian academic and clinical settings. Between December 2017 and March 2020, batteries of tests were administered to patients, assessing suicidal ideation and behavior, mental pain (usual and worst mental pain in the past 15 days), depression, and childhood maltreatment. Results: A total of 2,137 psychiatric patients (1,313 women and 824 men) were included in the final sample, and 315 reported having attempted suicide in the last 3 months. Suicide attempters (compared to nonattempters) had higher odds of reporting worse mental pain (odds ratios [ORs] between 1.02 and 1.17; P < .001) and suicidal intent with/without a specific plan (ORs between 11.57 and 11.77; P < .001). They also had higher odds of having a personality disorder (borderline personality disorder: ORs between 2.65 and 3.01; P < .001; other personality disorders: ORs between 1.96 and 2.28; P < .01) and major depression (ORs between 1.62 and 1.70; P < .05). Childhood trauma was associated with suicide risk directly (standardized effects between 0.06 and 0.07; P < .01) and indirectly through mental pain (usual mental pain: standardized indirect effect = 0.11, P < .001; worst mental pain in the past 15 days: standardized indirect effect = 0.12, P < .001). Conclusions: Mental pain constitutes a crucial framework for assessing the individual need for psychiatric help. Assessing mental pain allows identification of the main ingredient of suicide risk and puts the clinician in a strategic position to unlock some motives behind the wish to die. Further research is needed to learn if childhood adversities may interact with adult mental pain and thus foster suicide risk.

High depression symptomatology and mental pain characterize suicidal psychiatric patients

Abstract: Abstract Background Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered. Methods 2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk. Results More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments. Conclusions Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.

Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction

Abstract: Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety.This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis.READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety.This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions.

Mental health in transgender individuals: a systematic review

Abstract: Abstract Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders’ prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.

The Psychiatric Consequences of Long-COVID: A Scoping Review

Abstract: The COVID-19 pandemic has represented a new form of traumatic event, affecting the general population worldwide and causing severe disruption of daily routine. A new urgent concern is related to the burden associated with COVID-19 symptoms that persist beyond the onset of infection, the so-called long-COVID syndrome. The present paper aims to: (1) describe the most frequent psychiatric symptoms reported by patients affected by long-COVID syndrome; (2) evaluate methodological discrepancies among the available studies; (3) inform clinicians and policy-makers on the possible strategies to be promoted in order to manage the psychiatric consequences of long-COVID syndrome. Twenty-one papers have been included in the present review, mostly with a cross-sectional or cohort design. Significant heterogeneity of long-COVID syndrome definitions was found. The presence of psychiatric symptoms was evaluated with very different assessment tools. The most common psychiatric symptoms of the long-COVID syndrome included fatigue, cognitive disturbances/impairment, depression, and anxiety symptoms. The rate of fatigue varied from 93.2–82.3% to 11.5%, cognitive impairment/cognitive dysfunction from 61.4% to 23.5% and depressive-anxiety symptoms from 23.5%to 9.5%.

Using sport-based interventions for people with severe mental disorders: results from the European EASMH study

Abstract: Abstract People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.

Barriers in care pathways and unmet mental health needs in LGBTIQ + communities

Abstract: Abstract Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.

Trait-Related Impulsivity, Affective Temperaments and Mood Disorders: Results from a Real-World Multicentric Study

Abstract: Trait-related impulsiveness is highly prevalent in patients with mood disorders, being associated with negative outcomes. The predictive role of affective temperaments on trait-related impulsivity is still understudied. The aim of the present study is to investigate the relationship between impulsivity and affective temperaments in a sample of euthymic patients with mood disorders. This is a real-world multicentric observational study, carried out at the outpatient units of seven university sites in Italy. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego and the Barratt Impulsiveness Scale. The study sample included 653 participants, mainly female (58.2%), with a mean age of 46.9 (±14.1). Regression analyses showed that higher levels of trait-related impulsivity were associated to suicide attempts (p < 0.000), the presence of psychotic symptoms during acute phases (p < 0.05), a seasonal pattern (p < 0.05), a lower age at onset of the disorder (p < 0.05), cyclothymic (p < 0.01) and irritable temperaments (p < 0.01). The results of our study highlight the importance to screen patients with mood disorders for impulsivity and affective temperaments in order to identify patients who are more likely to present a worse outcome and to develop personalized and integrated early pharmacological and psychosocial treatment plans. Novelties of the present paper include the recruitment of patients in a stable phase, which reduced possible bias in patients’ self-reports, and the multicentric nature of the study, resulting in the recruitment of a large sample of patients with mood disorders, geographically distributed across Italy, thus improving the generalizability of study results.

Self-harm and suicidality among LGBTIQ people: a systematic review and meta-analysis

Abstract: Abstract Research evidence has consistently documented a higher risk of suicidality in the Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) population. This systematic review and meta-analysis aimed to report a detailed description of research data regarding the risk of Attempted Suicide (SA), Suicide Ideation (SI), and Non-Suicidal Self-Injury (NSSI) behaviours for LGBTIQ people and their subgroups. Medline, Scopus, PsycINFO, and EMBASE were searched for studies reporting a comparative estimation of SA, SI, and NSSI rates among LGBTIQ population and the general population (i.e. heterosexual/cisgender), without restrictions on participants’ age and setting for the enrolment. Pooled analyses were based on odds ratios (ORs, with 95% CIs), estimated through inverse variance models with random effects. Fifty studies were selected for the quantitative synthesis and included fifty samples involving 3.735.601 controls and 87.252 LGBTIQ people. LGBTIQ people reported an increased risk of SA (OR:4.36[95%CI:3.32;5.71]), SI (OR:3.76[95%CI:3.02;4.69]), and NSSI (OR:4.24[95%CI:3.23;5.55]). Among LGBTIQ subgroups, the Bisexual group has shown the highest risk of suicidality (SA, OR:6.71; SI, OR:5.04; NSSI, OR: 5.03), followed by the Lesbian-Gay for attempted suicide (SA, OR:6.03), and the Transgender-Intersex-Queer for suicide ideation and non-suicidal self-injury (SI and NSSI, OR:3.42). The quality of the evidence ranged from low to moderate. Our findings have shown that LGBTIQ people report a higher risk of suicidality compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQI mental health needs and suggest supportive strategies as well as preventive interventions (e.g. supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity and mortality in this at-risk population.

Use of social network as a coping strategy for depression among young people during the COVID-19 lockdown: findings from the COMET collaborative study

Abstract: Abstract Background Use of social media (SM) has exponentially grown particularly among youths in the past two years, due to COVID-19-related changing lifestyles. Based on the Italian COvid Mental hEalth Trial (COMET), we investigated the association between SM use and depressive symptoms among Italian young adults (aged 18–24). Methods The COMET is a nationwide multi-center cross-sectional study that investigated socio-demographic data, social networking addiction (BSNAS), depression, anxiety, and stress (DASS-21), as well as impulsiveness (BIS-15) and aggressiveness (AQ) in a large sample of youngsters, in order to assess the association between BSNAS and DASS-21 indices. Mediation analyses were performed to evaluate the role of impulsiveness and aggressive personality traits in the association between SM use (SMU) and depression. Results 75.8% of the sample ( n = 491) had a problematic SMU. SMU was reduced by high AQ and high DASS-21 scores ( F = 42.338, p < 0.001, R 2 = 0.207). Mediation analyses showed that SMU negatively predicted depressive symptomatology with the interaction mediated by AQ total ( ß = − 0.1075), physical ( ß = − 0.207) and anger ( ß = − 0.0582), BIS-15 total ( ß = − 0.0272) and attentional ( ß = − 0.0302). High depressive levels were predicted by high AQ scores, low SMU levels, low verbal and physical AQ, and low attentional BIS-15 ( F = 30.322, p < 0.001, R 2 = 0.273). Depressive symptomatology negatively predicted SMU with their interaction mediated by AQ total ( ß = − 0.1640), verbal ( ß = 0.0436) and anger ( ß = − 0.0807), BIS-15 total ( ß = − 0.0448) and attentional ( ß = − 0.0409). Conclusions SMU during the early phases of the COVID-19 pandemic could have a beneficial role in buffering negative consequences linked to social isolation due to quarantine measures, despite this association being mediated by specific personality traits.

Medium and long‐term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real‐world, multicentric study

Abstract: This study aims to explore the long‐term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post‐intervention in terms of improvement of: (1) patients’ symptoms and global functioning and (2) relatives’ objective and subjective burden and coping strategies.

Does antenatal depression predict post-partum depression and obstetric complications? Results from a longitudinal, long-term, real-world study

Abstract: Background Main aims of the present paper are to: (1) assess the prevalence of antenatal depression (AD) and identify its predictors; (2) analyse the impact of AD on obstetric outcomes and on the incidence of post-partum depression. Methods All pregnant women referring to the Gynecology and Obstetrics inpatients unit of the University of Campania “Luigi Vanvitelli” were invited to participate. Upon acceptance, women completed the Italian version of the Edinburgh Postnatal Depression Scale and an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women were assessed at each trimester of pregnancy, immediately after the childbirth and after one, three, 6 and 11 months. Results 268 pregnant women were recruited, with a mean of 32.2 (±5.81) years. Ninety-seven women (36.2%) reported the presence of depressive symptoms during pregnancy. Predictors of AD were personal history of depression, a family history for depressive disorders and problematic relationships with the partner. The presence of AD was associated to a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, labor induction and admission of the new-born into neonatal intensive care unit. Mothers with antenatal depression are less likely to natural breastfeed. Lastly, antenatal depression was a risk factor for higher EPDS scores at follow-ups. Conclusions Our results support the idea that women should be screened during pregnancy and post-partum for the presence of depressive and anxiety symptoms. Health professionals should be adequately trained to detect psychiatric symptoms during pregnancy.

Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial

Abstract: Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p < .001) and of the walking MET (OR: 7.68; p < .001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p < .05) and to reduce that of junk food (OR:0.23; p < .05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.

PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: a naturalistic, longitudinal, multicenter study

Abstract: Abstract The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.

Mental health for LGBTQI people: a policies' review

Abstract: Abstract The mental health of lesbian, gay, bisexual, transgender, queer, intersexual (LGBTQI) individuals is significantly influenced by many factors such as difficulties in coming-out, poor acceptance, isolation and discrimination as well as minority-related stress. LGBTQI individuals, in fact, show a significant higher risk of mental health conditions, substance- use disorders and suicide. In addition, mental health services access may be difficult for personal and social barriers as well as a lack of adequate and specific mental health support. This review aims to assess and describe international policies, guidelines, position statements and recommendations regarding the promotion and protection of mental health rights for LGBTQI people. The search has been focussed on peer-reviewed papers, Governmental and Mental Health Association- Guidelines and Position Statements, Health Agencies - Guidelines and Position Statements (with a specific focus on mental health), LGBTQI Alliances and Foundations Publishing (with a specific focus on mental health). In addition, relevant international initiatives, and projects in the field of LGBTQI mental health will be described.

The Short-Term Consequences of COVID-19 on Mental Health: State of the Art from Available Studies

Abstract: Since the outbreak of the COVID-19 pandemic, the consequences on mental health have been found to be considerable, with potential effects on the general population and in high-risk groups, with a variety of physiopathological mechanisms [...].

Impact of clinical decision-making participation and satisfaction on outcomes in mental health practice: results from the CEDAR European longitudinal study

Abstract: Abstract The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients’ satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study ‘Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)’, a longitudinal observational study, funded by the European Commission and carried out in six European countries. Patients’ inclusion criteria were: (a) aged between 18 and 60 years; (b) diagnosis of a severe mental illness of any kind according to the Threshold Assessment Grid (TAG) ≥ 5 and duration of illness ≥ 2 years; (c) expected contact with the local mental health service during the 12-month observation period; (d) adequate skills in the language of the host countries; and (e) the ability to provide written informed consent. The clinical decision-making styles of clinicians and the patient satisfaction with decisions were assessed using the Clinical Decision Making Style and the Clinical Decision Making Involvement and Satisfaction scales, respectively. Patients were assessed at baseline and 1 year after the recruitment. The sample consisted of 588 patients with severe mental illness, mainly female, with a mean age of 41.69 (±10.74) and a mean duration of illness of 12.5 (±9.27) years. The majority of patients were diagnosed with psychotic (45.75%) or affective disorders (34.01%). At baseline, a shared CDM style was preferred by 70.6% of clinicians and about 40% of patients indicated a high level of satisfaction with the decision and 31% a medium level of satisfaction. Higher participation in clinical decisions was associated with improved social functioning and quality-of-life, and reduced interpersonal conflicts, sense of loneliness, feelings of inadequacy, and withdrawal in friendships after 1 year (p < 0.05). Moreover, a higher satisfaction with decisions was associated with a better quality-of-life (p < 0.0001), reduced symptom severity (p < 0.0001), and a significantly lower illness burden associated with symptoms of distress (p < 0.0001), interpersonal difficulties (p < 0.0001), and problems in social roles (p < 0.05). Our findings clearly show that a higher involvement in and satisfaction of patients with clinical decision-making was associated with better outcomes. More efforts have to be made to increase the involvement of patients in clinical decision-making in routine care settings.

Undergraduate psychiatric education: current situation and way forward – CORRIGENDUM

Abstract: [This corrects the article DOI: 10.1192/bji.2021.48.].

Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries

Abstract: Abstract Background While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice. Results SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.

The biopsychosocial model of schizophrenia and cancer: Unraveling the etiopathogenesis of complex diseases

Abstract: Schizophrenia and cancer are complex disorders causing severe impairment and premature mortality. They both include a wide range of different illnesses, with different symptoms, course, and outcome. Although the causes of schizophrenia remain largely unknown, research into the etiopathogenesis of cancer has led to clarify its main genetic and environmental factors [1]. Our understanding of the etiopathological mechanisms of schizophrenia is still far from being conclusive. It is now conceptualized as a neurodevelopmental disorder, lying on a continuum, from mild psychotic experiences observed in the general population to frank psychotic episode. Our diagnosis of schizophrenia is mainly based on non-observable signs and symptoms reported by patients, that are associated with various degrees of disability and that last for at least 6 months [2]. One of the most accepted theories of schizophrenia is the stress-vulnerability model [3], according to which psychotic symptoms would be based on a genetic or biological vulnerability, and triggered by stressful environmental factors [4]. This model is based on the biopsychosocial model of modern medicine. Cancer follows a similar pathway. Several genetic loci have been identified to be responsible for the liability to the illness, and several biological (e.g., hormones), social (e.g., education), environmental (e.g.,

Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions

Abstract: Abstract Background The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. Methods This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. Results 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. Conclusions The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study

Abstract: Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2–3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771–0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.

Why lithium should be used in patients with bipolar disorder? A scoping review and an expert opinion paper

Abstract: ABSTRACT Introduction Lithium treatment is considered the gold standard for the long-term management of bipolar disorder and recurrent unipolar depression. It is also extremely effective in other psychiatric conditions characterized by impulsivity and aggression, and for the prevention of suicidal behaviours. Areas covered This paper provides a scoping review and an expert commentary regarding the use of lithium in adult patients. Available information about efficacy, tolerability, dosing, and switching is analyzed, and the strategies that may be most useful in real-world clinical settings are highlighted. Expert opinion Lithium is effective on different domains of bipolar disorder, including the long-term prevention of recurrences of affective episodes, management of acute mania as well as in the prophylaxis of all affective episodes. Lithium has been defined a ‘forgotten drug,’ since its use in routine clinical practice has been declined over the last 20 or 30 years. Reasons for this trend include lack of adequate training on the management of lithium side effects. Considering its efficacy, use of lithium in ordinary clinical practice should be promoted. Several strategies, such as using slow-release formulations, can be easily implemented in order to minimize lithium side effects and improve its tolerability profile.

Does the Brain Matter? Cortical Alterations in Pediatric Bipolar Disorder: A Critical Review of Structural and Functional Magnetic Resonance Studies.

Abstract: BACKGROUND Pediatric bipolar disorder (PBD) is associated with significant psychosocial impairment, high use of mental health services and a high number of relapses and hospitalization. Neuroimaging techniques provide the opportunity to study the neurodevelopmental processes underlying PBD, helping to identify the endophenotypic markers of illness and early biological markers of PBD. OBJECTIVE The aim of the study is to review available studies assessing structural and functional brain correlates associated with PBD. METHODS PubMed, ISI Web of Knowledge and PsychINFO databases have been searched. Studies were included if they enrolled patients aged 0-18 years with a main diagnosis of PBD according to ICD or DSM made by a mental health professional, adopted structural and/or functional magnetic resonance as the main neuroimaging method, were written in English and included a comparison with healthy subjects. RESULTS Of the 400 identified articles, 46 papers were included. Patients with PBD present functional and anatomic alterations in structures normally affecting regulations and cognition. Structural neuroimaging revealed a significant reduction in gray matter, with cortical thinning in bilateral frontal, parietal and occipital cortices. Functional neuroimaging studies reported a reduced engagement of the frontolimbic and hyperactivation of the frontostriatal circuitry. CONCLUSION Available studies on brain connectivity in PBD patients potentially indicate less efficient connections between regions involved in cognitive and emotional functions. A greater functional definition of alteration in brain functioning of PBD patients will be useful to set up a developmentally sensitive targeted pharmacological and non-pharmacological intervention.

Editorial: Mortality of people with severe mental illness: Causes and ways of its reduction

Abstract: COPYRIGHT © 2022 Luciano, Pompili, Sartorius and Fiorillo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Mortality of people with severe mental illness: Causes and ways of its reduction