Narcissistic Personality Disorder (NPD) has a prevalence of 6,2% on general population, with greater rates for men (7,7%) than women (4,8%). It has been frequently associated with substance misuse, Bipolar Disorder (type I and II), anxiety and other personality disorders, but seldom it has been associated with Major Depressive Disorder.

The emphasis put on sex by elder people with NPD hasn't been widely studied in Literature. Frustration on the maintenance of a fixed rate of weekly sexual intercourse with their partners has led to a MDD in two outpatients that, for this reason, came to our Community Mental Health Center (CMHC).

Find if the supposed relation between certain Life Events for people with a well-controlled NPD can lead to a MDD can be detected.

Both completed the Minnesota Multiphasic Personality Inventory (MMPI-II) that confirmed the co-existence.

Diagnostically, these patients presented an exaggerated self-appraisal even during the depressive phases, attempts to gain others’ approval and attention, very little interest on others’ thoughts and efforts to gain personal advantages in a depressive frame.

This report suggest the necessity of further studies on the relation between NPD and MDD when a kind of frustration in important fields of patients’ life occurs.

The Compulsory Health Treatment (TSO) is an action applicable in case of justified need and clinic emergency, in presence of the refusal to Health Treatment Volunteer (TSV) in a subject suffering from specific illnesses, among which there are severe psychiatric illnesses.

The TSO is the subject of discussion, because it's actually an action that violates – even if only temporarily – the free will of the person. It's a procedure justified by the impossibility of applying alternative practices that ensure a speedy recovery to the subject of his psychic integrity, consistent with the need of the person.

The aim of this study is to evaluate the epidemiology of TSO in Trieste between 2011 and 2013.

This retrospective study was conducted on 74 TSO performed at the CMHC and the Emergency Unit of Trieste, on 71 people (22 women, 49 men). Data analysis were on gender, diagnosis, TSO's days' number, frequency and significant changes during the TSO, with a comparison of these variables between the data of 2011, 2012 and 2013.

The number of people under TSO was the same in the three years, with a countertrend of gender (decrease of 30% of women; increase of 46% of men). There was a decrease about days of TSO in the three years.

It's necessary to implement practices that promote good cooperation from the subject, to establish a contractuality which allows to limit TSO only for time strictly necessary.

A review of the literature shows that the self-injurious behaviours are more common among females, and suicides among male subjects. A significant difference between the two genders is also reflected in the choice of means used to commit the act of self-injuring, considering the male gender predilection for more violent means.

Some recent studies indicate trends that deviate from the above data in the literature or indicate a tendency to an attenuation of these differences.

Reasons for engaging in self-harm behaviours include to regulate emotion and to elicit attention. Correlates of these practices include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors.

Aims:

the aim of this study is to evaluate the gender difference in self-injurious behaviour.

Our retrospective study was conducted making a comparison between a period of time before and after the start of an articulated program of prevention of suicidal behaviors in Trieste, from 1983 to 2007.

In the '80, the self-injurious behavior were more common among males; after 2000 years this difference has continuously attenuated. This trend is in contrast with findings in the international literature.

Even the repeated acts of self-harm were more common among males.

Regarding the data on suicides, they were more frequent in male subjects, and this fact has remained stable over time, in accordance with international data.

More studies are necessary to evaluate gender difference in self-injurious behaviour.

Trieste is a city characterized by a high mean age of the resident population, with 6,000 people with a cognitive impairment. Evidences show that is necessary to have a multidisciplinary approach, making alliances with the social network and families, while dealing with people with cognitive impairment. Because of this, the 3rd catchment district has developed a Mobile Daily Centre that aims to promote health, abilities and socialization giving the possibilities for these people to stay in a social context.

Evaluating the impact of the Mobile Daily Centre on QoL of people with Cognitive Impairment.

Considering the rate of hospitalization and access to the first aid unit at the general hospital.

Retrospective Observational Study for the period between 01.01.2012 and 30.04.2014 on people in charge to the MDC. We have considered socio-demographic variables such as age, gender, care-givers; clinical variables such as psychopharmacotherapy and acetylcolinesterase-inhibitors drugs; rates of hospitalization, number of accesses to the first aid unit and of interventions of the MDC.

in the period of the study 20 patients have been followed by the MDC; half of them had a psycho-pharmacological prescription. Very low rates of institutionalization have been detected.

MDC, in these small numbers, has shown to reduce the number of improper institutionalizations while guaranteeing to the elder people to maintain their abilities and socialization and to their care-givers periods of relief. Moreover, it promotes social inclusion and destigmatization. These results suggest that more territorial work and further studies should be done.

The suicidal behaviours constitute a significant problem in terms of public health, thus a major goal of the WHO is to reduce these behaviours.

In the '80s suicide rates and suicide attempts in the Trieste were the highest in Italy, comparable with those of Central Europe. Since the '90s a project was launched to prevent suicidal behaviour and suicide rates and non-lethal self-harm gestures have plummeted.

We study the sociodemographic variables of this phenomenon.

The aim of our study is to monitor the performance of non-lethal self-harm over time and identify evidences to implement prevention strategies

We conducted retrospective study in the period 01.01.2000- 31.12.2007.

We analyzed the records of hospital emergency rooms in Trieste, screened according to the keywords that indicate the diagnosis of access “self-harm” and “voluntary intoxication”.

Socio-demographic variables were stratified by age and gender.

Outcome variables were evaluated. Data were compared with those of a study conducted from 1993 to 1990.

The study showed a mean of 85/100,000 inhabitants. The methods most frequently used were drug intoxication and cutting. There was a reduction in hospitalisations rates and an increased number of appointments in the Mental Health Department by the subjects with a suicide attempt history.

The rates of non-lethal self-harm in the period considered decreased compared to the '80s, while the average age of those who commit the act increased. These data can be used to enhance the primary and secondary prevention strategies.

Sporting practice for psychotic patients have been demonstrated to be efficacious as a rehabilitation tool at various levels, improving social interaction, self esteem, body self consciousness, reduce anxiety and depression, reduce stigma, improve compliance, reduce admission rates, reduce aggressiveness, reduce family burden.

Since 1999 the Fuoric'entro Polisportiva was founded in Trieste, with the support of the Department of Metal Health, with the aim of influencing recovery at several levels.

Evaluate the impact on participants' health.

Demonstrate the outcome of the rehabilitation program based upon the sporting activity.

The research is a descriptive, case-control study, led on 40 patients (20 cases and 20 controls) followed by the Trieste's Metal Health Department. We considered as items living situation, professional condition, gender and age, diagnosis, therapy and its compliance, admissions’ number and duration, main therapeutic interventions, following up a previous study on the same rehabilitation program.

In the cases’ group there is a stable improvement of the professional and living conditions, compliance and a reduction of admissions’ number and duration.

A rehabilitation program based on sporting can improve coping abilities, psychopathological conditions, person's 'social functioning”, family burden.

Schizophrenia is a chronic disorder which severely limits the social and occupational functioning.

Employment, education, relationships, housing and health are among the most frequently stated life and treatment goals among persons suffering from schizophrenia.

Rehabilitation for persons with schizophrenia aims at preservation and improvement of psychosocial functions, promotes recovery-oriented interventions and, therefore, serves the central goals of affected persons.

The goals of these models focus on improving knowledge, coping, self-care, social support and self-management strategies.

The aims of this cases report is to underline the effectiveness of multidimensional approach, which included drug treatment, psychosocial therapeutic interventions, supported employment, peer-supported housing.

We report 8 patients with a early onset psychosis, detected with EriRaos and clinical interview.

Diagnostically, these patients had a real improvement of their psychosocial functions in areas such as work, social relationship and independent living skills.

Cognitive functioning, education, negative symptoms, social support and skills, age, work history and rehabilitation service to restore community functioning have proven to be strong predictors for successful psychiatric rehabilitation.

Spices-use is continuously increasing in Western Countries, especially for legal reasons. Intoxication has been widely associated with psychotic symptoms.

Here we present a case-report that seems to highlight this possible association between canabimimetics and psychosis, stressing the use of 'Spices” as an instrument of auto-determination in the young patient's opinion.

Find if the supposed relation between certain Life Events and Spices use for people with a use consequent to a Dependent Personality traits can lead to an unmasking of a psychosis.

Clinical interviews, Eri-Raos, drug-use and literature revision.

Diagnostically, these patient presented right after a Spice intoxication psychotic symptoms like delusions, strong distress, the feeling of being observed and considered 'mad”, self-isolation that strengthened the need of Spice use and more difficulty (but self-reported need) to stay with others and to self-determinate herself in meaningful relationships. These symptoms have had a strong relief after the establishment of a relationship with our community mental health center (CMHC) and its multidisciplinary staff, that took care whit the patient of the whole life, in particular of the details that were stressful for her.

This report, being in accordance with others, suggests the necessity of further studies on the relation between Spice-use and psychotic symptoms, in particular for patients with a use that has roots to Dependent Personality Traits.

The rate of non fatal self-injurious behaviour in young people has increase in recent years. Non fatal self-injurious behaviour such as cutting oneself and abuse of substance is often performed without suicidal intent to cope with emotional distress although it is well known to have a close association with future suicidal behaviour.

Evaluating people under 29's suicidal behaviours' rates.

Monitoring developments in not lethal self injurious behaviour in the population of adolescents and young adults in Trieste to identify strategies that will guide the prevention of suicidal behaviour in this age group.

Retrospective study based on verbal access to emergency, extracts under the headings “self-harm” and “poisoning” during period 2000-2007. We considered as variables the calculation of rates for the age groups 15-19 and 20-29 years, mode of self-injurious act coded according to the parameters of the ICD-10.

The average rate for the age group 15-19 years was found to be 0.5 cases per 100,000 inhabitants, while for ages 20-29 was found to be 1.3 cases per 100,000 inhabitants. There wasn't a significant difference between the two genders.

The methods most frequently adopted were found to be voluntary intoxication and cutting.

To counter the fragility and risk of self-harm and suicide in adolescents and young adults, our Local Health Company launched in 2014 a dedicated website. The site provides information on the types of conditions that may affect the target population and the self-destructive behaviors.

Since 1960, a decade after the introduction of phenothiazine drugs, there were reports of drug related ocular opacities and pigmentation in patients who had been receiving continuous high dose therapy, particularly with chlorpromazine. These ocular effects seem to be related to high doses of phenothiazines and are potentially irreversible. The purpose of our study is to evaluate the pathophysiology of ocular damage, risk factors, treatment and any potential reversibility.

Bibliographic research used PubMed and PsychINFO and conduced to 12 papers.

Analysis of papers has shown that the main pathophysiological mechanism is related to an alteration of excretion of catecholamines, that exposure to sunlight presents a risk factor for the development of corneal deposits and cataract while, as regards the reversibility of these effects, the data are still controversial.

It is necessary, for psychiatrists, the information of the various ocular adverse effects of therapy with phenothiazine so that can be arranged to create a closer and more effective collaboration with an ophthalmologist to prevent and treat this disease.

Moreover, other studies are necessary to lead to an appropriate treatment plan.

A collaboration between the Child and Adolescent Unit 2 (Badof-2) and Community Mental Health 2 (CMHC-2) started several years ago in order to have a joint take in charge of under 25 people presenting needs to either one of the services. A major focus has been put, in this period, on early psychotic onset.

The impact of schizophrenia and other psychotic disorders on daily life has been very well studied in clinical populations and in general ones, leaving some gaps on which are more heavily involved in the resulting disability. In this study, we have used the HoNOS scale, in the Italian validated version, in order to evaluate the single items.

We have enrolled all the under-30 people taken in charge by the two aforementioned services in the period 2013–2016 with a ICD-10 F20–F29 diagnosis, dividing them in two subgroups (′13–′14 and ′15–′16) in order to find if there was an impact of the prolonged time of take in charge. A HoNOS evaluation has been submitted to all the 21 people found.

HoNOS scores of the first subgroup are generally lower than the ones of the second subgroup (median: 6 vs. 16.5). Self-harmness, cognitive disorders and post-psychotic depression have a heavier impact in daily life than the classic positive and negative symptomatology. Focusing on psychosocial recovery programs, this area has been partly marginally affected.

The two subgroups show different HoNOS scores, with lower ones in the ′13–′14 group. More studies on general population and covariates should be conducted.

The authors have not supplied their declaration of competing interest.

The factitious disorder is characterized by simulation or exaggeration by the subject of his/her physical or psychological symptoms to take a sick role. This disorder may be associated with a real disease, used to simulate other symptoms and receive treatment. Our case is represented by a 49-year-old man, affected by Arnold Chiari Malformation Type I (ACM-I), a structural defect in the cerebellum with extension of the cerebellar tonsils into the foramen magnum, without involving the brain stem. The patient had three surgical operations involving the complete resolution of the disease. However, the subject reported a worsening of all symptoms, with the outcome of a severe self-limitation, with admission to a residential care and taken over by the multidisciplinary equipe of the district. Symptoms, which mainly consisted in pain, motor functional impairment, headaches, slurred speech were not evaluated due to the ACM-I. This diagnosis was confirmed when there was the complete resolution of the symptoms in a date pointed by the patient.

To make an appropriate differential diagnosis, in addition to the neurological examination, the subject had psychiatric interviews and completed an MMPI evaluation.

Neurological examinations revealed no residual outcome of the ACM-I. At MMPI there were not significant peaks. Regarding to the attitude towards this test and its validity, it appears an obvious attempt to lie from the patient, which tries to present himself in a favourable unrealistically way.

This case shows that appropriate diagnosis can help health services in a better management of their resources in such situations.

The authors have not supplied their declaration of competing interest.