Anxiety disorders are one of the most common mental illnesses, and a consistent increase was observed after the COVID-19 pandemic. Mindfulness refers to a process that leads to a mental state characterized by nonjudgmental awareness of the present experience. Mindfulness can be considered both a skill and a practice. The stronger is the ability to adopt a mindful state, the less suffering one will experience. While Mindfulness-based Psychotherapies have shown efficacy in their treatment, they have not yet been thoroughly studied in Italian public mental health services. In Detached Mindfulness, negative thoughts are acknowledged and avoided by turning them into actions using a standardized, time-limited, metacognitive intervention.

The purpose of this study is to examine the efficacy and cost-effectiveness of Detachment Mindfulness for twelve patients with Generalized Anxiety Disorder (GAD) not being treated pharmacologically.

We enrolled 12 patients diagnosed with GAD according to DSM-V in an 8-session program of Detached Mindfulness Psychotherapy (once a week). The Generalized Anxiety Disorder - 7 Scale (GAD-7) and the Kellner Symptom Questionnaire (SQ) were used to assess anxiety symptoms at baseline (T0), after 4 sessions (T1), and at the end of treatment (T2). The Client Satisfaction Questionnaire (CSQ-8) was used to assess treatment satisfaction.

The GAD-7 score showed consistent reductions in generalized anxiety symptoms after Detached Mindfulness treatment (mean decrease of -42% at the end of the program). As measured by SQ, patients also reported improvement in physical well-being, relaxation, and somatic symptoms significantly respect to baseline. As for treatment satisfaction, ten out of twelve patients rated their treatment as satisfactory. As reported by patients, mindfulness can become a powerful and effective means to relate to one’s own internal experiences such as anxiety or fear, learning to recognize them, staying with them and avoiding their consequences.

These results showed that detached mindfulness was an effective and cost-effective intervention for GAD, given the short amount of time it requires and the ease with which it can be implemented. For its extensive use in the public mental health system to be further supported, studies on larger populations are needed.

None Declared

Treatment Resistant Depression (TRD) is a complex, heterogeneous and multifactorial clinical condition that affects patients’ quality of life, their psychosocial functioning as well as suicidal risk. Intranasal esketamine is a new add-on treatment specifically approved for TRD.

The aim of the study was to evaluate the efficacy and safety of intranasal esketamine treatment combined with intensive Cognitive Behavioral psychotherapy (CBT), together with treatment satisfaction, in two complex clinical cases of TRD with high suicidal risk in a 12 months follow-up.

Two male patients, 67 and 63 years old, with TRD, defined by at least two therapeutic failures with SSRI/SNRI and positive screening for high suicidal risk at the Columbia Suicide Severity Rating Scale, were selected for treatment with intranasal esketamine + CBT as an add-on to SSRI/SNRI antidepressant therapy. Psychopathological assessment were made by means of Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Columbia Suicide Severity Rating Scale (C-SSRS), Clinical Global Impression (CGI), Short Form Health Questionnaire (SF-36 items) at T0, every 7 days for the first 3 months, then every month. Treatment satisfaction was evaluated by means of the Client Satisfaction Questionnaire (CSQ-8), administered by trained nursing staff at 1, 3, 6 and 12 months. CBT specifically focused on depression was administered by a certified psychotherapist, weekly for the first 4 months, fortnightly for the next 3 months, monthly for the remaining 3 months.

After 2 administrations of esketamine the total HAM-D score was reduced by an average of 10 units and the suicidal risk was progressively reduced to zero according to C-SSRS. After 12 months one of the two patients reached and actually maintains clinical remission; the other one maintains a condition of mild depression; both without suicidal ideation and with a significant increase in perceived quality of life. Treatment was well tolerated, with mild and temporary adverse effects, self-limited to the administration sessions. CBT has contributed to increasing insight, cognitive resources, social interaction and self-esteem, and has made it possible to structure and carry on new life projects. The variation of the mean scores for CSQ-8 shows that esketamine + CBT treatment was considered as very satisfactory throughout the observation period.

Intranasal esketamine associated with intensive CBT sessions showed to be effective, safe and satisfactory in the real world clinical management of two complex cases of TRD with high suicidal risk, improving quality of life, social functioning and eliminating suicidal ideation within 12 months follow-up. Satisfaction with the treatment contributed to strengthening adherence and improving the operator-patient therapeutic relationship.

None Declared

Although clozapine is considered the most effective drug for Treatment Resistant Schizophrenia (TRS), only 40% of patients treated will meet clinical response. Literature reviews and meta-analytic data offer no definite conclusions about the most effective clozapine augmentation strategies. Nevertheless, it has been suggested that the lack of evidence should not discourage clinicians from trying out new strategies in individual patients. Brexpiprazole is a novel 5-HT and DA modulator antipsychotic that exhibits partial agonism to D2/D3 and 5HT1A receptors, antagonism to 5HT2A and α-1B/2C receptors and represents a promising new drug in the pharmacotherapy of schizophrenia for both acute and maintenance treatment. In current literature there is no evidence of experiences in brexpiprazole augmentation for clozapine resistant patients.

This case report describes a successful clinical experience of brexpiprazole augmentation in a complicated case of clozapine resistant paranoid schizophrenia with consistent negative symptoms, the clinical evolution and metabolic improvement consequent to this therapy combination.

In a 27 male TRS patient, sequentially treated with adequate doses of risperidone, cariprazine, aripiprazole and olanzapine monotherapy, prescribed for adequate time, clozapine treatment was started, with a gradual titration from 25 to 300 mg/day, without significant clinical response on both positive and negative symptoms. Successively was introduced fluoxetine, from 10 to 30 mg/day, with no relevant clinical improvement. After 2 months of pharmacological stabilization with clozapine and fluoxetine described dosages, brexpiprazole was introduced starting from 1 mg/day and rapidly increasing till 4 mg/day.

After 6 weeks of treatment, PANSS positive and negative subscales showed a significant decrease, respectively from 28 to 17 and from 42 to 20, while general psychopathology subscale decreased from 66 to 34. Negative sub-items with major improvement were those regarding blunted affect, emotional withdrawal, poor rapport, and passive/apathetic social withdrawal. Brexpiprazole augmentation also allowed to slowly decrease (in 6 months) clozapine dose till actual 150 mg/day, with a significant improvement in general tolerability and a slow decline in metabolic parameters (BMI from 36.5 to 30.3; fasting glucose from 112 to 92 mg/dL; total cholesterol from 248 to 182 mg/dL; total triglycerides from 392 to 198 mg/dL).

In this case report brexpiprazole augmentation in a clozapine resistant young schizophrenic patient was an effective strategy with significant symptoms improvement, in particular in PANSS general psychopathology and PANSS negative subscales. The consequent clozapine dose reduction contribute to the slow decrease in metabolic parameters considered.

None Declared

Psychoses represent serious psychiatric disorders in which an individual perceptions, thoughts, mood and behavior are significantly altered. Each person who develops a psychosis lives a unique set of symptoms and experiences that may widely vary depending on life circumstances. Although cognitive behavioral psychotherapy (CBT) for psychosis is recommended by main international guidelines, its effectiveness in real-world is still a subject of controversy.

The aim of this study was to evaluate, in an Italian outpatient clinical setting, eventual improvements induced by a 6 months intensive CBT specific programme focused on metacognition and emotional regulation and its consequences on psychosocial functioning and subjective well-being in pharmacologically stabilized psychotic patients.

Eight patients with schizophrenia spectrum disorders (DSM-V), clinically and pharmacologically stabilized, were included in a 6-month program of weekly CBT sessions with focus on metacognition, emotional dysregulation, social functioning and subjective well-being. Patients were assessed with the Metacognitions Questionnaire-30, Difficulties in Emotion Regulation Scale, Heinrichs Quality of Life Scale, The Psychological General Well-Being Index, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale at baseline and at 3 and 6 months, to verify any improvement on these specific domains and, possibly, on general psychopathology.

In this study CBT showed to be effective on all domains evaluated, most notably for younger patients with a short history of disease (<5 years). Metacognitive capacity was the dimension with most evident improvements, followed by the ability to modulate emotions and the consequent improvement in psychosocial functioning and perceived subjective well-being. During the 6 months follow-up none of the enrolled patients experienced symptoms exacerbation or psychotic relapses.

In conclusion, the 6-month CBT treatment showed to be effective for stabilized psychotic patients, improving metacognitive functions, emotional regulation, psychosocial functioning, and subjective well-being. In addition, insight, adherence and the therapeutic alliance improved. The absence of psychotic relapses is not attributable with certainty to the effect of CBT since, for this purpose, longer duration studies on larger case series and with RCT methods are required. However, it is plausible that the improvement obtained in disease awareness and adherence may be a facilitating factor in relapse reduction.

None Declared

SARS-Co-V2 neuroinvasive ability might be the basis for the onset of delirium and neuropsychiatric outcomes.

We hypothesized that some infected patients with preexisting cognitive dysfunction may present delirium as unique manifestation of COVID-19 infection or as a prodrome of a new episode consistent with the psychiatric history.

We conducted a PubMed literature search to verify whether cognitive impairment might predispose to COVID-19. We included three patients with mild cognitive impairment and delirium at admission for SARS-Co-V2 suspected infection. Delirium was diagnosed according to DSM-5 criteria‚ Cognitive Assessment Method and Coma Glasgow Scale.

Literature analysis evidenced patients presenting delirium or delirium-like symptoms as clinical manifestation of COVID-19, plus a cognitive impairment‚ from mild to severe‚ which preexisted or was evidenced during the acute phase or after the infection. Most studies described delirium in patients with a past neurological/psychiatric history. Contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a past neuropsychiatric history. Our patients had no history of other medical complications. Our first patient had no psychiatric history‚ the second reported only a depressive episode‚ and the third had story of bipolar disorder. Delirium resolved completely after 2 days in the first patient. The other patients required 4 and 14 days to resolve: delirium appeared as the prodrome of a new psychiatric episode in line with their past history.

Clinicians should acknowledge the possibility that COVID-19 infection may appear as delirium and acute psychiatric sequelae as unique manifestation.

No significant relationships.

TRD is a highly disabling condition, often responsible for chronic clinical course, high number of relapses and elevated suicide risk. Intranasal esketamine is currently the only available pharmacological therapy specifically indicated for TRD, as add-on therapy to antidepressant treatment with SSRI or SNRI.

The purpose of the study was to evaluate the safety and efficacy of intranasal esketamine associated with CBT in a complex clinical case of TRD, over a six-month follow-up.

A 67-year-old patient with TRD was selected for treatment with intranasal esketamine+CBT as add-on to antidepressant therapy. Before each treatment session the HAM-D rating scale was administered. The patient underwent weekly CBT sessions throughout the 6 months follow-up. The effect on physical well-being and social functioning was evaluated by means of Short-Form-Health-Survey-36.

After the first two administrations of intranasal esketamine the total score on HAM-D decreased by 10 units (from 26 to 16). After 6 weeks of treatment decreased from 26 to 12 with the disappearance of suicidal ideation present at T0. After 6 months the total HAM-D score decreased from 26 to 8. Treatment was well tolerated, with mild adverse effects, confined to the first two hours post-administration. In particular, mild sedation, dizziness, slight transient blood pressure rise were reported, never required medical intervention and resolved spontaneously during the observation period.

Intranasal esketamine add-on therapy + CBT was an effective and safe treatment allowing to achieve and maintain symptomatic remission in a complex case of TRD, improving quality of life, social functioning, and reducing suicidal ideation over a six-month follow-up.

No significant relationships.

Abnormalities of emotional processing have been reported in both anxiety and depressive disorders. Anxiety might be related to a hyperactive preattentive fear response or to a reduced efficiency of late regulatory processes, whereas depression might be related to a reduced response to positive emotions. In the present study event-related potentials (ERPs) were used to investigate involuntary processing of stimuli with different emotional valence in 33 healthy controls [HC] and 55 clinically stable patients (16 with panic disorder [PD], 15 with obsessive-compulsive disorder [OCD], 13 with unipolar depression [UD] and 11 with bipolar depression [BD]).

The ERPs were recorded during a target detection task, in which erotic, threatening, disgusting and neutral stimuli were used as distracters.

Patients showed abnormalities of the sequence, duration and topography of the ERP components related to emotional processing. Patients with anxiety disorders showed abnormalities of the early components in response to threatening stimuli. Patients with BD showed abnormalities of both early and late ERPs components. OCD and UD patients demonstrated similar abnormalities of the late ERP components in response to erotic stimuli.

According to our results, abnormalities of emotional processing are observed in both anxiety and affective disorders and might have both distinct and shared characteristics in these disorders.

To evaluate relationships between alexithymia, somatic complaints and depressive symptoms in a non-clinical sample of school-aged Italian adolescents.

A mixed male-female sample of 168 school-aged adolescents with a mean age of 15.8 years was investigated with self-reported rating scales. Scales were: Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory (BDI), Symptom Checklist 90 - Somatization Subscale (SCL-90-SOM), State-Trait Anxiety Inventory (STAI), Rosemberg Self Esteem Scale (RSES). Subjects were evaluated at three times: at the beginning (T0), at the middle (T1) and at the end (T2) of the scholastic year.

30 subjects (17.9%) were categorized as alexithymics and, overall, showed greater psychological distress than non-alexithymics. Alexithymia levels remained stable during the time as well as the number of alexithymics. Alexithymics were more suitable to develop more severe depressive symptoms. Results of a linear regression supported the notion that depressive symptoms at endpoint were significantly associated with female sex, DIF subscale of TAS-20 and higher SCL-90-SOM scores.

Alexithymia, depressive symptoms and somatic complaints appeared to be highly correlated in adolescence.

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Anorexia Nervosa (AN) is characterized by body-size overestimation that reflects a distortion of body-representation. Self-body recognition can be both implicit and explicit. The former is based on cognitive and perceptual mechanisms, the latter relies on motor simulation. Previous studies showed that participants, when submitted to a hand laterality judgment task (Implicit task) that required mental rotation showed better performances when the stimuli consisted of their own rather than other's hand (self-advantage). By contrast, the self-advantage was absent when self-recognition (Explicit task) was explicitly required.

This study aimed to investigate whether the overestimation of anorexic's own body size extended to the motor representation of the bodily-self influencing the implicit self-advantage. Furthermore, we assessed the possible relationship between the implicitly recognition of one's own body part and Interoceptive Sensitivity (IS; sensitivity to stimuli originating inside of the body).

Healthy Controls (HC) and restrictive AN patients were submitted both to Implicit and Explicit tasks with self and other's hands presented in the original size or modified to look fatter or thinner. We also assessed participants’ IS by means of a heartbeat perception task.

As previously reported, HC showed specific self-advantage effect only when a motor simulation is required. Furthermore higher IS is related to faster performances only in the implicit task in which a mental motor rotation. The differences between AN patients and HC concerning IS and bodily-self recognition will be also discussed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Assess the profile of side effects on sample of outpatients treated with long-lasting injection paliperidone LLIP.

Study of a population of 67 patients, 25 people are female and 42 are male. In female sample, more than 52% are diagnosed of Schizophrenia and the majority of female do not refer side effects (88%) and only a little percentage of 12 refer side effects such as amenorrhea (F20), stiffness (F20) and relapse (F25). In male sample, more than 54.7% are diagnosed of Schizophrenia and the majority of male do not refer side effects (80%) and only a little percentage of 20 refer side effects (F70) such fear of injection and sexual dysfunction (F21).

In our sample, the number of women diagnosed with schizophrenia have a greater number of side effects respects to men with the same diagnosis. However, it would be important to increase the sample size of women to conduct a comparative study men/women to assess research in this field.

The authors have not supplied their declaration of competing interest.