In mental health prevention, person-centered, and rights-based approaches, the role of recovery is highlighted (WHO, 2021). Various evaluation tools are used in rehabilitation objectives and programs, including the Specific Levels of Functioning Scale (SLOF) (Mucci et al. Schizophr Res 2014;159 144-50) and the Recovery Assessment Scale – Domains and Stages (RAS-DS), a self-measure of mental health recovery. It includes 38 items clustered into four recovery domains and meets two functions. In addition to measuring self-reported outcomes, it increases service-user control towards objectives and recovery action plans (Honey et al. BMC Psychiatry 2023;23 500).

To evalue the efficacy of RAD-DS in a psychiatric rehabilitation facility to be used as a routine tool in daily rehabilitation activity.

In our observational study, we recruited 103 inpatients (total: 103 patients, females: 38 patients, males: 65 patients) in a psychiatric rehabilitation facility. The patient presented with psychiatric disorders that met the diagnostic criteria of DMS-5 (schizophrenia, bipolar disorder, MDD, personality borderline disorder). Epidemiological data are shown in Table 1.

All patients were undergoing a psychiatric rehabilitation program and were observed during a one-year evaluation.

In all patients, the following rating scales were administered at baseline (T0) and after a year (T1):

For the evaluation of social measures, life outcomes, and functioning and recovery:

• - Recovery Assessment Scale – Domains and Stages RAS-DS

• - Specific Levels of Functioning Scale (SLOF)

• - Global Assessment of Functioning (GAF)

For psychopathological evaluation:

• - Brief Psychiatric Rating Scale (BPRS)

The data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.

The RAS-DS total score results (Table 2) show a not significant difference between T0 vs. T1 (mean: 101.80 vs. 104.37, p. 0.193). An improvement in the score was observed after one year of rehabilitation treatment in the subgroup “Doing things I value” (T0 vs. T1: mean 16.15 vs. 18.77, p 0.001). Statistically significant differences were observed in the subgroups “Mastering my illness” (T0 vs. T1: mean 18.3 vs. 20.85, p. 0.021). In the other subgroups, the differences were not statistically significant. Interestingly, these results are comparable to those found with SLOF and GAF (respectively, p. 0.972 and p. 0.873).

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The current trend of research and clinical practice is to give more importance to psychiatric rehabilitation treatment (Franza Psychiatr Danub 2022;34(Suppl 8) 9-13). The results obtained with our observational study indicate the possible usefulness of indicators of patient well-being, as well as the RAS-DS in the management of psychiatric rehabilitation programs. The expectations, indications, and perceptions of psychiatric patients can be decisive in improving recovery.

None Declared

Bipolar Disorder (BD) is a frequent psychiatric disorder, which can be associated with high disability. Psychotic symptoms occur in more than half of bipolar patients and are associated with an unfavorable course of the disorder (Chakrabarti et al. World J Psychiatry 2022; 12(9) 1204-1232).

The aim of this study is therefore to identify clinical and biological markers able to discriminate between BD patients with (BD-PS) and without lifetime psychotic symptoms (BD-NPS) to facilitate early diagnosis and to implement a target clinical management of these patients.

We recruited 665 patients consecutively hospitalized for BD at Fondazione IRCCS Policlinico (Milan) and at San Gerardo Hospital (Monza). Data were obtained through a screening of the clinical charts and blood analyses conducted during the hospitalization. Patients were assessed by psychometric scales. The two groups (BD-PS and BD-NPS) were compared by t tests for quantitative variables and χ2 tests for qualitative ones. Variables that resulted to be significant in univariate analyses were inserted in binary logistic models with the presence of psychotic symptoms as dependent variable.

Among the total sample, 64.5% of patients were affected by BD-PS while 35.5% by BD-NPS. The final binary logistic regression model showed that, compared to patients with BD-NPS, those with BD-PS had a longer duration of hospitalization (p=0.007) and were more frequently hospitalized for a manic episode (p=0.001). In addition, subjects with BD-PS had a lower score on the current Global Assessment of Functioning (GAF) (t = 3.157; p = 0.002) and were more frequently males (χ² = 4.061; p = 0.044; OR = 1.399). With regard to biological variables, patients with BD-PS, compared to the counterpart, had a higher Neutrophile to Lymphocyte Ratio (NLR) (t = 2.776; p = 0.006), lower levels of Gamma-Glutamyl Transferase (γGT) (t = 2.249; p = 0.026), higher total bilirubin (t = 2.348; p = 0.019) and creatine phosphokinase (CPK) (t=2.807; p = 0.005), lower total cholesterol (t = 2.369; p = 0.018) and triglycerides (t = 2.554; p = 0.013).

Our data appear to be in line with the literature, especially with respect to the occurrence of psychotic symptoms mainly in manic episodes and their association with greater clinical severity, longer hospitalization and worse outcome (Altamura et al. Aust N Z J Psychiatry 2019; 53(8) 772-781). From a biological point of view, it seems important to emphasize that patients with lifetime psychotic symptoms presented a higher NLR, revealing more prominent low-grade inflammation in these patients than the counterpart. These data confirm the possibility of using NLR as biomarker of severity in bipolar patients, as proposed previously by other authors (Kulacaoglu et al. Nord J Psychiatry 2022). Future multi-center study have to confirm the results of the present study.

None Declared

Sadness, nostalgia, deep discomfort, guilt and feelings of loss, hopelessness are just some of the emotions that overwhelm people who are experiencing the death of a loved one (Franza et al. Psychiatr Danub 2022; 34 (8) 60-63). The unusual mourning process in the time of COVID-19 challenges the usual process of coping with loss. The absence of the funeral rite and coping in time of COVID-19 affects the grieving process. The consequences of “bodiless” bereavement in survivors of people who died during the COVID-19 pandemic may be similar to Post Traumatic Stress Disorder (PTSD) (Spurio. Psychiatr Danub 2021; 33 (Suppl 9) 102-107).

To evaluate the effects of the absence of the funeral rite on anxiety, depression, PTSD and hope in family members of people who have died from COVID-19.

In our observational study, 23 family members (12 females; 11 males; mean age: 48.56 yrs) who experienced a bereavement of a loved one without participation in funeral rites due to COVID-19 restrictions were recruited. They had turned to mental health professionals (psychiatrists and psychologists) as suffering from anxiety and depressive disorders. The subjects interviewed between the months of May 2020 and July 2020 (T0) were administered the following evaluation scales: Beck Hopelessness Scale (BHS), Beck Depression Inventory -2 (BDI-II); Anxiety Zung, and PTSD Checklist for DSM-5 (PCL-5).

The same scales were administered after 1 year (T1) and after two years (T2).

All the relevant data were analysed using EZAnalyze Version 3.0, Microsoft Excel Add-ln. Repeated Measures ANOVA Variables used for analyzing scales scores.

The main results are shown in Table 1. High values of hopelessness, anxiety and depressive symptoms were observed in T0. The score was reduced in the following times. In BHS the ANOVA results indicate that at least two of the repeated measures differed significantly (P – Unadjusted: T0 and T2: .003, T1 and T2: .009; P – Bonferroni: T0 and T1: .009, T1 and T2: 0.28). Similar results were highlighted in the Zung and DBI-II scales. These results indicate high levels of anxiety and depression at the beginning of the observation period (T0). The results for the assessment of PTSD indicate statistically significant differences (P. .000, Eta Squared: .378).

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Our little study evaluated some psychological factors in the emotional process of “normal” and complicated mourning. The loss of a loved one is inevitably an extremely painful event and is accompanied by a series of highly emotional experiential pathways. In the first months after death, family members have high levels of anxiety, depression, and hopelessness. There is a need to deepen the study with a higher number of participants and with a comparison with “normal” bereavement

None Declared

According to DSM V, substance-induced psychotic disorder is a mental health condition in which the onset of psychotic symptoms can be traced to the use of a psychotropic substance. The pathogenesis of this disease is still poorly understood; current literature traces its causes back to genetic predisposition and early traumatic events (i.e. child abuse).

The present study aims to identify specific clinical features and biochemical markers which could be addressed as predictors for the long-term prognosis of this disease. Moreover, we aim to identify specific correlations between the clinical phenotype and the underlying substance abuse, in order to allow the early start of a tailored treatment.

Between 2020 and 2022 we recruited 218 patients referring to the Policlinico Hospital in Milan and the San Gerardo Hospital in Monza, Italy. All the patients were diagnosed with substance induced psychotic disorder: 31 reported alcohol abuse (14,2%), 71 psichostimulants (32,6%), 116 cannabis, (53,2%). For each patients, we collected demographic data, medical records and a comprehensive psychometric assessment (GAF, PANSS, BPRS, Modified Sad Person Scale-MOAS). Furthermore, we collected a blood sample for dosing Na+, K+, Na+/K+, hemogram with formula and platelets, glucose , urea, creatinine, uric acid, transaminases, γGT, bilirubin, plasma proteins, albumin, LDH, CPK, PCHE, cholesterol, HDL, LDL, Tg, TSH.

Chi squared test (χ²) has been used to compare qualitative variables between the 3 subgrous (alcohol-, psychostimulants- and cannabis-induced psychotic syndromes) (fig.1). One way ANOVA test has been used to compare quantitative variables between the same 3 subgroups (fig.2). After removing one of the subgropus (alcohol-induced psychotic symptoms), the same analysis have been repeated. Significant variables have been included in a binary logistic regression model in order to confirm their validity as predictors for cannabis- and psychostimulants-induced psychotic disorders (fig 3). Finally we performed Omnibus test and Hosmer-Lemeshow test in order to verify the validity of these regression models.

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For each considered subgroups, we indentified the following features. Alcohol induced psychotic syndrome: higher age of onset and age of hospital admission, higher cholesterol and hurea levels, , high comorbidity with medical conditions anxiety/depression, low social functioning, higher suicidal risk;, higher hospitalization rate. Cannabis induced psychotic syndrome: higher hemoglobin and albumin levels, more severe psychiatric symtoms (BPRS), higher smoking rates. Psychostimulants induced psychotic syndrome: higher multi-drug abuse risk. We could assume that according to this consideration the treatment protocols for each of these subgroups should be tailored according to their specific features.

None Declared

The oculomotor system is closely linked to the neural circuits of attention. Recent evidence shows a novel role for eye vergence in orienting visual attention.

Identify patterns of attention disruption through eye vergence.

We investigated whether modulation in attention related eye vergence is disrupted in ADHD.

We measured eye vergence in children previously diagnosed with ADHD while performing a cue/no-cue task and compared the results to agematched controls.

We observed a strong modulation in the angle of vergence in the control group but not in the ADHD group. In addition, in the control group the modulation in eye vergence was different between the cue and no-cue condition. This difference was absent in the ADHD group.

Our study supports the observation of deficient binocular vision in ADHD children. We argue that the observed disruption in eye vergence modulation in ADHD children is proof of a deficient cognitive processing of sensory information. Our work may provide new insights into attention disorders, like ADHD.

Taste perception is a complex phenomenon modulated by different factors, such as taste receptors and memory brain circuitry. The palatability of the food, that activates central reward pathways, also plays an important role in taste perception. It means that taste is able to influence the choice of food and then the eating behavior.

It's well known that people with anorexia nervosa (AN) have lower sensitivity to reward stimuli and recent studies have shown that altered function of taste neural circuitry may contribute to restricted eating in AN.

The aim of this study is to evaluate, in patients suffering from AN, the activation of the brain areas involved in taste perception and in central reward mechanisms to both pleasant and aversive taste stimuli and to correlate gustatory neural circuitry activity with eating behaviors, temperament measures and/or sensitivity to reward and to punishment.

12 underweight AN patients and 12 normal-weight healthy subjects underwent a functional MRI to measure brain areas activation to repeated stimuli of a pleasant taste, a sucrose solution, alternated with an aversive taste, a bitter solution, and a water taste.

Preliminary results showed, in patients with AN, a dysfunctional activation of brain areas involved in both taste perception and reward mechanisms following both the pleasant and aversive stimulus.

These results, if confirmed in future analyses, may improve our knowledge about the pathophysiological mechanism of AN.

Eye movement recordings can provide information about higher-level processing of visual information. Recent evidence shows a novel role for eye vergence in orienting attention (Solé Puig et al., 2013). Based on such eye tracking data, the BGaze method (Braingaze; Spain) detects visual attention. The outcomes of the BGaze method have been applied to classify ADHD patients from healthy controls.

In this study, we validated the BGaze method.

We therefore recorded eye movements in children while performing a visual detection task.

We evaluated the BGaze method using 4 types of supervised machine learning algorithms. In total, 138 different trained models were tested. Nineteen ADHD diagnosed patients (children 7–14 years of age) and 19 healthy age matched controls were used to build the 138 models. We performed 30 times repeated random sub-sampling validation. In each repeated random split, training set consisted of 80% of the data and test set of the remaining 20%. Finally, all the 138 models were tested with a validation set consisting of 232 children, including 22 ADHD patients.

Across all the 138 models, BGaze method showed an average accuracy of 90.84% (minimum 86.21%; maximum, 95.26%) and an average AUC of 0.95 (minimum 0.90; maximum, 0.97). Best models gave accuracies of 92%, AUCs of 0.96 and FN and FP rates of 4.3% and 7.5%, respectively. Mean scores during the training-testing phase averaged 99.63%.

The BGaze method is robust, accurate, and can provide an objective tool supporting the clinical diagnosis of ADHD.

The authors have not supplied their declaration of competing interest.

The functional interplay between brain hemispheres is fundamental for behavioral, cognitive and emotional control. Several pathophysiological aspects of eating disorders (EDs) have been investigated by the use of functional Magnetic Resonance Imaging (fMRI).

The objective of the study was to investigate functional brain asymmetry of resting-state fMRI correlations in symptomatic patients with anorexia nervosa (AN) and bulimia nervosa (BN).

We aimed at revealing whether brain regions implicated in reward, cognitive control, starvation and emotion regulation show altered inter-hemispheric functional connectivity in patients with AN and BN.

Using resting-state fMRI, voxel-mirrored homotopic connectivity (VMHC) and regional inter-hemispheric spectral coherence (IHSC) analyses in two canonical slow frequency bands (“Slow-5”, “Slow-4”) were studied in 15AN and 13BN patients and 16 healthy controls (HC). Using T1-weighted and diffusion tensor imaging MRI scans, regional VMHC values were correlated with the left-right asymmetry of corresponding homotopic gray matter volumes and with the white matter callosal fractional anisotropy (FA).

Compared to HC, AN patients exhibited reduced VMHC in cerebellum, insula and precuneus, while BN patients showed reduced VMHC in dorso-lateral prefrontal and orbito-frontal cortices. The regional IHSC analysis highlighted that the inter-hemispheric functional connectivity was higher in the ‘Slow-5′Band in all regions except the insula. No group differences in left-right structural asymmetries and in VMHC vs callosal FA correlations were found.

These anomalies indicate that AN and BN, at least in their acute phase, are associated with a loss of inter-hemispheric connectivity in regions implicated in self-referential, cognitive control and reward processing.

The authors have not supplied their declaration of competing interest.

Taste perception is a complex phenomenon modulated by different factors, such as taste receptors and memory brain circuits. The palatability of the food, that activates the central reward pathways, also plays an important role in taste perception. It means that taste is able to influence the choice of food and then eating behaviour.

It is well known that people with anorexia nervosa (AN) have a lower sensitivity to reward stimuli and recent studies suggested that altered function of taste neural circuitry may contribute to restricted eating in AN.

The aim of this study was to evaluate, in patients suffering from AN, the activation of brain areas involved in taste perception and in central reward mechanisms to both pleasant and aversive taste stimuli and to correlate gustatory neurocircuitry activity with eating behaviours, temperament measures and/or sensitivity to reward and to punishment.

Fifteen underweight female AN patients and sixteen normal-weight healthy women underwent a functional MRI to measure brain areas activation to repeated stimuli of a pleasant taste (sucrose solution), alternated with an aversive taste (bitter solution), and water taste.

Compared to healthy controls, patients with AN showed a significantly reduced activation of left insula and left dorsolateral prefrontal cortex to sweet stimulus and reduced activation of right parietal cortex to bitter stimulus.

These results, if confirmed in future studies, may improve our knowledge about the pathophysiological mechanisms of AN.

The authors have not supplied their declaration of competing interest.

To evaluate the use of remifentanil–propofol administered as target-controlled infusion during awake fibreoptic intubation for anticipated difficult tracheal intubation in acromegalic patients.

In all, 20 consecutive acromegalic patients underwent elective endonasal endoscopic transsphenoidal pituitary surgery. After premedication with midazolam 0.03 mg kg−1, initially a target-controlled infusion of remifentanil 1.0 ng mL−1 and propofol 1.5 μg mL−1 was started. The fibreoptic intubation was performed by the same physician experienced with the fibreoptic technique. During the fibreoptic procedure the target concentrations of remifentanil and propofol ranged between 1.0 and 5.0 ng mL−1, and between 1.5 and 3.5 μg mL−1, respectively. Changes in heart rate and mean arterial pressure were recorded during airway manipulation, during tracheal intubation, and at 1 and 3 min after. On the first postoperative day, patient recall and level of discomfort during fibreoptic intubation were evaluated.

Endotracheal intubation was efficaciously and quickly secured in all patients. A significant increase in mean arterial pressure and heart rate was recorded only during tracheal intubation (P < 0.05). Oxygenation was sufficient and no bradypnea or apnoea was recorded. All patients later described their anaesthetic experience as satisfactory. During fibreoptic intubation, remifentanil (ng mL−1) and propofol (μg mL−1) mean effect-site concentrations were 3.2 ± 0.3 and 2.0 ± 1.0, respectively.

Remifentanil and propofol target-controlled infusion provided satisfactory conscious sedation allowing for successful oral fibreoptic intubation in acromegalic patients with no recall.