Recovery in psychotic disorders is a concept that evolved through the last decades. Thanks to the contribution of different researchers, together with the recovery movement, a switch happened from a service-based to a client-based approach towards recovery. The Dutch framework considers recovery as the interplay of symptomatic, personal, functional and societal aspects, determined by different biological, psychological, personal and social factors. Literature on this fourdimensional perspective is still scarce. In addition, even if an increased incidence of psychotic disorders has been recognized in ethnic minority populations and migrants, studies on the influence of ethnicity and migration on recovery in psychotic disorders is limited.

To write a systematic literature review on how ethnic minority status and migration history may affect symptomatic, personal, functional and societal recovery.

A systematic search of the main databases, followed by a four-step selection process to include studies comparing migrants or ethnic minority populations and the non-minoritarian/autochthonous population in terms of recovery. A qualitative, narrative summary has been performed.

Thirty-eight articles have been included. Literature is heterogeneous, focused on clinical outcomes and mostly based on data from the UK and the USA. As a common thread, ethnic minority status and migration history result to negatively influence societal, personal and, to a lower extent, clinical recovery.

Further studies based in different cultural backgrounds and focused on recovery in its multiple aspects are needed, to get a better understanding of the contextual and structural factors that affect the interaction between ethnicity, migration and recovery in psychotic disorders.

No significant relationships.

Child abuse is associated with a wide range of mental disease including psychotic disorders. Few studies have investigated the role of child abuse in contributing to increase the risk of psychosis in migrant population.

To explore the risk of first episode psychosis (FEP) in migrants and natives for each type of trauma i.e. physical abuse (P.A.), sexual abuse (S.A.), emotional abuse (E.A.), physical neglect (P.N.) and emotional neglect (E.N.).

Within a large case- control incidence sample of FEP from the EU-GEI study (The EUropean Network of National Schizophrenia Networks Studying Gene–Environment Interactions) we evalued the assocition of childhood trauma with FEP in migrants and natives. Associations were adjusted for age, gender, social status, level of education, family history of psychosis and cannabis use. Trauma was assessed through Childhood Trauma Questionnaire (CTQ).

CTQ mean score was higher in FEP migrants (45.4, sd 15.6) than in FEP natives (41.7, sd 13.9) (p = 0.002). In natives every type of child abuse was associated with FEP. In migrants P.A., S.A., P.N. were associated with FEP. We found a dose – dependent relationship between trauma and FEP.

Child abuse is common in individuals with psychosis. FEP migrants are more exposed to childhood trauma. Clinicians should routinely assess patients for childhood trauma. When treating a FEP migrant patient, clinicians must be aware of an underlying traumatic childhood adversity more than of a traumatic migration history.

In this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders.

MEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors.

The search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders.

Even though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants’ language proficiency upon arrival.

The experience of care giving inventory (ECI) is a self-reported measure of the caregiving experience as seen by the carer of a person with a serious mental illness. It comprises eight negative subscales and two positive subscales; positive and negative scores are obtained from these (ECI total positive and ECI total negative). This study aims to assess the validity and the reliability of the Italian version of the ECI and to compare the experience of carers in London and Bologna as measured by the ECI.

The sample consisted of 95 Bologna carers and 69 London carers of patients suffering from a functional psychotic disorder. The internal consistency of the Italian ECI and correlation between the Italian ECI total negative and the GHQ-12 (external validity) were estimated. Independent t-tests and chi-squared tests were used to compare sample characteristics and mean ECI scores. Regression analyses were used to control for confounders.

Internal consistency and validity of the Italian ECI were similar to these previously found. The Bologna caregivers had a higher ECI total negative than London carers; this difference was partially explained by worse patients' functioning and by a higher proportion of parents in Bologna. Bologna carers scored significantly lower on ECI total positive after controlling for relationship and patient functioning.

The Italian ECI is a well-accepted and valid instrument to describe caregiving experiences. The similar scores in ECI total negative between London and Bologna underline a cross-cultural consistency of negative experience of caregiving and re-emphasise the importance of patients functioning in different cultural contexts. The differences found for ECI total positive suggest area for further research.

To evaluate the clinical and functional effects of cannabis abuse in patients at First Episode Psychosis (FEP) referring to Community Mental Health Centre (CMHC) “Bologna Ovest” and in patients admitted with a diagnosis of psychosis at the Modena Emergency Psychiatry Ward (EPW).

All FEP patients, aged 18-35, referring to CMCH “Bologna Ovest” in a 6-years period were evaluated and followed-up at 3 and 12 months. Of the 1559 psychiatric admissions at the Modena EPW in a 3-year period, those with a positive history for substance abuse were selected.

Among the 88 Bologna Ovest FEPs, 32% were cannabis abusers (FEP-c). In Bologna, FEP-c were more frequently natives (23.39% vs 31.13%; c sq=5.1; p=0.02) single (26.38% vs 0,0% c sq=7.3, p=0.007) and unemployed (13.50% vs 18.32%, c sq=2.4, p=0.1). Non FEP-c did not use any other drug (0.0% vs 26.1%, c sq=77.5; p< 0.001). A trend towards higher prevalence of hospital admission at follow-up was found for FEP-c (4.20% vs 2.4%, c sq=3.8, p=0.07). 22.0% of patients admitted at the Modena EPW had a positive history for substance abuse: of these, 7% were diagnosed with paranoid schizophrenia, which significantly correlated with the use of cannabinoids (alone or in association).

Our results enlighten that cannabis use is frequent among psychotic patients admitted to hospital and worsens clinical course of FEP patients, consistently with previous evidence (Hambrecht & Hafner, 1996; Hafner et al., 2004).

Migration is a growing phenomenon in western countries. Several studies report a greater prevalence of psychiatric disorders among migrants. Some studies indicate a interesting relation between such disorders in migrants and their migration history, particularly the process of integration in the host country (Bhugra and Jhons 2005; Morgan et al 2010).

To present the Bologna Migration History Questionnaire, that is a research tool to study the migration history and identify the related determinants of psychiatric disorders.

We conducted a literature review on questionnaires used to study the determinants of psychiatric disorders in migrants and on etiopathogenetic hypotheses. We identified the main determinants to be investigated and expanded a research tool already used in a Mental Health Centre (MHC) of Bologna accordingly. A first version of this tool was discussed during a workshop with fieldworkers from different MHCs in Italy and with international experts on migration and mental health.

The developed tool includes three sections: 1) Pre-migration phase; 2) Migration phase; 3) Post-migration phase. Through the tool, information is gathered on: socio-economic factors that precede and follow the migration, reasons and organization of the migration, relations and social support in the host country, detected changes and satisfaction achieved within different fields of experience. Information can be retrieved either from medical records or through semi-structured interviews with the patients within a month from the first contact.

Currently the tool has been distributed to different Italian MHC to assess its feasibility with regard to data collection and the appropriateness of questions. Young psychiatrists and trainees show great interest in this study. We discuss discuss research perspectives for young psychiatrists within international research projects to better investigate the relation between migration and mental health in western countries.

We describe the transcultural working method of the Bologna Multiethnic Mental Health Centre (University of Bologna, Italy). The team is composed by psychiatrists, psychologists, anthropologists, social workers and cultural mediators. The main approach is psychotherapy by means of group setting, which is used as for counselling as for longer and more structured psychotherapy.

We carried out a chart review and clinician survey of social, clinical, and service use characteristics of all immigrant patients from 1999 through 2006. We also fulfilled the AMDP -SYSTEM (Manual for the Assessment and Documentation of Psychopathology) for all these patients.

A total of 135 clinic patients was followed up during this period. Most of these patients came from North Africa (32%) and Subsaharian Africa (25%) for financial purposes and 70% were in Italy for less than 10 years. More than ¼ are undocumented. One third of the patients were affected by adjustment disorders, an other third by psychotic disorders and the last third by depression or anxiety disorders. Group setting and helping relation have shown transcultural efficacy, especially during the first period after migration, on psychopathology and adjustment's abilities. This method was effective among every ethnic and diagnostic groups, except for cases in which cultural components, preceding migration, were responsible of suffering.

Starting from therapeutic efficacy of our model, we propose that immigrants psychological distress in Italy is mainly due to cultural shock and role identification loss.

We aimed is to describe the phenomenology of mental disorders in migrants referred to Bologna West Community Mental Health Centre(CMHC), by analysing the psychopathological dimensions that underlie their clinical diagnoses.

We recruited all migrants who attended the Bologna West CMHC between May 1999 andJuly 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis:(1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlieclinical diagnoses.

We found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism ofthe psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms.

A mixed categorical-dimensional approach adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of migrants patients.

Substance abuse is a well established risk factor for First-Episode Psychosis (FEP). We hypothesized that substance use at baseline could be an independent risk factorfor a worse clinical course.

An incidence cohort ofpatients with FEP collected in an 8 year period (2002-2009) at the Bologna WestCommunity Mental Health Centers (CMHCs) was assessed at baseline and at 12 month follow-up. Hospitalizations were used as clinical outcomes.

Substance users had asignificantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001).

This study showed the independent effect of substance use on FEP course. Clinical implications will be discussed.

Tarricone I, Boydell J, Panigada S, Allegri F, Marcacci T, Minenna MG, Kokona A, Triolo F, Storbini V, Michetti R, Morgan C, Di Forti M, Murray RM, Berardi D. The impact of substance use at psychosis onset on First Episode Psychosis course: results from a 1 year follow-up study in Bologna. Schizophr Res. 2014 153(1-3):60-3.

Allegri F, Belvederi Murri M, Paparelli A, Marcacci T, Braca M, Menchetti M, Michetti R, Berardi D, Tarricone I. Current cannabis use and age of psychosis onset: a gender-mediated relationship? Results from an 8-year FEP incidence study in Bologna. Psychiatry Res. 2013 Nov 30;210(1):368-70.

Research has established that there are high rates of first episode psychosis (FEP) in immigrant populations. These findings could indicate that socio-environmental risk factors, such as individual social class, social capital, early trauma, life events, neighborhood deprivation could be relevant in explaining the differences in incidence rates observed between migrants and natives, following the socio-developmental model of Morgan et al. (2010). Some preliminary results also indicate that migration history itself versus ethnicity could implicate higher risk of the onset of psychotic disorders.

To present preliminary findings from the EUGEI European Network of National Schizophrenia Networks Studying Gene Environment Interactions study.

Population based FEP incidence/case control study. Comparison of the incidence rate of FEP and of the distribution of several risk factors (e.g. substance abuse, neighborhood deprivation, urbanicity and trauma) in natives and migrants in different countries across Europe.

Preliminary results of the EUGEI study will be discussed in comparison with previous evidences.

The EUGEI study allows a deeper understanding of the excess of FEP found among migrants in Europe.

The authors have not supplied their declaration of competing interest.

Researches show that the period of migration, or the migration process itself, may confer an increased risk for psychosis. Some studies have addressed whether the high rates of psychosis found in migrants could be due to higher genetic or environmental risk factors. Facing severe or chronic stress such as trauma, social isolation, low socio-economic status, late-life social adversity may result in long term, sometimes permanent, alterations of the biological stress response system, leading to the onset of psychosis.

This study aims to examine, in a large sample of first episode psychosis patients, whether negative social experiences like stressful life events and difficulties, trauma and isolation have significantly higher frequencies in migrants with respect to natives.

The present study is conducted within the framework of the EUGEI (European Network of National Schizophrenia Networks Studying Gene Environment Interactions) study, a Europe-wide incidence and case–control study of psychosis conducted in 12 centers chosen to include areas with large first and subsequent generation migrant populations.

Data about age, gender, migration history, trauma, life events, ethnicity, social class and family history of mental disorders have been collected.

Preliminary data on the relationship between trauma and migration in first episode psychosis will be presented.

Since migration is an important stressful life event, and difficulties in integration in host countries may remain chronic, it is important to identify in each context the most vulnerable minority groups in order to implement targeted prevention interventions.

The authors have not supplied their declaration of competing interest.

To determine whether disparities exist in mental health care provision to immigrants and Italian citizens with severe mental illness in Bologna, Italy.

Records of prevalent cases on 31/12/2010 with severe mental illness and ≥1 contact with Community Mental Health Centers in 2011 were extracted from the mental health information system. Logistic and Poisson regressions were carried out to estimate the probability of receiving rehabilitation, residential or inpatient care, the intensity of outpatient treatments and the duration of hospitalisations and residential care for immigrant patients compared to Italians, adjusting for demographic and clinical covariates.

The study population included 8602 Italian and 388 immigrant patients. Immigrants were significantly younger, more likely to be married and living with people other than their original family and had a shorter duration of contact with mental health services. The percentages of patients receiving psychosocial rehabilitation, admitted to hospital wards or to residential facilities were similar between Italians and immigrants. The number of interventions was higher for Italians. Admissions to acute wards or residential facilities were significantly longer for Italians. Moreover, immigrants received significantly more group rehabilitation interventions, while more social support individual interventions were provided to Italians.

The probability of receiving any mental health intervention is similar between immigrants and Italians, but the number of interventions and the duration of admissions are lower for immigrants. Data from mental health information system should be integrated with qualitative data on unmet needs from the immigrants' perspective to inform mental health care programmes and policies.

In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population.

A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia.

Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14).

A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

Research mostly conducted in the UK and northern Europe has established that there are high rates of first-episode psychosis (FEP) in large cities and immigrant populations; moreover, psychosis has been found to be associated with cannabis use and early trauma. The present study aimed to evaluate the incidence rate of FEP and the distribution of several risk factors (e.g. age, ethnicity, substance abuse) in Bologna, Italy.

The Bologna FEP (BoFEP) study is an 8-year prospective study. All FEP patients, 18–64 years old, consecutively referred to the West Bologna Community Mental Health Centre (CMHC) from 2002 to 2009 were evaluated. Sociodemographic information, migration history and clinical data were collected through an ad-hoc schedule. Psychiatric diagnoses were recorded using the Schedule for Clinical Assessment of Neuropsychiatry (SCAN).

The overall incidence rate (IR) in the BoFEP study was 16.4 per 100 000 person-years [95% confidence interval (CI) 13.9–18.9]. The incidence was higher in young people, men and migrants (MI).

The IR of FEP found by the Bologna study is lower than that found by other European studies. However, as in other studies, the incidence was higher in certain groups. This heterogeneity has implications for policy and mental health service development, and for understanding the aetiology of psychosis.

Weight gain is a long-recognized side-effect of antipsychotic (AP) drugs and a major health concern in the treatment of psychosis. The strength of the causal relationship between AP drug exposure and weight gain can only be gauged by a drugs trial conducted on AP-naive patients.

We conducted a review of the literature regarding the amount of weight gain induced by APs in AP-naive patients and carried out a meta-analysis of mean weight gains.

We found 11 primary studies reporting the effects of APs on body weight or body mass index (BMI) in AP-naive patients. The mean body weight and BMI gains in AP-naive patients were highly significant from the first weeks of treatment. When we limited the analysis to studies conducted on patients hospitalized and without any adjunctive treatment potentially affecting weight, the resultant sample showed less heterogeneity and confirmed the final picture of weight gain at around 3.8 kg and 1.2 points BMI.

Weight gain associated with AP therapy in AP-naive patients occurs rapidly in the first few weeks and continues during the following months. Clinicians should be aware of the high probability of causing weight gain in AP-naive patients and should strictly monitor such patients.