According to current diagnostic systems, affective symptoms do not represent a fundamental criterion for the diagnosis of DD. However, numerous studies have highlighted frequent comorbidity between DD and Mood Disorders and have elucidated the importance of the affective state in the development and persistence of delusions. Thus, some factor analysis studies have identified the existence of a depressive dimension in DD, suggesting a substantial psychopathological heterogeneity in DD. However, these important affective features have not evaluated from a phenomenological point of view and in their relationship with delusions.

The aim of the present study is to investigate the relationship between personality, trait affectivity and severity of delusions in patients with Delusional Disorder (DD).

Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (NPI), the Positive and Negative Affect Schedule (PANAS) and the Psychotic Symptom Rating Scale (PSYRATS). Next, we analysed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions.

The severity of delusions was directly associated with “Grandiose Fantasy” item of narcissistic personality and inversely related with the feelings of shame, fear and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of the delusions, that, in in DD patients, would lie on an affective core of shame.Table 2.

Pearson correlation coefficient

The severity of delusional beliefs in DD patients would lie on an affective core of shame upon predisposing personality traits. These findings could help to develop a psychotherapeutic approach for delusional patients focused in the feeling of shame.

None Declared

In schizophrenia, there is evidence for anomalies in the extension and plasticity of the peripersonal space (PPS), the portion of space surrounding our body, plastically shaped through motor experiences. An impaired multisensory integration at the PPS level would underpin the disembodiment, a core feature of the disorder linked to subjective perturbations of the sense of self (“Self-disorders”) and of the intersubjective dimension (“schizophrenic autism”).

The present study was aimed at: 1) exploring possible associations between PPS data, psychopathological dimensions, and subjective experiences in schizophrenia; 2) identifying a specific PPS profile in patients with early-onset schizophrenia.

A motor training with a tool was used to assess the PPS size and boundaries demarcation in twenty-seven schizophrenia outpatients. Moreover, they underwent a thorough psychopathological evaluation with the Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS). Subsequently, the sample was divided into early (EOS) and adult-onset (AOS) subgroups, that were compared with respect to their PPS and psychopathological profiles.

PPS features (size and boundaries demarcation) were associated with PANSS negative score, subjective experiences of existential reorientation (EASE Domain 5 scores) and traits of schizophrenic autism (ARS scores; Fig. 1). PPS parameters (Fig. 2) and ARS scores, but not PANSS and EASE differentiated between early and adult-onset subgroups.

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Our results suggest a link between PPS patterns, negative symptoms, and disturbances of the subjective experience, particularly in the intersubjective domain, in schizophrenia. Moreover, they candidate specific PPS profiles and schizophrenic autism traits as EOS markers.

None Declared

Evidence from contemporary research has highlighted abnormal subjective pre-psychotic experiences as an expression of schizotropic vulnerability, for which trajectories up to First Rank Symptoms have been described. Embodiment is crucial to the conceptualisation of these experiences as the distinctive feature of schizophrenic phenomena. In fact, these are embedded in precise experiential frameworks such as Diminished Self-Affection and Hyperreflexivity, which constitute in nuce the experience of Dis-Embodiment. The latter responds poorly to conventional therapies, thereby affecting considerably the prognosis quoad valetudinem of Schizophrenia.

This study is intended to explore the use of specific psychomotor therapy protocols aimed at fostering Embodiment in patients with Schizophrenia, especially by investigating its efficacy and specificity on self-perceived body disorders, on characteristic motor abnormalities and on psychopathological dimensions.

The study involves the participation of 20 patients throughout 10 weekly 90-minute meetings of Embodied Psychomotor Therapy (EPT) in groups of approximately 5 participants. Despite being partially inspired by current approaches, EPT is conceived as a specific activity intended for patients with schizophrenia: each meeting combines intersubjective coordination activities (complex motor sequences, harmonious control of voluntary movement and movement in space, body-awareness), intra-subjective coordination (mirroring, demarcation and identification of one’s own boundaries, single-group dynamics), and exercises aimed at developing motor skills (proprioception, balance, posture, rhythm and speed). At the beginning of the activity (T0) and after 10 meetings (T1) participants will carry out self-administered and externally administered assessments, for the evaluation of motor (BMS, LOFOPT, BBS, AIMS, SRRS), psychopathological (PANSS, FBF, ABP), social functioning (SOFAS) and daily physical activity level (IPAQ) dimensions.

The study is still ongoing, due to limitations dictated by the Sars-CoV-2 pandemic. Preliminary results at T0 indicate a positive correlation between low levels of daily physical activity (IPAQ) and poor functioning (SOFAS). Significantly higher motor impairment with respect to the general population is also confirmed in all motor scales used. Moreover, a positive correlation between low levels of motor coordination (BMS_MC) and balance (BSS_TOT) was found together with basic symptoms related to loss of control or self-agency (FCQ_KO). Furthermore, the first results suggest an overall improvement in motor performance at T1.

The longitudinal analysis will enable the extent of the impact of EPT on functioning, motor and psychopathological dimensions of the patients to be determined, providing useful elements for planning specific rehabilitation interventions for schizophrenia.

None Declared

The disruption of minimal Self is believed to be a core element of Schizophrenia and intimately connected to a disruption of bodily self, which in turn leads to impairments in intersubjectivity dimension. Motor abnormalities have been associated to Schizophrenia since the early conceptualization of the disorder, as well as inefficient body-related multisensory integration processes are considered nowadays a plausible origin of disembodied Self. In particular, there is evidence for significant abnormalities in Peripersonal Space (PPS) extension in Schizophrenia patients. PPS is the plastic sector of space immediately surrounding our body, whose coherent representation is based on efficient body-related multisensory integration processes. With a specific experimental task based on multisensory integration processing, we estimated PPS size and PPS boundary’s demarcation in 27 Schizophrenia patients, confirming a narrower PPS size and weaker bodily boundary in patients, thus paving the way for a deeper investigation of the mechanisms underlying the disruption of bodily self (Ferroni et al., Schziophr.Bull.2022, 5 1085-1093). We suggest that disembodiment might be responsible for the loss of the immediate linkage between Self and others (“intercorporeality”), so linking the disruption of the corporeal dimension to specific anomalies of intersubjectivity in Schizophrenia patients. Since language is one of the most important instrument through which intersubjectivity unfolds, it is intriguing to hypothesize a connection between language and multi-sensory processing.

Therefore, the present study was aimed at investigating possible correlations between patients’ motor impairments in multi-sensory integration processes and their alterations in language and communicative interactions.

Twenty-five outpatients were recruited in an experimental task investigating PPS extension; they were administered the Scale for the Assessment of Thought, Language and Communication (TLC) and the Clinical Language Disorder Rating Scale (CLANG).

Our data showed significant correlations between TLC and CLANG total scores and PPS size, with narrower PPS size for more severe formal thought disorders and higher language and communication impairments.

Our preliminary results seem to confirm the presence of a link between language impairment and multi-sensory processing, suggesting that bodily and linguistic disorganization may have a common origin which has yet to be explored in depth. Future research is needed to identify linguistic and motor endophenotypic patterns, potentially intertwined with each other, capable of early predicting Schizophrenia development and thus usable as early diagnostic tools.

None Declared

Patients with schizophrenia present severe communication difficulties in various linguistic areas. In the last two decades research has invested significant effort in trying to better characterize the linguistic profile of patients with schizophrenia, with the purpose to help and guide diagnosis and treatment. Moreover, speech data could be easily gathered through non-invasive techniques and are therefore seen as particularly promising by clinicians. However, surprisingly very little is known about interactional dialogue management, i.e. turn-taking, in these patients. ‘Schizophrenic autism’, the peculiar intersubjective experience also linked to anomalies in the sense of the self (‘Self-disorders’) presented by these patients, could be at the basis of an unusual turn-taking management.

The objective of the present study was to investigate turn-taking patterns of patients with schizophrenia and to explore their possible associations with psychopathological dimensions and subjective experiences.

We obtained double-channel audio-recordings from interviews with twenty patients with schizophrenia (SCZ) and twenty healthy controls (HC). Participants answered general questions to elicit spontaneous dialogues, to improve the ecological validity of the task. The audio files obtained were then analyzed with Praat, a software widely used in experimental phonetics. We subsequently quantified a set of conversational metrics (participant floor occupation, mutual silence, overlap between speakers, speaking turn and pause duration). Patients also underwent a thorough psychopathological and phenomenological evaluation with the Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS).

Our results show that the SCZ group displayed a reduced participant floor occupation, an increased mutual silence, and shorter speaking turns as compared to the HC. (Fig. 1, Fig. 2). We found significant associations between conversational features and psychopathology (Fig. 3). Two multivariate linear regressions showed that the participant occupation floor and the average speaking turn duration (dependent variables) were negatively related to the severity of negative symptoms and Self-Disorders. Interestingly, Self-Disorders were the best predictors of conversational engagement.

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Our results, although preliminary, suggest the existence of peculiar turn-taking patterns in schizophrenia, linked to negative symptoms and disturbances of the subjective experience, particularly in the Self domain. Our results suggest also how the use of experimental linguistic methodology is applicable to clinical settings and underscores the importance of research projects in this field that are strongly interdisciplinary in both design and conduct.

None Declared

Self Disorders (SDs) are regarded as the subjective phenotype of Schizophrenia vulnerability. The EASE (Examination of Anomalous Self-Experiences) scale is the most detailed and widely used instrument to investigate SDs, but it requires long administration times and specific training. The IPASE (Inventory of Psychotic-like Anomalous Self-Experiences) scale might be a self-administered instrument of widespread use for an easier SDs investigation.

The present study was aimed at validating the Italian version of IPASE, testing its internal consistency and usability for a first level SDs survey. A secondary objective was to confirm the correlations between IPASE, EASE, main symptom dimensions, subjective bodily experiences, symptoms of schizophrenic autism as well as levels of global functioning.

Fifty patients with Schizophrenia were administered the IPASE scale in its Italian version, the Examination of Anomalous Self-Experiences scale (EASE), the Positive And Negative Symptoms Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS) to assess global functioning, the Autism Rating Scale (ARS) and the Abnormal Bodily Phenomena questionnaire (ABPq). The internal consistency of IPASE in its Italian version was investigated and the correlations between IPASE, EASE, ABP, ARS, PANSS and SOFAS were explored.

The internal consistency of the Italian version of IPASE was high (α 0.97). The IPASE and EASE total scores were positively correlated with each other, as were many of the conceptually related subdomains of both scales. The IPASE score was negatively correlated with global functioning (SOFAS) and positively correlated with total PANSS scores and with PANSS negative domain. Moreover, the IPASE total score was positively correlated with autism dimension (ARS), while anomalies in subjective experience of the lived body were coherently correlated with higher scores in IPASE “somatization” subdomain.

The IPASE may be an easy instrument with high internal consistency for an initial investigation of SDs. IPASE domains appear to be correlated with the SDs investigated through EASE and with the main symptomatologic dimensions of Schizophrenia, in particular with negative symptoms. IPASE might also be a useful instrument for a first level investigation of subjective experiences concerning intersubjectivity and bodily dimensions.

SDs are confirmed to be a core feature of the schizophrenia psychopathology, with a adverse impact on global functioning.

None Declared

Language and conversation are deeply interrelated: language is acquired, structured, practiced in social interactions and linguistic resources (specifically syntactic, prosodic and pragmatic aspects) contribute to finely tuning turn-taking. Nevertheless, most studies focused on verbal aspects of speech in schizophrenia, with scant attention to their relation to conversation, where language is experienced at most.

The present study was aimed at investigating a possible association between language impairment and conversational characteristics in a sample of clinically stable patients diagnosed with schizophrenia (N = 35, ages 18-65).

A spontaneous speech sample was recorded. For the assessment of language skills, the Scale for the Assessment of Thought, Language and Communication (TLC) and the Clinical Language Disorder Rating Scale (CLANG) were used, while conversational variables were extracted with an innovative method of semi-automatic analysis. The possible associations were investigated through the Pearson Correlation.

Figure 1 represents graphically the correlational matrix between conversational variables and linguistic scale scores. In the heatmap, blue means negative and red positive correlations, the stronger the colour, the larger the correlation magnitude. Moreover, the significant associations are indicated with stars.

The results suggest that in schizophrenia spectrum disorders the disturbances of language, at a syntactic, prosodic and pragmatic level, have significant impact on communicative interaction.

Thus, conversation analysis might be a promising method to quantify objectively communicative impairment with the benefit of representing an ecological assessment, examining the performance of patients in the real situation of language use, which is social interaction.

No significant relationships.

A primary disruption of the bodily self is considered a core feature of schizophrenia patients (SCZ). The “disembodied” self would be underpinned by an inefficient body-related multisensory integration mechanism occurring in the Peripersonal Space (PPS). PPS is a plastic sector of space surrounding our body, whose extent is altered in SCZ. Although PPS represents a malleable interface marking the perceptual border between self and others, no study has investigated the potential alteration of its plasticity in SCZ.

We investigated the PPS extension and its plasticity in SCZ and their potential correlations with the clinical scales.

Thirty SCZ and thirty healthy controls (HC) underwent a multisensory task to estimate PPS boundary before and after a motor training. Patients were also administered the Positive And Negative Syndrome Scale (PANSS) and the Examination of Anomalous Self-Experience (EASE).

Data confirm a narrower PPS extent in SCZ than in HC, whereas no differences in PPS expansion was found in the two groups after the motor training (Figure 1). Positive symptoms were associated directly with PPS extent and inversely with PPS plasticity. No associations were found between PPS and EASE domains. Figure1: Graphical representation of PPS expansion in SCZ and HC. Both panels show individual normalized sigmoid fits

The present study suggests a narrower PPS extent and a preserved PPS plasticity in SCZ with respect to HC. Both PPS extent and plasticity are related to the severity of positive symptoms. These results highlight the potential role of rehabilitation interventions in order to improve patients’ weakened body boundary.

No significant relationships.

Delusions are a key feature of schizophrenia psychopathology. From a phenomenological approach, Jaspers (1913) differentiates between “primary” or true schizophrenic delusions, defined as an unmediated phenomenon that cannot be understood in terms of prior psychological origin or motivation, and “secondary” delusions, understandable from the patient’s mood state or personality. Primary delusions have been considered the hallmark of reality distorsion dimension in schizophrenia, disregarding a possible affective patwhay to delusional belief.

The present study was aimed at elucidating the psychopathological trajectories to delusion in schizophrenia through the investigation of both affective and schizotypal trait dispositions.

Seventy-eight participants affected by schizophrenia were administered the Peters Delusional Inventory (PDI), the Positive and Negative Affective Scale (PANAS), the Experience of Shame Scale (ESS), the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS) and the Perceptual Aberration Scale (PAS).

The severity of delusional ideation (PDI) was positively related to both affective (PANAS positive dimension, ESS) and schizotypal traits (MIS, PAS and REF). Moreover, referential thinking (REF) mediated the relationship between “magical ideation” (MIS) and delusions severity (Fig. 1), whereas experience of shame (ESS) was a moderating factor in the between referential thinking and delusion severity (Fig. 2).

The study findings suggest that in schizophrenia patients, severity of delusions is underpinned by an intertwining of both affective and schizotypal pathways.

No significant relationships.

Patients with schizophrenia show severe difficulties in interpersonal communication, including impairments in conversation skills, like the turn-taking. To our knowledge, very few studies to date have taken into account conversation analysis in order to investigate turn-taking in schizophrenia patients.

To investigate the conversational patterns in schizophrenia patients; to assess possible associations between dialogic features, abnormal subjective experiences and symptom dimensions.

Thirty-six patients with Schizophrenia underwent an interview, subsequently analyzed with an innovative semi-automatic analysis. Positive and Negative Syndrome Scale (PANSS) was adopted for the investigation of psychopathology and Examination of Anomalous Self Experience (EASE) for Self-Disorders.

Dialogic exchanges are graphically represented in Figure 1. An inverse correlation was found between participant speaking time and PANSS negative symptoms score (r = -0.44, p value < 0.05; Figure 2), whereas no associations were found between conversational variables and PANSS positive or disorganization dimensions. Finally, a positive correlation was found between the EASE item “spazialization of thought” and average pause duration (r = 0.42, p value < 0.05).

The finding of a relationship between negative symptoms and conversational patterns suggest that conversational features in schizophrenia are expression of the “core” negative dimension of the disorder. The association with the phenomenon of thought spatialization seems to suggest that the disturbances of the stream of consciousness impact on natural dialogic interactions. Ultimately, conversation analysis seems a promising tool to study dialogic exchanges of patients with schizophrenia.

No significant relationships.

While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial.

investigating whether alexithymia is associated with PD regardless of psychopathology severity.

1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction.

167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects.

At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57).

The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.

Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptom (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.

Seventy-five patients affected by schizophrenia were administered the SCID-IV, the PANSS, the YBOCS and the SOFAS.

The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high).

In both groups, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at higher levels of disorganization (Figure 1).

Data suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS. Particularly, mild OCS contributes to higher levels of functioning in patients with psychosis at low levels of disorganization. In keeping with the historical concept of “pseudoneurotic schizophrenia”, we speculate that obsessive dimension might have a pathoplastic influence in milder forms of schizophrenia spectrum disorders, balancing the effect of underlying low disorganization symptoms.

The authors have not supplied their declaration of competing interest.

Depression is an established risk factor for acute coronary syndrome (ACS), nonetheless the mechanisms underlying this association are still unclear and literature disagrees on the role played by anxiety. Moreover, most of the studies included subjects with a long lasting history of heart disease or recurrent depressive episodes that could bias the results.

We performed serial assessments of anxiety, depression and new cardiac events in a cohort of never-depressed patients in the two years after their first ACS.

Clarify the role of anxiety and depression in predicting new cardiac events.

Two hundred and fifty-one consecutive patients completed the two-years follow-up. The presence of depression was evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and its severity with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected at baseline, when GRACE-score was calculated, and at 1, 2, 4, 6, 9, 12 and 24-months follow-ups.

Forty-two patients (16.7%) developed a second cardiac event and, of these, eighteen (42.9%) had a previous depressive episode. At Cox Regression, controlling for confounding clinical variables (e.g. GRACE-score), developing a first-ever depressive episode was a significant risk factor (OR = 2.38; 95%CI = 1.11–5.14; P = 0.027) whereas baseline anxiety was protective (OR = 0.56; 95%CI = 0.38–0.81; P= 0.002). The latter, moreover, moderated the effect of incident depression on new cardiac events.

Our results confirm the well-established detrimental effect of depression on cardiac prognosis and suggest clinicians to keep in mind anxious symptoms when facing a patient at his/her first ACS.

The authors have not supplied their declaration of competing interest.

Recent studies have underlined the importance of considering the form of thoughts, beyond their content, in order to achieve a better phenomenological comprehension of mental states in mood disorders. The subjective experience of thought overactivation is an important feature of mood disorders that could help in identifying, among patients with a depressive episode, those who belong to the bipolar spectrum.

Patients with a diagnosis of bipolar disorder (BD) were compared with matched healthy controls (HC) on a scale that evaluates thought overactivation.

Validate the Italian version of a scale for thought overactivation (i.e. STOQ) in a sample of bipolar patients.

Thirty euthymic BD and 30 HC completed the Subjective Thought Overactivation Questionnaire (STOQ), the Ruminative Responses Scale (RRS), the Beck Depression Inventory-II (BDI-II) and global functioning (VGF).

The 9-items version of the STOQ has been back translated and its internal consistency in this sample was satisfactory (alpha = .91). Both the brooding subscore of RRS (b-RRS) (r = .706; P < .001) and STOQ (r = .664; P < .001) correlate significantly with depressive symptoms whereas only the first correlate with VGF (r = –.801; P < .001). The two groups did not differed in the b-RRS (HC = 8.41 vs BD = 9.72; P = .21), whereas BD where significantly higher in the STOQ total score (HC = 6.62 vs. BD = 14.9; P = .007).

Our results, although limited by the small sample size, confirm the validity of the STOQ and suggest that this scale could grasp a feature characteristic of BD, independently from their tendency to ruminate. The latter seems to impact more on global functioning.

The authors have not supplied their declaration of competing interest.

Many clinicians are reluctant to use traditional mood-stabilizing agents, especially lithium, in children and adolescents. This review examined the evidence for lithium’s safety and efficacy in this population.

A systematic review was conducted on the use of lithium in children and adolescents with bipolar disorder (BD). Relevant papers published through June 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.

30 articles met inclusion criteria, including 12 randomized controlled trials (RCTs). Findings from RCTs demonstrate efficacy for acute mania in up to 50% of patients, and evidence of long-term maintenance efficacy. Lithium was generally safe, at least in the short term, with most common side effects being gastrointestinal, polyuria, or headache. Only a minority of patients experienced hypothyroidism. No cases of acute kidney injury or chronic kidney disease were reported.

Though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes.