International Classification of Diseases 11th Revision (ICD-11) has inserted complex post-traumatic stress disorder (cPTSD) as a clinically distinct disorder, different from PTSD. The diagnosis of cPTSD has the same requirements for the one of PTSD, in addition to disturbances of self-organization (DSO – e.g., disturbances in relationships, affect dysregulation, and negative self-concept).

This study aimed to explore suicidality in PTSD and cPTSD. We examined also the association between clinical dimensions of hopelessness (feelings, loss of motivation, future expectations) and other symptomatologic variables.

The sample, recruited at the Fondazione Policlinico Tor Vergata, Rome, Italy, consisted of 189 subjects, 132 diagnosed with PTSD, and 57 with cPTSD, according to the ICD-11 criteria. Participants underwent the following clinical assessments: Clinician-Administered PTSD Scale (CAPS), Impact of Event Scale-Revised (IES), Beck Depression Inventory (BDI), Symptom Checklist-90-Revised (SCL-90), Dissociative Experience Scale (DES), Beck Hopelessness Scale (BHS).

cPTSD showed significantly higher BHS-total (p = 0.01) and BHS-loss of motivation subscale (p <0.001) scores than PTSD. Besides, cPTSD showed significantly higher scores in all clinical variables except for the IES-intrusive subscale. By controlling for the confounding factor “depression”, suicidality in cPTSD (and in particular the BHS-total) appears to be correlated with IES-total score (p = 0.042) and with DES-Absorption (p = 0.02). Differently, no such correlations are found in PTSD.

Our study shows significant symptomatologic differences between PTSD and cPTSD, including suicidality. Indeed, suicidality in cPTSD appears to be correlated with the “loss of motivation” dimension, which fits well within the ICD-11 criteria of DSO.

No significant relationships.

Amongst different subtypes of Conversion Disorder (CD), DSM-V lists the Psychogenic Non-epileptic seizures (PNES). PNES are defined as episodes that visually resemble epileptic seizures but, etiologically, they are not due to electrical discharges in the brain.

Our study aims to explore the differences between PNES and other CDs. In particular, we studied the suicidality and its correlations with dissociation and alexithymia.

Patients, recruited from the Psychiatry and Clinical Psychology Unit of the Fondazione Policlinico Tor Vergata, Rome, Italy, were diagnosed with PNES (n=22) and CD (n=16) using the DSM-5 criteria. Patients underwent the following clinical assessments: HAM-D, BDI, DES, BHS, TAS, CTQ.

PNES showed significantly higher scores than CD in all assessments, except for BDI-somatic (p=0.39), BHS-feeling (p=0.86), and the presence of childhood trauma. PNES also showed significantly higher suicidality (p = 0.003). By controlling for the confounding factor “depression”, in PNES suicidality (and in particular the BHS-loss of motivation) appears to be correlated with DES-total score (p = 0.008), DES-amnesia (p = 0.002) and DES -derealization-depersonalization (p = 0.003). On the other hand, in CDs, the BHS-total score shows a correlation with the TAS-total score (p = 0.03) and BHS-Feelings with TAS-Externally-Oriented Thinking (p = 0.035), while only the BHS-Loss of motivation appears correlated with DES-Absorption (p = 0.011).

Our study shows significant differences between PNES and CD, in several symptomatologic dimensions, including suicidality. Indeed, in PNES suicidality appears to be related to dissociation, while in CDs it appears mainly to be correlated with alexithymia.

Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.

We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.

Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).

Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.

1. (1) How to adapt group schema therapy for older adults.

2. (2) How to explore feasibility and outcome.

3. (3) Treat older personality disorder patients as intensively as younger adults.

To identify factors associated with suicide attempts using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study).

All baseline characteristics of 8,871 adult patients with schizophrenia collected in patients included in the SOHO study were included in a GEE logistic regression post-hoc analysis comparing patients who attempted suicide during the study with those who did not.

A total of 384 (4.3%) patients attempted or committed suicide. The risk factors that resulted statistically associated with suicide attempt were a lifetime history of suicide attempts (OR 3.6 [95% CI 2.8, 4.6; p< 0.0001]), suicide attempts in the last 6 months (OR 2.5 [95% CI 1.8, 3.4; p< 0.0001]), prolactin-related side effects (OR 2.0 [95%CI 1.4, 2.9; p=0.0002]), CGI depression (OR 1.2 [95% CI 1.1, 1.3; p=0.0004]) and history of hospitalization for schizophrenia (OR 1.4 [95% CI 1.1, 1.8; p=0.009]).

In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.

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).

White matter abnormalities play a prominent role in the pathogenesis of schizophrenia. Diffusion tensor imaging (DTI) studies showed a widespread decrease in fractional anisotropy (FA) in psychotic disorders.

To examine white and grey matter abnormalities in first episode psychosis (FEP).

We obtained T1-weighted and DTI magnetic resonance images (1.5 T) from 8 right-handed drug-naïve FEP patients and 8 healthy controls. The DTI data set was used to calculate FA maps; we carried-out optimized voxel-based morphometry (VBM) analysis of grey matter (GM) and FA maps using SPM2.

Patients were assessed with a neuropsychological battery comprising the Trail Making Test, the Stroop Colour Word Test, the Wisconsin Card Sorting Test and a test of Facial Affect recognition.

The voxelwise analysis showed decreased FA in the superior longitudinal and inferior fronto-occipital fasciculi, bilaterally, and in the left uncinate fasciculus. We observed reduced GM volume in the left frontal cortex (Brodmann areas [BA] 47, 13, 11, 10, and 9) and in right frontal (BA6), temporal (BA34) and occipital (BA 18, 19, and 30) cortex.

Neuropsychological assessment showed impaired executive function and deficit in facial affect recognition.

Our findings showed fronto-temporal disconnectivity in FEP and structural alterations in both cortical and subcortical regions.

Neuroanatomical findings are consistent with patients’ neuropsychological performance.

Further studies to establish a relationship between white and grey matter disarray on one hand and neuropsychological testing are needed.

The international literature underlines an high rate of comorbidity between early psychosis and substance abuse associated to poor outcomes.

The aims of the present study are to evaluate the rate of substance abuse among subjects at first contact for psychotic disorder with one of the three Community Mental Health Centers (CMHC) of Bologna Ovest and to consider its influence on the course of the disease.

A retrospective study was conducted on subjects aged between 18-30 years with ICD-10 F2 (schizophrenia, schizotypal disorder and delusional disorder) diagnosis at first contact with a Bologna Ovest CMHC over a five-year period (January 2002- December 2006).

The sample was investigated about the presence of ‘Substance Abuse’ according to ICD-10 criteria. A 1-year follow-up assessment was performed.

Among the 56 patients recruited, 26 (46%) meet the ICD-10 criteria for ‘Substance Abuse’ (Abusers). Cannabis is the most frequently used substance (88%). Psychosis appears 1,1 year before among Abusers compared to Non-Abusers. At 1-year follow-up the 46% of Abusers works or studies compared to 67% among Non-Abusers. Moreover hospital admission concerns the 31% of subjects among Abusers and only the 17% of Non-Abusers group.

This study confirms the high rate of substance abuse among subjects with early psychosis reported in literature and suggests its potential negative influence on the course of psychotic disease. To improve the prognosis of patients with psychotic disorder and concurrent substance abuse it seems necessary promoting an integrated intervention between the CMHCs and the Addiction Services.

International literature has recently given great attention to risk factors and early detection of psychosis. According to this research line we have investigated the main characteristics of subjects at first contact for psychotic disorder with one of the three Community Mental Health Centers (CMHC) of Bologna Ovest.

A retrospective study was conducted recruiting subjects with ICD-10 F2 diagnosis (schizophrenia, schizotypal disorder and delusional disorder), psychosis onset between 18-30 years and at first contact with a Bologna Ovest CMHC over a five-year period (January 2002-December 2006).

The identified sample was evaluated on socio-demographic characteristics, history of substance abuse, history of hospital admissions and pathways to CMHCs.

The sample consists of 56 subjects. They are predominantly male (70%), unmarried (95%) and the most of them (79%) lives with their parents. Twenty-four patients (43%) have an eight year education, whereas 22 (39%) a thirteen year one. During the assessed period 24 (43%) subjects are unemployed and 15 (27%) are studying.

The median age of psychosis onset is 23,3 years and a concurrent substance abuse concerns 26 subjects (46%). Twenty-one (37,5%) patients present an history of hospital admissions.

Analyzing pathways to CMHCs we find that 16 (29%) subjects have been referred by hospital wards, 11 (20%) by their family, 10 (18%) by the General Practitioner, whereas 5 (9%) by themselves.

Notwithstanding the small size of the identified sample, this study seems to confirm the main characteristics of subjects at first contact for psychotic disorder reported in literature.

The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes.

To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal.

Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA.

675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = −.26; p = .05) and heart rate (r = .33; p = .01).

Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.

Psychosocial factors are often underestimated in psychotic patients, although they may profoundly influence (and be influenced by) clinical presentation and effectiveness of therapeutic interventions in these people.

To investigate relevance, relationship with clinical presentation and overall quality of life of multiple psychosocial factors in psychotic patients.

To evaluate whether knowledge about the illness and utilization of health services are defective in psychotic vs. non-psychotic patients and whether these correlates with the type of psychotic symptoms, cognitive performances, global social functioning, quality of life, and acceptance of pharmacotherapy.

Approximately 110 patients were enrolled after written informed consent. Patients were administered the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance scale (PSP), the Drug Attitude Inventory (DAI), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). All patients were also screened for cognitive performances. Patients and relatives completed a questionnaire on knowledge about the illness and on the level of utilization of mental health services. Patients were subdivided in psychotic (cases) and non-psychotic (controls) based on their score on the PANSS.

Psychotic patients and their relatives showed lower levels of knowledge about the illness. These features were associated with the other variables assessed in a very complex and multidimensional model of reciprocal influences.

Lack of response to pharmacological treatments and to overall therapeutic interventions in psychotic patients may also depend on multiple psychosocial factors, which may be carefully investigated and become the target of adjunctive, effectiveness-focused interventions.

According to the NMDA-R hypofunction hypothesis of psychosis, the administration of certain antagonists at NMDA-R, such as ketamine, may exacerbate psychotic symptoms in humans and provide a preclinical model of psychosis. Both ketamine and antipsychotic drugs induce molecular changes in genes of the post-synaptic density (PSD), involved in glutamate signaling and dopamine-glutamate interplay.

Memantine, an antagonist/partial agonist at NMDA-Rs with procognitive properties, has been proposed as an adjunctive treatment for schizophrenia.

We tested the hypothesis that memantine and propsychotic NMDA-Rs antagonists (ketamine and MK-801) may elicit divergent molecular changes at glutamatergic synapses.

Sprague-Dawley rats were treated by:

1. 1) vehicle;

2. 2) MK-801 0.8 mg/kg;

3. 3) memantine 5 mg/kg;

4. 4) ketamine 25 mg/kg;

5. 5) ketamine 50 mg/kg.

We compared, by in situ hybridization histochemistry, the expression of PSD genes in cortical and striatal brain regions.

Homer1a expression was significantly induced by ketamine 25 mg/kg and reduced by MK-801 in striatum and cortex. Arc expression was significantly induced by ketamine and memantine in the cortex and by MK-801 in nucleus accumbens. Homer1b/c expression was significantly decreased by ketamine compared to vehicle in motor cortex and dorsolateral striatum. PSD-95 expression was significantly decreased by MK-801 compared to vehicle in all striatal regions and by ketamine in dorsomedial striatum.

These results demonstrate that NMDA-Rs antagonists with different pharmacological properties trigger different molecular changes at glutamatergic synapses. These results are consistent with the different clinical profiles of these compounds and with the observation that NMDA-R blockade is not necessarily associated to psychosis exacerbation.

Borderline personality disorder (BPD) is a chronic condition with a strong impact on patients’ affective, cognitive and social functioning. Neuroimaging techniques offer invaluable tools to understand the biological substrate of the disease. We aimed to investigate gray matter alterations over the whole cortex in a group of Borderline Personality Disorder (BPD) patients compared to healthy controls (HC).

Magnetic resonance-based cortical pattern matching was used to assess cortical gray matter density (GMD) in 26 BPD patients and in their age- and sex-matched HC (age: 38 ± 11; females: 16, 61%).

BPD patients showed widespread lower cortical GMD compared to HC (4% difference) with peaks of lower density located in the dorsal frontal cortex, in the orbitofrontal cortex, the anterior and posterior cingulate, the right parietal lobe, the temporal lobe (medial temporal cortex and fusiform gyrus) and in the visual cortex (P < 0.005). Our BPD subjects displayed a symmetric distribution of anomalies in the dorsal aspect of the cortical mantle, but a wider involvement of the left hemisphere in the mesial aspect in terms of lower density. A few restricted regions of higher density were detected in the right hemisphere. All regions remained significant after correction for multiple comparisons via permutation testing.

BPD patients feature specific morphology of the cerebral structures involved in cognitive and emotional processing and social cognition/mentalization, consistent with clinical and functional data.

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.

A total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.

LoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.

LoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.

The authors have not supplied their declaration of competing interest.