Aripiprazole LAI is approved for the treatment of schizophrenia in adults. Recently, Europe and Canada approved the use of the two-injection start (TIS) regimen: two separate injections of 400 mg long-acting aripiprazole along with a single 20 mg dose of oral aripiprazole. Aripiprazole showed efficacy in the treatment of adolescents with acute schizophrenia in several controlled trials, leading to its approval for 13-17 year-old adolescents with schizophrenia by the EMA. However, the LAI formulation still remains off-label in adolescents.

To demonstrate the efficacy and safety of the TIS regimen of aripiprazole LAI formulation in a 16 year-old adolescent with schizophrenia.

We evaluated the symptoms of schizophrenia and general severity by means of the PANSS and CGI scales. The scales were administered at hospital admission, after 3 weeks, 5 weeks, and at 4-weeks follow-up.

At the admission the patient PANSS total score was 136, the CGI score of 7. Aripiprazole was started and up-titrated to 30 mg/day. After 3 weeks, the positive symptoms were significantly reduced; due to the persistence of negative symptoms, clozapine 100 mg/day was added. At week 5 the PANSS total score decreased to 81. Due to poor insight we proposed aripiprazole LAI with the two-injection start. One month later, global functioning and illness insight improved; PANSS score was 43, CGI score 2. There was no evidence of akathisia or other side effects.

Aripiprazole LAI showed good efficacy and tolerability in an adolescent with schizophrenia. The two-injection start regimen was a safe and viable option.

No significant relationships.

Clozapine has proven to have a unique efficacy on treatment-resistant schizophrenia (TRS). Nevertheless, studies show that 47%-63% of clozapine-treated patients may fail to respond after around 12-years of treatment (CRS). Several augmentation strategies have been proven to be effective in CRS.

Hereby, we present two clinical cases of CRS successfully managed with brexpiprazole augmentation.

A 48-year-old man without comorbid substance use, treated with clozapine-brexpiprazole augmentation, and a 20-year-old man with comorbid substance use, treated with clozapine-brexpiprazole combination and subsequently with twice-injection aripiprazole (TIA). They were administered with the following assessments at t0, t1-3 (first month), t4-8 (monthly until 6-month follow-up): CGI, BPRS, PANSS, CDSS, Craving VAS, BARS, BIS-11, HRS-A, MADRS, YMRS, AIMS.

At 1-month follow-up, both patients showed a considerable improvement (respectively 75% and 55.9% reduction of PANSS total score). At 6-month follow-up, reached only with the first patient, we noticed a further improvement (an overall 37.5% reduction of PANSS total score from the baseline).

The present work is the first report describing combination treatment strategies with clozapine and brexpiprazole which appear to give promising results.

No significant relationships.

Despite COVID-19 pandemic significantly impacting mental health, few studies evaluated effects on perinatal mental health.

Therefore, we aimed at assessing pregnant and puerperal women during first and second COVID-19 waves.

70 women (41 pregnant and 29 puerperal) consecutively afferent to our outpatient service for Perinatal Mental Health (March 2020-March 2021) were administered Edinburgh Postnatal Depression Scale (EPDS), Fear of COVID-19 (FCV-19-S), Coronavirus Anxiety Scale (CAS) and Wijma Delivery Expectancy/Experience questionnaire (WDEQ).

Women who reported last menstruation date (LMD) in 2019 second semester showed higher EPDS scores (p=0.026), those with estimated delivery date (EDD) in 2021 second semester showed higher CAS scores than those with EDD in 2020 first semester (p=0.020) or in 2021 first semester (p<0.001). Women with clinically significant EPDS Scores reported higher FCV-S-19 (p=0.005) and CAS (p=0.003). Subjects with a previous psychiatric hospitalization showed higher FCV-S-19 (p=0.003). A weak positive correlation (r=0,290; R2=0,084; p=0.015) has been observed between FCV-S-19 and EPDS. Furthermore, there was a strong positive correlation (r=0,377; R2=0,142; P=0.001) between CAS and EPDS and between CAS and FCV-S-19 (r=0,641; R2=0.410; p<0.001). All subjects showed high scores for tocophobia after experiencing delivery.

COVID-19 pandemic significantly impacted pregnant and/or postpartum women also without a previous psychiatric condition. Early identification and screening tools should be routinely provided to all pregnant and postpartum women.

No significant relationships.

Ekbom Syndrome (ES) is a condition characterized by the fixed, delusional belief that one’s body is infested by parasites or other vermin, in absence of supporting clinical evidence. Literature suggests antipsychotic treatment for the management of behavioural and psychotic symptomatology, long-acting-injectable (LAI) antipsychotics for poor compliance.

A case report of a 70-year-old woman with an ES diagnosis treated with LAI palmitate paliperidone was followed-up for an 8-months period, resulting in a confirmed diagnosis of secondary ES to Lewy Body Dementia (LBD).

Patient was admitted to the local psychiatry ward presenting with new-onset visual and tactile hallucinations and social withdrawal. She was diagnosed with ES in a context of executive functions impairment. She was initially treated with risperidone, then switched to LAI Paliperidone due to poor compliance. Subsequently she was monitored monthly for 8 months by administering PANSS, MOCA, GAF, BPRS, PSP, complete neurocognitive assessment and neuroimaging studies

After 8 months a progressive cognitive deterioration and worsening of motor impairment confirmed a secondary ES to a LBD. Meanwhile, a significant reduction of psychotic symptomatology (delusions and somatic hallucinations) was observed at BPRS and PANSS positive scale, even after treatment discontinuation due to the onset of extrapyramidal symptoms of the underlying condition.

LAI Paliperidone treatment induced a complete remission of psychotic symptoms, with no relapse even after discontinuation of treatment. Moreover, close observation during follow-up allowed early diagnosis of LBD, which has been associated with a more favorable course.

No significant relationships.

Non-suicidal self-harm (NSSH) include deliberate behaviours with the intent to self-injure. NSSH prevalence ranges 15.5%-31.3% in adolescents and young adults<25 years-old.

Our aim is characterizing the psychopathological domains occurring in adolescent and young adults with NSSH during the second COVID-19-related wave (October 2020-August 2021).

A cross-sectional study recruited inpatients aged 15-24 consecutively afferent to psychiatric ward due to NSSH, by investigating anger rumination(ARS), emotional regulation (DERS), dissociation (DES-II), metacognitive capabilities(MCQ-30), perceived stress (PSS), self-criticism (LOSCS), emotional intelligence (Reading the Mind in the Eyes Test-RMET), aggressiveness (AQ), impulsiveness (BIS-11), hopelessness(BHS), alexithymia (TAS-20). NSSH were characterized by using suicide score scale(SSS) and deliberate self-harm interview (DSHI).

A 7-fold increase in young inpatient access was observed from 2019 to 2021. DSHI median was 2 (95%CI=1,17-2,73), SSS-12months median was 5 (95%CI=4.2-6.7), SSS-lifetime median was 5 (95%CI=3.4-5.3) and MINI median was 5 (95%CI=3.4-4.7). Linear regression analysis and Pearson’s correlations revealed strong correlations between DSHI and BHS (r=0.550), TAS-20 (r=0.495), AQ-hostility(r=0.529),AQ-total (r=0.446), PSS(r=0.454), DERS-total (r=0.621), DERS-lack_of_control (r=0.658),MCQ-total(r=0.534),MCQ-perception_danger_not_control (r=0.583); between SSS-12months and AQ-total (r=0.456), AQ-Anger (r=0.443), BIS-total(r=0.457),BIS-Attentional-Impulsiveness (r=0.511),BIS-Complex-Motor-Impulsiveness (r=0.507), PSS (r=0.617), DERS(r=0.571), DES(r=0.559).

COVID-19-related increased perceived stress and depressive symptomatology may have facilitated the onset of severe NSSH in adolescents and young people with trait impulsiveness, hostility and affective dysregulation.

No significant relationships.

The peripartum is a period at high risk for the onset of depressive symptoms. The prevalence of peripartum depression (PD) ranges from 6 to 20% and is burdened with high adverse birth outcomes, poor mother-infant bonding, and a high risk for suicidal ideation and attempts. However, PD is underrecognized and consequently undertreated.

We aimed at screening depressive symptoms in women during pregnancy and postpartum, and evaluating the socio-demographic and clinical characteristics associated with depressive symptoms.

199 women, 55 during pregnancy and 144 in the postpartum period, consecutively admitted to the Perinatal Mental Health Service of Ancona (Italy) were administered a socio-demographic and clinical questionnaire together with the Edinburgh Postnatal Depression Scale (EPDS). Women scoring ≥ 12 at the EPDS were considered screening positive.

Twenty women (10%) were screening-positive. These women were more often foreigners (R2=0,032; β=0,178; p=0,012), single (R2=0,026; β=0,163; p=0,022), with a positive psychiatric family history (R2=0,114; β=-0,337; p=0,001) and more frequently affected by physical comorbidities unrelated to pregnancy (R2=0,03; β=0-0,174; p=0,014). These women also had more gestational comorbidities such as gestational hypertension (R2=0,02; β=-0,154; p=0,030), shortening of uterus neck (R2=0,05; β=-0,234; p=0,001), and miscarriage threats/placental abruption (R2=0,004; β=-0,067; p=0,001).

Our study highlighted the association between depressive symptoms and potentially dangerous gestational comorbidities. Our results further stress the need to screen all women in the peripartum for the presence of depression, in order to identify those at-risk and eventually put in place strategies to prevent further complications to mothers and children.

No significant relationships.

Patients with severe mental illness (SMI) have a higher risk of weight gain, dyslipidemia and insulin-resistance. It was observed that insulin resistance has a pathoplastic effect: in Schizophrenia it was associated with a greater severity of negative symptoms, whereas in Bipolar Disorder it was associated with more chronicity and rapid cycling. Moreover a correlation was observed between obesity and a worse outcome in Bipolar Disorder type I.

We aimed at assessing the influence of dysmetabolisms on clinical characteristics in patients with SMI.

We recruited 78 patients with SMI consecutively hospitalized in the Psychiatry Clinic of the Ospedali Riuniti of Ancona, Italy. We administered a checklist for socio-demographic and clinical features (diagnosis, age of onset, illness duration, number of episodes, number of episodes per year, suicidal attempts and comorbidities), and evaluated the following metabolic parameters: weight, height, BMI, abdominal circumference, blood pressure, total cholesterol, HDL, triglycerides, glycemia and insulinemia. We determined insulin-resistance according to the HOMA-IR model. We performed bivariate Pearson correlations to compare metabolic and socio-demographic/clinical parameters.

The analyses showed positive correlations between BMI and disease duration (P = 0.003), and BMI and the number of episodes (P = 0.022). Furthermore, a positive correlation was found between HOMA-IR and the number of episodes per year (P = 0.008). The associations remained statistically significant after controlling for age through partial correlations.

Weight gain and insulin-resistance in severe mental illness are associated with a more severe SMI, as suggested by the greater number of acute episodes.

No significant relationships.

Obsessive-Compulsive Disorder (OCD) is characterized by the presence of intrusive thought (obsessions) and ritualistic behaviour (compulsions). First-choice psychopharmacological treatment is based on serotonin reuptake inhibitors (SRIs). However, about half of OCD do not or partially respond to SRIs (TR-OCD) and need an augmentation strategy with second-generation antipsychotics (SGAs).

We report a case of severe OCD with comorbid anorexia nervosa, restrictive type (AN-r) treated with fluoxetine (up to 40 mg daily) and lurasidone (37 mg daily bedtime) augmentation.

At baseline and monthly 4-months-follow-up were administered Y-BOCS-II (Yale-Brown Obsessive Compulsive Scale), CGI-S (Clinical Global Impression-Severity), SCL-90 (Symptom Checklist-90 items) and EDI-3 (Eating Disorder Inventory-3).

Compared to the baseline, a clinically significant clinical response was observed on OC at Y-BOCS-II (≥35% Y-BOCS reduction) and eating symptomatology at EDI-3 after 1 month of augmentation treatment, while a full remission after 3 months (Y-BOCS scoring ≤ 14)(p<0.01). We also noticed, throughout clinical follow up interviews, improvement in patient’s social skills and life satisfaction.

Further longitudinal and real-world effectiveness studies are needed to confirm these preliminary findings and investigate the potential of lurasidone augmentation strategy in attenuating OC symptomatology in TR-OCD and whereas a comorbid AN-r is present.

No significant relationships.

A growing amount of studies investigating the mental health impact of the current COVID-19 pandemic worldwide have been recently published, even though very few studies investigating the impact of the COVID-19 outbreak and lockdown on the mental health of fathers of newborns during the COVID-19 pandemic, particularly on paternal postpartum depression (PPD).

A case report describing a 37-years-old man with an obsessive-compulsive personality who manifests the onset of a clinically relevant PPD following his wife’s delivery during the COVID-19 pandemic and the onset of obsessive symptomatology.

At baseline and during a 12-months follow-up were administered the Edinburgh Postnatal Depression Scale (EPDS), Fear of COVID-19 (FCV-19-S), Coronavirus Anxiety Scale (CAS) and Y-BOCS-II (Yale-Brown Obsessive Compulsive Scale).

Patient was successfully treated with vortioxetine up to 20 mg/die with a significant clinical remission of depressive and obsessive symptomatology at 6 months and a maintenance therapy with vortioxetine 10 mg daily.

PPD should be better investigated, particularly the impact of COVID-19 pandemic on mental health of fathers of newborns during the COVID-19-related situation.

No significant relationships.

COVID-19-related physical isolation, fear and anxiety determined de novo mental illnesses, by potentially facilitating the emergence of Hikikomori traits (i.e., a severe social withdrawal condition).

The present study aims at screening a cohort of university students for the Hikikomori traits and assessing a set of psychopathological determinants associated with Hikikomori, particularly boredom and loneliness dimensions.

A cross-sectional web-based survey was carried out by administering Hikikomori Questionnaire (HQ-11), Italian Loneliness Scale (ILS), Multidimensional State Boredom Scale (MSBS), Depression Anxiety Stress Scale (DASS-21) and Toronto Alexithymia Scale (TAS-20).

1,148 respondents (767 women and 374 men, mean age: 23.2±SD=2.8 years old) were recruited. 70.7% declared to have experienced psychological distress. HQ-11 average total score was 18.4±SD=7.5 with statistically significant higher values in the males (p=0.017) and amongst students studying Informatics, Mathematics/Physics/Chemistry, Science of Communication and Engineering. The HQ-11 positively correlated with ILS (r=0.609), MSBS (r=0.415), TAS-20 (r=0.482) and DASS-21 (r=0.434).

This study represents the first screening of the Hikikomori phenomenon in Italian university students. Hikikomori traits appear to be particularly represented in the Italian youth population and should be carefully investigated in future studies.

No significant relationships.

Age at onset of type-I bipolar disorder (BD-I) typically averages 12-24 years, is older among patients with type-II-BD (BD-II), even though generally before 50-years-old (EOBD). Clinical observation of late-onset BD (LOBD) posed some questions regarding a differential phenotypic/psychopathological manifestations and affective temperaments between LOBD vs EOBD.

A case-control pilot-study was carried out to investigate psychopathological, clinical and temperamental features of a psychogeriatric cohort of LOBD and EOBD subjects.

Out of 74 enrolled patients, 64 patients (31 EOBD, 33 LOBD) were included and administered an ad hoc socio-demographic datasheet, BPRS, CGI, GAF, HAM-D, GDS, MSRS, MRS, MOCA and TEMPS-M.

LOBD is significantly associated with higher rates of BD-II diagnosis (X2 = 26.1, p<.001), depressive (p=0.05) and mixed states (p=0.011), higher comorbid anxiety levels and depressive affective temperament (p<.001); while clinical manifestations of geriatric EOBD is significantly associated with higher endocrinological (X2 = 7.815, p=.005) and metabolic comorbidity (X2 = 6.896, p=.009), a diagnosis of BD-I, manic episodes and hyperthymic (p=.001) affective temperaments. GDS and MSRS total scores were significantly higher in LOBD (respectively, p<.001 and p=.008).

Further studies with larger sample sizes and a control group should verify whether LOBD is a distinct psychopathological entity from EOBD and evaluate differences (if any) in terms of prognosis and treatment between EOBD and LOBD.

No significant relationships.

Hikikomori represents the severe social withdrawal condition of the so-called ‘modern type-depression” (MTD). Digital addictions, including Internet addiction (IA), Internet gaming disorder (IGD) and smartphone addiction, have been associated with MTD and Hikikomori.

This is a post-hoc study aimed at assessing digital addictions in a cohort of university students with a positive screening for MTD and Hikikomori.

A cross-sectional web-based survey was conducted by administering the Hikikomori Questionnaire (HQ-11), Internet Addiction Test (IAT), Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) and the Smartphone addiction scale-Short Version (SAS-SV).

Among 1,148 respondents, a significant association was found between the HQ-11 scale and the DASS-21 total score (r=0.434). The HQ-11 positively correlated with IAT, IGDS9-SF and SAS-SV (r=0.329; r=0.292 and r=0.205 respectively).

Digital addictions appear to be widely diffuse among university students positive to the Hikikomori and MTD screening. Further longitudinal studies are needed to weight and balance the potential consequences of digital tools in Hikikomori subjects.

No significant relationships.

The COVID-19 pandemic led to the implementation of digital psychiatry (DP) in everyday clinical practice, resulting in the need for a skilled healthcare workforce.

Our purpose was to investigate the level of training, knowledge and expertise of young mental health professionals and medical students in DP, as well as exploring their beliefs and experiences in this field.

An ad hoc cross-sectional survey was designed and administered to Italian medical students, psychiatry trainees, and early career psychiatrists.

Most of the sample declared that the topic of DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on DP. Nevertheless, they mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that the academic background should include a dedicated course/module (54.4%). Moreover, most subjects declared that DP is less effective than in-person interventions (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p≤0.05).

During the current pandemic, DP represented an ideal response to the need for physical distancing by ensuring the advantage of greater access to care. However, DP interventions are still uncommon, and there remains a certain resistance to their use in mental health care. The lack of formal training during the academic training could be a limiting factor. Therefore, addressing these issues in academic settings could be crucial to spreading this innovative practice also in the post-COVID-19 era.

No significant relationships.

Several studies demonstrate that patients with Bipolar Disorder (BD) have worse physical health in comparison with the general population, reporting higher frequency of cardiovascular disease, diabetes, hepatitis, and respiratory disease (Kilbourne et al., 2004; Casey, 2005; Perron et al., 2009). However, no studies have reported whether medical comorbidities correlate with clinical characteristics such as diagnosis, comorbidity, or other clinical variables.

We evaluated patients with BD diagnosed by SCID-I. Medical conditions were classified by ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic.

The following variables were also collected: psychiatric comorbidity, age at onset, duration of illness, duration of untreated illness (DUI), lifetime suicide attempts.

309 patients with BD were recruited; the 68% had type II disorder. 195 (63%) were females. Age at onset was 50.7 years. 170 patients (55%) had at least one medical condition; the most frequent were endocrine/metabolic (23%), vascular (21%), musculoskeletal (11%). Medical comorbidity was related with age and DUI. Hepatic conditions were associated with Axis-II comorbidity.

within medical conditions, endocrine/metabolic disease is the most frequently represented in patients with BD. DUI, which has been associated with worse outcome of BD (Suominen et al., 2007; Morken et al., 2009; Dell’Osso et al., 2010), is also associated with a higher medical burden also after controlling for age. This association might be mediated by the worse lifestyles and low levels of access to care in under-recognized patients.