Anxiety disorders are among the leading contributors to global disability and frequently co-occur with major depressive disorder (MDD), chronic pain, and various psychiatric or somatic comorbidities. Effective management of these conditions necessitates a personalized approach informed by current scientific evidence. Extended-release (XR) venlafaxine, a serotonin-noradrenaline reuptake inhibitor, has emerged as a first-line pharmacological option, endorsed by international guidelines for generalized anxiety disorder, panic disorder, and social anxiety disorder. Its dose-dependent dual mechanism, initially serotonergic, progressing to noradrenergic, enables tailored therapeutic strategies aligned with symptom severity. This narrative review, integrating Italian expert consensus and recent literature, highlights the robust efficacy of XR venlafaxine across anxiety disorders, its favorable tolerability profile due to the osmotic pump zero-order release formulation, and its unique capacity to address residual symptoms such as anhedonia and SSRI-induced emotional blunting. Emerging evidence suggests additional roles for venlafaxine in immunomodulation and the promotion of neuroplasticity, which may further enhance its therapeutic benefit. Given the established role of XR venlafaxine as a key therapeutic option in the pharmacological management of anxiety disorders, and acknowledging the impact of CYP2D6 metabolic variability on its efficacy and tolerability, pharmacogenetic testing could be recommended to optimize treatment personalization. It holds particular promise for patients with comorbid or treatment-resistant profiles, offering measurable benefits in quality of life, functional outcomes, and long-term disease management.
BACKGROUND:Violent behaviours continue to be a significant problem worldwide. The introduction of Motion Rooms, particularly within acute psychiatric settings, can provide a safe and therapeutic intervention that, by promoting emotional self-regulation, reduces emotional distress and aggressive behaviors. AIM:To assess the effects of a therapeutic intervention through the use of the Motion Room on the risk of violent behavior and the use of physical restraint. MATERIALS AND METHODS:A longitudinal design was used to evaluate the effectiveness of the Motion Room in an acute psychiatric unit. The Italian version of the Broset Violence Checklist (BVC-ita) was used for the assessment of the risk of aggression before (T0) and 2 hours after intervention (T1). RESULTS:102 patients were enrolled, 96 (94.12%) completed the intervention. The number of subjects at moderate/high risk decreased significantly at T1 (p=0.01). In the two hours following the intervention, one patient was subjected to physical restraint. CONCLUSIONS:Our results suggest that sensory rooms can be a strong support for nursing staff in preventing aggressive behavior in an acute psychiatric ward. Further research with broader sampling and randomized studies is needed.
The history of the transition from Kraepelin's concept of manic-depressive psychosis and endogenous depression to the current model of major depression is traced. In particular, the changes that have characterized the transition from the narrative psychopathology of the positivist era to the operational psychiatry of the DSM-III and its successors over the last century are critically reviewed. The birth of psychopharmacology, with the consequent entry of market interests into psychiatry and de-institutionalization, have shifted psychiatric patients from mental hospitals to outpatient clinics, resulting in enormous changes in both quantity and quality of samples. The changing composition of psychiatric population, with an ever-increasing prevalence of non-psychotic cases, and the progressive abandonment of the phenomenological cultural substratum in favor of more empirical paradigms, has rendered old classifications based on narrative criteria inadequate. Hence the need for more 'scientific' models, driven mainly by the need for reproducibility, was necessary for the application of scientific empirical methods. This article focuses on the changes that the concept of depressive illness has undergone in the transition from descriptive psychopathology to the current operational diagnoses. The various forms of depression described prior to DSM-III (endogenous depression, neurotic depression, reactive depression, atypical depression, seasonal depression, masked depression, involutional depression, depressive pseudodementia), examined in the frame do DSM-5, are either excluded because of the lack of evident depression (masked depression, depressive pseudodementia) or all absorbed into the single broad category of major depressive disorder, which thus becomes a broad container which is likely to lack homogeneity, as has been repeatedly pointed out over the years. On the other hand, what the authors of DSM (the latest edition in particular) have proposed as a remedy, the sub-categorization of the disorder through the description of specific typer (the specifiers), is in fact ignored both in research and in clinical practice.
The present study aims to clarify whether salivary and serum nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels might reflect the cognitive processing style of healthy subjects and migraine sufferers. All subjects underwent the recording of visual evoked potentials (VEP) to evaluate visual habituation. Dosing of plasmatic and salivary levels of NGF and BDNF was performed as well. Our research provides insights into the role of neurotrophins and the analytic style of processing visual information in pain mechanisms, potentially identifying them as targets for new integrated therapeutic strategies, both pharmacological and non-pharmacological, for primary headaches.
BACKGROUND:This survey aimed to investigate how physicians in Italy recognize, diagnose, and manage tardive dyskinesia (TD), as well as to assess and identify gaps in the current treatment approaches. METHODS:A non-interventional cross-sectional online survey was conducted among Italian physicians who had managed patients with TD in the 1 year prior to the survey. The questionnaire explored physicians' demographics, clinical experience, diagnostic methods, treatment strategies, perceptions of TD impact, and health care resource utilization related to TD. Data were summarized descriptively. RESULTS:The survey included 70 psychiatrists and 30 movement disorder neurologists. Most patients presented with mild (49%) or moderate (35%) TD. Treatment strategies varied by TD severity; antipsychotic dose modification or switching was common, particularly to clozapine, quetiapine, and aripiprazole, whereas TD-specific add-on treatments such as tetrabenazine were rarely used (12% to 21% of physicians prescribed the treatment). Movement impairment was primarily assessed through patient or caregiver reports on quality-of-life impact, while standardized scales like the Abnormal Involuntary Movement Scale were underused, especially by psychiatrists. Physicians acknowledged significant challenges including a lack of highly effective treatments and an absence of specific Italian or European guidelines. TD was perceived as significantly affecting patients' physical and psychosocial functioning and increasing health care resource utilization. CONCLUSIONS:This study highlights variability and unmet needs in TD diagnosis and management among Italian specialists. Add-on treatments such as tetrabenazine are not considered standard of care in Italy due to lack of clinical practice guidelines, concerns around drug efficacy, adverse events, and overall treatment satisfaction.
Scopo. In Italia, le persone con disturbi mentali gravi (DMG) sono spesso assistite in strutture residenziali psichiatriche (SRP). I DMG comportano sintomi persistenti, deterioramento del funzionamento e marginalizzazione sociale. Nonostante l’obiettivo delle SRP sia promuovere la recovery personale, ovvero una vita al meglio delle proprie possibilità, l’adozione di tali approcci resta problematica. Questo studio mira a valutare l’efficacia della recovery personale rispetto al trattamento standard per migliorare funzionamento e benessere dei pazienti, integrando alle valutazioni l’uso di biomarcatori e tecnologie innovative, e diminuire burden e burnout per caregiver e professionisti. Metodi. EMPOWER-RES è un trial clinico multicentrico non randomizzato che confronterà persone con DMG in SRP trattate con approccio orientato alla recovery personale (n=36) o con trattamento standard (n=36), appaiate per sesso, età e diagnosi. Il trattamento orientato alla recovery personale utilizzerà la Mental Health Recovery Star, strumento che rappresenta dieci dimensioni della vita e monitora le fasi del processo di cambiamento. Valutazioni standardizzate saranno condotte al basale e dopo 6 mesi su persone con DMG, caregiver e professionisti. Saranno inoltre raccolti dati tramite app per smartphone (esperienze quotidiane, umore, relazioni), accelerometri (attività fisica e ritmo sonno-veglia) e biomarcatori biologici. Risultati. Non ancora disponibili. Discussione e conclusioni. Si ipotizza che i percorsi di recovery incrementeranno significativamente il Funzionamento Personale e Sociale (punteggio FPS ≥5 punti a 6 mesi), ridurranno il burden dei caregiver e il burnout dei professionisti. Lo studio offrirà nuove evidenze per ottimizzare i servizi di salute mentale e le opzioni terapeutiche per persone con DMG in SRP.
OBJECTIVE:Femicide represents the most extreme expression of violence against women. This article aims to frame femicide through a shared medico-legal definition and to illustrate its distinctive forensic characteristics, highlighting their relevance for prevention, while also addressing the convergence between forensic evidence and the recent legal recognition of femicide in Italy. METHODS:The paper integrates conceptual analysis with empirical evidence derived from a nationwide forensic case-series conducted in Italy, involving 27 university Institutes of Forensic Medicine. Femicide cases were identified according to a shared medico-legal definition grounded in the violation of the victim's right to self-determination. Circumstantial, relational, and lesional patterns were systematically analyzed and interpreted within an interdisciplinary framework. RESULTS:Femicide emerged as a distinct form of female homicide, predominantly occurring in intimate or domestic contexts and characterized by recurrent forensic features, including overkillng, involvement of identity-related body areas such as the face and erogenous zones, and the use of multiple or combined methods of attack. These patterns were significantly less frequent in other female homicides and challenge narratives centered on psychopathology of the perpetrator. DISCUSSION AND CONCLUSIONS:Findings support the recognition of femicide as a specific and identifiable phenomenon rooted in the denial of women's self-determination. The medico-legal approach provides objective elements that not only facilitate post hoc classification but also offer valuable insights for risk assessment and prevention. Knowledge, shared definitions, and awareness are essential tools to recognize violence early and to prevent its lethal escalation.
This article offers an interdisciplinary analysis of femicide as a historical, anthropological, and structural phenomenon, arguing that it should not be understood as a contingent anomaly or an archaic residue, but as a recurrent form of violence rooted in the dynamics of human social organisation. The analysis distinguishes between proximate causes, which vary across time and space in relation to legal, economic, and cultural contexts, and underlying causes, characterised by a high degree of transhistorical and transcultural stability. Comparative data indicate that femicide occurs predominantly within intimate relationships, disproportionately affects young women and women of reproductive age, and is more frequent in contexts of socio-economic vulnerability. The article reconstructs the genealogy of the concept of "femicide," from its first nineteenth-century lexical appearance to its theoretical reformulation beginning in the Seventies, and to the emergence, in the twenty-first century, of the notion of "feminicide." The analysis integrates a historical-structural perspective with an anthropological-evolutionary approach, highlighting the role of predispositions related to sexuality, jealousy, and control. These predispositions are not treated as deterministic, but as strongly shaped by processes of socialisation. On this basis, the article argues for shifting a substantial part of prevention "upstream," addressing not only femicide as an extreme event but also the more ordinary forms of domination and relational violence. It advances the hypothesis that systematic school-based anti-bullying prevention may constitute an effective long-term strategy for reducing gender-based violence, through education in scientific rationality, the recognition of cognitive biases, non-violent conflict management, and an understanding of institutional functioning.
Femicide is recognized as one of the most severe expressions of gender-based violence and causes complex assessment issues for both criminal justice systems and forensic psychiatry. This paper assesses the relationship between mental disorder and criminal responsibility of perpetrators of femicide and intimate partner homicide (IPH), through a comparison of clinical-forensic evidence from different national contexts. Four international studies (England and Wales, Sweden, Mexico, and South Africa) and the report of the Italian Parliamentary Commission on femicide for the 2017-2018 biennium were considered. Overall, a substantial proportion of perpetrators present psychiatric symptoms or prior contact with mental health services; however, judicial findings of non-responsibility remain relatively infrequent. In England and Wales, symptoms of mental disorder at the time of the offence are reported in approximately 20% of IPH cases, whereas outcomes closest to findings of non-responsibility concern less than 1%. In Sweden, 41.3% of IPH perpetrators had previous contact with psychiatric services, but major mental disorders at the time of the offence account for approximately 11% of cases. Higher frequencies are observed in samples selected for forensic psychiatric evaluation. In Italy, among 118 cases concluded with sentencing, a mental disorder affecting criminal responsibility was recognized in 24.6% of cases: full insanity in 13.6%, partial insanity in 7.6%, and suspension of proceedings due to incompetence to stand trial in 3.4%. Overall, the findings highlight the need to carefully distinguish between psychiatric diagnosis and legal constructs of criminal responsibility. The presence of a mental disorder does not automatically imply non-responsibility and requires an individualized clinical-forensic assessment, focusing on the nexus between psychopathological condition, capacities at the time of the offence, and the relational context in which the act occurred.
Within the complexity of the phenomenon of femicide, it is possible to identify some recurring elements that support some reflections on the etiological mechanisms of this dramatic phenomenon. The personality profile of the male perpetrator of femicide is very often characterized by the variable interaction of several key psychological and behavioral dimensions, potentially characterized by psychopathology, such as jealousy, possessiveness, impulsiveness, aggression, and dependence. These personality traits appear to be fundamental in the couple's relationship, and the breakdown of this relationship due to the woman's evolution toward greater autonomy can induce in the man a reaction of emotional dyscontrol, centered essentially on anger. This, even in a state of lucidity, awareness, and self-determination, can result in the woman's murder. The cultural context of belonging can naturally play a role in fostering this development. Excessive anger, a primary factor in the mental state of the perpetrator of femicide, can extend its effects to broader destructive behaviors, both toward other family members and toward the femicide himself, thus shaping the frequent phenomenon of femicide-suicide. Although the limited literature consistently indicates a low incidence of recognized mental disorders in the perpetrator prior to the act, the overall picture of the event appears repetitive and indicates a basic formal structure that suggests a possible "syndromic" model of his psychopathology in which an excess of anger plays a central role. Early recognition of the dynamic factors underlying this structure can contribute to developing strategies for preventing femicide.
Homicide-suicide is a rare but highly impactful form of lethal violence characterized by the convergence of suicidality, interpersonal aggression, and psychopathology. This narrative review summarizes current evidence regarding epidemiology, major subtypes, interpretative models, psychiatric and relational risk factors, risk assessment strategies, prevention approaches, and medico-legal implications within forensic psychiatry. Available data suggest that homicide-suicide represents a distinct phenomenon rather than the mere succession of homicide and suicide, most frequently occurring in intrafamilial contexts, particularly in intimate partner violence. Depression, suicidal ideation, relational crisis, substance misuse, warning signs, and access to lethal means emerge as the most relevant clinical and contextual variables. From a forensic psychiatric perspective, risk assessment requires an integrated and dynamic approach combining clinical judgment, structured instruments, collateral information, and evaluation of relational escalation. Preventive strategies include early identification of high-risk configurations, restriction of access to lethal means, interagency collaboration, and timely protective interventions. Homicide-suicide therefore represents a major clinical and medico-legal challenge, highlighting the need for specific operational protocols and closer integration between suicide prevention and violence prevention frameworks.
After a brief reflection on the choice of the term femicide, the discussion moves toward a psychoanalytical reading of the phenomenon, starting from the classical texts of Sigmund Freud, Melanie Klein e Jacques Lacan, and extending to contemporary theorization on gender culture and the culture of the neutral. Dynamics of possession are analyzed through the lens of Italian feminism, in an interweaving of psychoanalysis and feminism aimed at assessing the risk and preventive factors of this harrowing phenomenon.
This editorial summarizes the 2025 Sapienza University conference on femicide, emphasizing a multidisciplinary approach. Femicide is defined as a structural "crime of power" rooted in gender inequality and the drive for domination, rather than isolated pathology. Risk factors include possessiveness, jealousy, and male identity crises triggered by female autonomy. Research identifies it as the terminal stage of relational violence, often involving "overkilling". Prevention requires early recognition of warning signs and "upstream" educational interventions to address aggression in schools. The authors call for a cultural transformation and institutional accountability to dismantle stereotypes that normalize violence. Ultimately, femicide is framed as a social problem needing coordinated clinical, legal, and cultural action across society.
Femicide represents an unparalleled criminal phenomenon both in Italy and worldwide, characterized by tolerance and substantial impunity rooted in a culture shared even by institutions. With Law No. 181 of 2025, Italy stands among the few European countries to have included the crime of femicide into the penal code, clearly defining the discriminatory structure of a crime too often romanticized and reduced to a private matter. Article 577-bis punishes anyone who causes the death of a woman with life imprisonment when the crime is committed as an act of hatred, discrimination, abuse, control, possession or domination on a woman. WHO data show that 35% of women experience violence, especially within the family, and that the leading cause of death for women aged 16 to 44 is murder by their partner or ex-partner. Globally, 137 femicides occur every day, approximately 50,000 per year. Only 10.5% of victims report to authorities. The Italian Commission of Inquiry found that 90% of 211 femicides were committed in an affective and familial context, and only in 15% of cases women had previously reported abuse. Male violence against women is systematic and discriminatory in every social, cultural and economic context. Binding supranational sources (CEDAW, ECHR, Istanbul Convention, EU Directives) are based on the assumption that these crimes are rooted in unequal relations between the sexes. The psychiatrisation of femicide perpetrators represents an interpretive distortion that makes invisible the discriminatory nature of the crime. International scientific evidence confirms that only a small percentage of femicides are committed by subjects with diagnosed mental disorders.
INTRODUCTION:Patients with schizophrenia require long-term treatment, and poor medication compliance during therapy is a common issue. Poor compliance can lead to recurrent fluctuations in the patients' disease course, exacerbate its progressive deterioration, severely impact patients' social functioning and quality of life, and thus represents an increasingly serious public health problem. Long-acting injectable antipsychotics (LAIs) are generally considered one of the most effective treatments in psychiatry, which can reduce the substantial economic burden on patients and society, lowering readmission rates, improving patients' quality of life, and decreasing healthcare costs. This study is a retrospective analysis based on follow-up data from patients with severe mental disorders. OBJECTIVE:The study aims to explore the factors influencing medication compliance in schizophrenia patients treated with paliperidone palmitate injection, providing a basis for developing targeted compliance intervention strategies in clinical practice. The study included schizophrenia patients receiving paliperidone palmitate injection and systematically analyzed the impact of variables such as demographic characteristics, caregiver competence, social functioning, disease duration, and the presence of comorbid chronic conditions on medication compliance. CONCLUSIONS:Medication compliance in patients with schizophrenia is influenced by the interaction of multiple factors. Among these, age ≥50 years is a core independent risk factor affecting medication compliance, while having a guardian with good caregiving ability serves as an independent protective factor. The impact of a disease duration ≥10 years on compliance approaches statistical significance (p=0.050). A comparison of social functioning across the dimensions of the SDSS revealed that differences in social functioning deficits between the two groups with different levels of medication compliance were only evident in the dimensions of social withdrawal and interest in and concern for the external environment. This suggests that deficits in these specific dimensions of social functioning are also important factors influencing medication compliance in patients.
This article aims to explore, through a psychological-narrative reading of the film "La Pianiste" (Haneke, 2001), specific dynamics that underpin paraphilic behavior. The focus is specifically placed on masochism and on the ambiguities surrounding the concept of consent within BDSM practices. The protagonist, Erika Kohut, is here described through the psychodynamic perspective together to the attachment theory. At the core of the analysis lies Erika's symbiotic and deeply oppressive relationship with her mother, which finds expression in self-harming rituals and submission fantasies. The erotic relationship and the sexual life of the protagonist, characterizing the film, poses a crucial question: how free is a "yes" in reality? While consent is often framed as a conscious and voluntary act, Erika's story reveals it to be a dangerously ambivalent terrain, shaped by unresolved psychic wounds. This work does not aim to stigmatize or pathologize BDSM practices, but rather to interrogate their "shadow zones": when do these practices become a space for reconstructing the Self, and when do they risk turning into a stage where unprocessed suffering is compulsively replayed?
This article compares two perspectives on depression: the modern psychiatric paradigm, which conceives of depression as an episodic nosographic entity with neurobiological underpinnings, sometimes accompanied by psychotic symptoms; and the Lacanian psychoanalytic framework, which understands depression as an affect secondary to a specific psychic structure and to the subject's relation to the Real. In Freud's work, depression may be endogenous (melancholia) or related to grief, whereas in Lacan's theory it may arise within any psychic structure (neurotic, perverse, or psychotic) and reflects a subjective renunciation of knowledge, carrying a fundamental ethical dimension. The paper discusses the clinical implications of Lacanian perspective: it is crucial to assess the possible presence of an underlying psychotic structure beyond the depressive affect, in order to prevent potential harm for the patients.
The management of risk associated with clinical processes is gaining increasing importance in both health policy and medical research. Data show that among mental health professionals, cases of violence and burnout are on the rise. Implementing appropriate risk management strategies in psychiatry should be considered a key objective. This study aims to provide an overview of the current state of psychiatric risk management, with particular focus on Italian community-based mental health services. Through a non-systematic review of international and national literature, we identify the main areas of risk in psychiatry, which can be summarized as: interpersonal violence, coercive interventions, environmental safety, adverse drug events, clinical errors, and professional burnout. In the Italian context, critical issues mainly concern the protection of staff well-being and safety, the management of forensic patients according to Law 81/2014, and the acquisition of informed consent. The National Action Plan for Mental Health 2025-2030 formally recognizes risk management as a field of action, outlining related priorities and operational strategies. For the effective implementation of risk management in community-based psychiatry, it appears to be necessary the dissemination of standardized assessment and monitoring tools, promote workforce continuous training, and strengthen the culture of consent and shared decision-making.
AIMS:This study aims to evaluate the impact of the Tor Vergata University psychological support service in promoting well-being and mitigating psychological distress among students. The research sought to examine changes in overall functioning and psychopathological dimensions following participation in a structured counseling intervention, assessing its role as a preventive and supportive resource within the academic environment. METHODS:A longitudinal study was conducted on 83 university students (mean age= 22.3±2.38 years; 69.9% female) who accessed the Sportello Studenti psychological support service. Participants completed standardized assessments at baseline (T0) and after seven counseling sessions held every two weeks (T1), with the Beck Depression Inventory-II (BDI-II), the Symptom Checklist-90-Revised (SCL-90-R), the Pittsburgh Sleep Quality Index (PSQI), and the Global Functioning: Role and Social Scales (GF: Role; GF: Social). Non-parametric paired comparisons (Wilcoxon signed-rank tests) were used to evaluate changes in psychological distress and functioning. RESULTS:Following participation in the counseling program, students showed significant improvements across functioning domains, while depressive symptoms and general psychopathology significantly decreased. DISCUSSION AND CONCLUSIONS:The results demonstrate that short-term counseling interventions delivered within a university setting can produce measurable benefits for students' mental health. The Sportello Studenti represents an accessible, preventive, and effective first-line service for addressing psychological distress in university populations. Future research with larger samples, control groups, and long-term follow-up is warranted to confirm these outcomes and further optimize psychological support strategies within higher education contexts.
This paper describes the psychological and clinical course of a nine-year-old girl from Gaza admitted to a Pediatric Department. A family-centered psychological intervention was implemented during hospitalization. The clinical presentation was consistent with post-traumatic stress disorder. The case highlights the importance of early psychological intervention in supporting trauma processing, limiting the effects of prolonged hospitalization, and fostering a shared multidisciplinary narrative of the traumatic experience.
