Generative artificial intelligence (AI) such as GPT-4 refers to systems able to understand and generate new coherent and relevant text by learning from existing data sets. The great opportunities that GPT-4 offers are accompanied by great risks. Indeed, the ease of access and use of such a tool also makes it the platform of choice for malicious users. The purpose of this work is to test the machine's capabilities in identifying and reframing so-called Techniques of Neutralization (ToN), rationalizations employed by offenders to justify their deviant behavior. The identification of such theoretical cornerstone of criminology in interviews with offenders is crucial for criminologists, as it provides relevant information on criminodynamics, risk assessment and possible intervention strategies. Our outcomes show a high level of the machine's accuracy in general ToN recognition of Published and Crafted ToN sentences in both Test 1 (precision of 0.82 and recall of 0.75 for "Denial of Injury" in Crafted ToN, precision of 0.93 and recall of 1 for "Absence of ToN" in Published ToN) and Test 2 (precision of 1.00 and recall of 0.83 for "Denial of Injury" in Crafted ToN, precision of 1.00 and recall of 1.00 for "Absence of ToN" in both ToN categories). Regarding the reformulation of sentences to remove ToN (Test 3), the model demonstrates high success rates for most ToN categories and high credibility of the reformulated sentences, indicating its ability to maintain the integrity of the sentences while removing the ToN. Our work analyses the application of the machine with respect to a previously untested construct, with the aim of observing the potential and, above all, the possible pitfalls behind the use of AI models in a hitherto little-explored context such as criminology.

BACKGROUND:Existing research on menopause and Bipolar Disorder indicates a general exacerbation in depressive symptoms but lacks clear distinctions between menopausal stages, despite their specific hormonal and symptomatic profiles. This study assesses how postmenopause versus the reproductive phase impacts the progression and antidepressant responsiveness of bipolar depression in women with Bipolar I Disorder. METHODS:This prospective cohort study included 364 women with moderate to severe depressive episodes. Participants were classified into postmenopausal and reproductive groups based on the Stages of Reproductive Aging Workshop + 10 criteria. Over four weeks, all participants received a personalized treatment, with depressive symptoms assessed weekly. RESULTS:Similar depression severity was observed between groups at the outset of the study. However, women in postmenopause experienced worse treatment responses and lower remission rates, despite the application of more complex treatment strategies. Notably, the impact of postmenopause on treatment outcomes, despite a small effect size, proved independent of age and comorbidities. CONCLUSIONS:This exploratory research is the first to specifically assess the impact of postmenopause on bipolar depression, revealing its independent and negative influence on treatment outcomes. The small outcomes differences observed between groups, achieved through the use of more complex treatment strategies, suggest that developing tailored therapeutic protocols could significantly improve the clinical management of these patients.

INTRODUCTION:Psychoeducation is a key intervention in mood disorders. With the rise of artificial intelligence (AI) conversational agents, tools like ChatGPT are increasingly consulted by patients. Yet, empirical data on how AI-generated psychoeducational content is perceived by patients and professionals remain limited. METHODS:In this cross-sectional study, 30 depressed inpatients submitted five open-ended questions to ChatGPT-4o. Responses were rated by patients using 5-point Likert scales for relevance, comprehensibility, usefulness, empathy, and acceptance. Independent safety checks were applied to all outputs. The same responses were later blindly evaluated, in randomized order, by three psychiatrists and three psychiatric rehabilitation technicians (PRTs). RESULTS:All outputs passed safety review. Patients assigned higher total scores (mean ± SD = 22.43 ± 2.64) than PRTs (17.63 ± 3.39) and psychiatrists (15.42 ± 2.02). The largest gaps involved empathy and acceptance, whereas relevance, usefulness, and comprehensibility differed less. PRT ratings were intermediate: closer to patients on relevance, comprehensibility, and usefulness, but closer to psychiatrists on empathy and acceptance. Within patients, no associations emerged with age, education, depression severity, or prior psychoeducation. CONCLUSIONS:Patients with mood disorders perceived ChatGPT-generated responses as more relevant, comprehensible, useful, accepting, and empathetic than health professionals did. With conversational agents entering psychoeducation, clinicians must develop strategies to critically integrate such tools, ensuring safety and quality while guiding patient use. The challenge is not resisting AI adoption, but framing it within safe, effective, and ethically sound psychoeducational care.

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention.

Objectives This study aims to investigate the effectiveness of Bright Light Therapy (BLT) in reducing irritability, psychomotor agitation, and anger attacks in patients with bipolar depression comorbid with alcohol misuse. These symptoms, though commonly observed in clinical practice, have been under-researched, particularly in relation to treatment and prevention strategies. Methods A randomized trial was conducted with 60 inpatients diagnosed with bipolar disorder (BD), depressive episode, and comorbid alcohol misuse. Participants were divided into two groups: Group A received pharmacotherapy augmented with BLT, while Group B received pharmacotherapy alone. Assessments included qualitative evaluations of irritability, psychomotor agitation, and anger attacks, along with the Hamilton Depression Rating Scale for depressive symptoms and the Modified Overt Aggression Scale for aggression. Results After a four-week BLT regimen, Group A exhibited approximately half the cases of irritability and agitation, and a third fewer cases of anger attacks, compared to their counterparts in Group B. Notably, the positive effects of BLT on these symptoms were independent of depressive symptom remission. Conclusions BLT shows promise as a well-tolerated, adjunctive therapy for managing the symptom-complexes of irritability, psychomotor agitation, and anger attacks in patients with bipolar depression comorbid with alcohol misuse. The therapeutic implications of these findings suggest that BLT could be a valuable addition to comprehensive treatment plans, offering a new approach to managing the challenges of BD.

Growing evidence supports sleep-wake disruption as a mechanism involved in mood disorders pathogenesis. Duration of depressive episodes varies widely, and longer depressive episodes have been connected to worse outcomes. We aimed to explore if the length of depressive episodes is related to objective modifications of sleep features. 35 subjects, aged 18-70, hospitalized for the treatment of a major depressive episode, either unipolar or bipolar, underwent polysomnography, upon admittance. Objective sleep features were correlated with the length of the ongoing depressive episode, measured in months. Positive correlations were found between the duration of the depressive episode and wake percentage (r=0.358, p=0.035), N3 latency (r=0.451, p=0.014) and wake after sleep onset (r=0.342, p=0,44). Our findings show that individuals suffering longer depressive episodes can experience objectively worse sleep features, in terms of increased night wakefulness and delayed deep sleep.

"Will menopause change my condition?" and "Do I need to change my medications when I enter menopause?" These are questions often asked with palpable concern by women diagnosed with bipolar disorder (BD) as they face the prospect of menopause. These inquiries reflect the significant clinical challenges encountered during this phase, marked by rapid changes in clinical conditions, an increase in depressive episodes, and symptom alterations that challenge the efficacy of previously successful treatments.1-3 Despite the universality of menopause and ongoing advances in psychiatric research, these issues remain critically relevant in clinical practice for psychiatrists managing BD, leaving professionals grappling for reliable answers to provide to their patients. The current body of literature exploring the relationship between BD and menopause is notably sparse and fraught with methodological limitations. Despite these identified gaps, as evidenced by more recent reviews by Truong and Marsh3 and Aragno et al.,1 these problems are still largely overlooked, and the issue of BD and menopause remains largely unresolved. The continuous oversight in addressing these critical aspects indicates a significant area of need within psychiatric research and clinical practice. Expanding upon the critical research needs highlighted by Perich et al. there is a pressing need for focused investigation into postmenopause (PM), currently a major gap in our understanding and management of BD during menopause. PM, according to the STRAW + 10 criteria,4, 5 particularly during phases +1c and +2, is characterized by hormonal stabilization marked by high levels of FSH and low levels of estradiol. This hormonal stability contrasts with the fluctuations observed during the menopausal transition (MT), making PM a distinct phase that requires independent study. The questions about how symptomatology and therapy for BD will change during menopause, raised at the beginning of this manuscript, remain unanswered but serve as crucial guides for future research. The fact that PM has never been studied independently as a phase represents both a challenge and an opportunity for future optimization of interventions in BD. It is now crucial to focus on understanding the impact of PM on BD. Clear definitions are needed, including the diagnosis of BD, its subtypes, and specifiers. Additionally, the specific phase of PM must be defined according to the STRAW + 10 criteria,4, 5 particularly focusing on phases +1c and +2, which are characterized by hormonal stabilization. Research should also concentrate on specific acute phases of BD, especially depressive phases which are more common during menopause. Longitudinal studies are necessary to evaluate the number and characteristics of relapses. Identifying the most effective acute phase treatments is essential, including assessing their effects on specific symptom complexes that may worsen during PM, such as somatic anxiety symptoms and insomnia. It is also vital to determine which strategies can maintain stability and when it is possible to reduce or discontinue maintenance medications. At our Mood Disorder Unit at the IRCCS San Raffaele Hospital in Milan, Italy, we are actively contributing to this area by recruiting women diagnosed with BD specifically in PM. We encourage other research and care centers to undertake similar recruitment efforts, with the ultimate goal of drafting specific guidelines to aid psychiatrists in the delicate management of BD during PM. This has the potential to revolutionize the management of BD during this phase. It is our hope that these recommendations will foster and support the efforts of the scientific and clinical community to better meet the needs of an increasing number of women living with BD during PM. By enhancing our understanding of specific pharmacological management during this phase, we can minimize trial-and-error approaches and reduce the burden of maintenance therapies. Streamlining treatment during PM not only improves the quality of life but also aligns with a broader strategy of personalized medicine, ensuring that treatments are both effective and better tolerated by patients at a stage when they may be less resilient to aggressive or unsuitable therapies. None of the authors report a conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Background: Sleep disturbances are a fundamental feature of depression, with their persistence after remission serving as a key risk factor for recurrence of depressive episodes, suicide, and hypnotics abuse. Though Adjunct Bright Light Therapy (BLT) has shown efficacy in treating depression by improving sleep duration and timing, its impact on subjective sleep quality remains underexplored. Objective: This study investigates the effect of adjunct BLT on the subjective experience of sleep quality of Major Depressive Disorder (MDD) inpatients. Methods: A randomized controlled trial was undertaken with 100 MDD consecutively admitted inpatients on consistent antidepressant regimens. Participants were divided into two groups; Group A, received pharmacotherapy augmented with BLT, Group B, received pharmacotherapy alone. The Hamilton Depression Rating Scale assessed depressive symptoms, while the Pittsburgh Sleep Quality Index (PSQI) evaluated subjective sleep quality. Results: While both groups displayed enhanced depressive symptomatology, only Group A manifested significant improvement in perceived sleep quality (PSQI scores: A T0 8.05 +/- 5.07 vs. T1 5.64 +/- 3.64, p < 0.001; B T0 7.11 +/- 3.17 vs. T1 6.50 +/- 3.04, p = 0.072). Limitations: Study limitations include its single-site design, lack of objective sleep measurement, and exclusive SSRI use, suggesting caution in generalizing findings. Further, the absence of placebo control and unmeasured expectancy effects may influence treatment outcomes. Conclusions: These findings underscore the criticality of subjective sleep quality in clinical evaluations and highlight the potential of adjunct BLT as an augmentation therapeutic strategy to ameliorate sleep perception in MDD patients, emphasizing its potential role in enhancing therapeutic outcomes.

Sleep plays a key role in the pathogenesis and clinical presentation of mood disorders. However, only a few studies have investigated sleep architecture during the manic episodes of Bipolar Disorder (BD) and changes in sleep parameters that follow clinical variations. Twenty-one patients (8 males, 13 females) affected by BD, manic phase, underwent polysomnographic recordings (PSG) at the beginning of the admission in our ward (T0) and after three weeks of hospital treatment (T1). All participants were clinically evaluated using Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ). During the admission, we observed an increase in both quantity (Total Sleep Time - TST) and quality (Sleep Efficiency - SE) of sleep. In addition, clinical improvement, evaluated with YMRS and PSQI scales, was accompanied by a significant increase in the percentage of REM sleep. According to our findings, the improvement of manic symptoms is accompanied by an increase in "REM pressure" (increase in REM% and REM density, reduction of REM latency). Overall, changes in sleep architecture appear to be markers sensitive to clinical variations during manic phases of Bipolar Disorder.

Objective: The symptom-complex irritability, widely used in descriptions of bipolar patients' manic and mixed states, also represents a common feature in depressive phases. Irritability negatively affects the clinical course of depression, leading to a higher risk of treatment non-adherence, violence, and suicide attempts. Nevertheless, proportional attention from the scientific literature seems to be scarce. We conducted the first randomised controlled trial with the aim of evaluating BLT as a possible therapeutic strategy for irritability in bipolar depression.Methods: 180 inpatients were randomly assigned to: Group A exposed to bright light therapy (BLT) daily, or Group B treated with pharmacotherapy only. A qualitative assessment of irritability was performed after a 4-week program.Results: Group A showed about one-third fewer cases of irritability compared to Group B, this reduction was not related to the overall remission of depressive symptoms.Conclusions: The present study supports the usefulness of BLT in irritability in bipolar depression. KEYPOINTSIrritability is an underestimated feature of bipolar depression.Irritability is related to higher suicide risk and lower quality of life.Bright light therapy is an effective strategy to reduce irritability in bipolar depression.

Violence and GenderVol. 10, No. 3 Letter to the EditorLetter to the Editor: Interpersonal Violent Behavior in Bipolar Disorder: A Preliminary Study on Gender DifferencesLorenzo Fregna, Francesco Attanasio, Guido Travaini, and Cristina ColomboLorenzo FregnaIRCCS San Raffaele Scientific Institute, Mood Disorder Unit, Milan, Italy.Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.Search for more papers by this author, Francesco AttanasioAddress correspondence to: Francesco Attanasio, MD, Vita-Salute San Raffaele University, Via Olgettina 58, Milan 20132, Italy E-mail Address: [email protected]https://orcid.org/0000-0002-8643-7814Vita-Salute San Raffaele University, Milan, Italy.Search for more papers by this author, Guido TravainiVita-Salute San Raffaele University, Milan, Italy.Search for more papers by this author, and Cristina ColomboVita-Salute San Raffaele University, Milan, Italy.Search for more papers by this authorPublished Online:14 Sep 2023https://doi.org/10.1089/vio.2023.0020AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Letter to the Editor: Interpersonal Violent Behavior in Bipolar Disorder: A Preliminary Study on Gender Differences." Violence and Gender, 10(3), pp. 173–174FiguresReferencesRelatedDetails Volume 10Issue 3Sep 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Lorenzo Fregna, Francesco Attanasio, Guido Travaini, and Cristina Colombo.Letter to the Editor: Interpersonal Violent Behavior in Bipolar Disorder: A Preliminary Study on Gender Differences.Violence and Gender.Sep 2023.173-174.http://doi.org/10.1089/vio.2023.0020Published in Volume: 10 Issue 3: September 14, 2023Online Ahead of Print:August 28, 2023PDF download