BACKGROUND:Since discovering the glymphatic system, there has been a looming interest in exploring its relationship with psychiatric disorders. Recently, increasing evidence suggests an involvement of the glymphatic system in the pathophysiology of psychiatric disorders. However, clear data are still lacking. In this context, this rapid comprehensive PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between the glymphatic system and psychiatric disorders. METHODS:We conducted a comprehensive review of the literature and then proceeded to discuss the findings narratively. Tables were then constructed and articles were sorted according to authors, year, title, location of study, sample size, psychiatric disorder, the aim of the study, principal findings, implications. RESULTS:Twenty papers were identified as eligible, among which 2 articles on Schizophrenia, 1 on Autism Spectrum Disorders, 2 on Depression, 1 on Depression and Trauma-related Disorders, 1 on Depression and Anxiety, 2 on Anxiety and Sleep Disorders, 8 on Sleep Disorders, 2 on Alcohol use disorder and 1 on Cocaine Use Disorder. CONCLUSION:This review suggests a correlation between the glymphatic system and several psychiatric disorders: Schizophrenia, Depression, Anxiety Disorders, Sleep Disorders, Alcohol Use Disorder, Cocaine Use Disorder, Trauma-Related Disorders, and Autism Spectrum Disorders. Impairment of the glymphatic system could play a role in Trauma-Related Disorders, Alcohol Use Disorders, Cocaine Use Disorders, Sleep Disorders, Depression, and Autism Spectrum Disorders. It is important to implement research on this topic and adopt standardized markers and radio diagnostic tools.

Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, Department of Psychiatry, Bhaktshreshtha Kamalakarpant Laxman (BKL) Walalwalkar Rural Medical College, Pune, India, 3 Faculty of Health Sciences, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa, 4 School of Health Science, Waterford Institute of Technology, Waterford, Ireland, 5 State Drug Dependence Treatment Centre, Ain Shams University, Cairo, Egypt, Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan, Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand, Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal, Department of Mental Health and Addictions, Waikato District Health Board, Hamilton, New Zealand, Department of Psychiatry, Medical Faculty, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia, Department of Family Medicine, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa, Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India, 13 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco, Department of Mental Health, Azienda Sanitaria Locale (ASL) 1 Avezzano-L’Aquila-Sulmona, L’Aquila, Italy, 15 State Drug Dependence Treatment Centre, Institute of Mental Health, Pt. Bhagwat Dayal Sharma (BDS) University of Health Sciences, Rohtak, India, 16 Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Department of Mental Helth, Azienda Sanitaria Locale (ASL) Teramo, Teramo, Italy

Although believed safer compared to short-acting benzodiazepines (BZD), in the past few years a growing concern has developed relating to the abuse of Z-drugs, and specifically of zolpidem. Here we aim to review the evidence for the misuse of zolpidem and describe several related cases collected in Italy. A comprehensive overview is here carried by using several databases, and by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics of Zolpidem and Abuse and/or Misuse as follows: ((Zolpidem[Title/Abstract]) AND (Abuse[Title/Abstract]) OR (Misuse[Title/Abstract])), without time and/or language restrictions. Furthermore, a case series of 8 cases of zolpidem misuse and/or abuse, collected in different Italian psychiatric settings (psychiatric public hospital, psychiatric private rehabilitation clinic, and private practice), have been here described. According to our findings, zolpidem should be prescribed with the same caution as BZDs, especially in patients with a history of drug abuse or in the elderly. Behavioural modifications, including bizarre behaviours, psychomotor agitation, sleep-related complex behaviours have been reported. Monitoring of zolpidem use in selected populations is warranted. Psychiatrists and physicians should be aware of the misuse potential of zolpidem and adopt measures restricting its use.

Stress during the pandemic has had an impact on the mental health of healthcare professionals (HCPs). However, little is known about coping and "maladaptive" coping behaviours of this population. This study investigates "maladaptive" coping behaviours and their correlation with stress, anxiety and insomnia of Italian HCPs during the pandemic. It reports on a cross-sectional, descriptive and correlational study based on a survey of 1955 Italian HCPs. Overall participants reported increases in cigarette smoking, time spent online and video playing. Overall reported alcohol consumption decreased but increased in those reporting drinking more than once a week. Those reporting starting smoking during the pandemic were found to have higher SAS and PSS scores. Those reporting being online for 3 or more hours were found to have higher ISS scores. Doctors who reported playing video games were found to have higher PSS, ISS and SAS scores whilst nurses who reported playing video games were found to have higher ISS scores. Doctors who reported playing for longer than one hour had higher PSS scores. Online behaviours may be a coping behaviour of HCPs affected by the pandemic. However, this is an underexplored area for the wellbeing of HCPs. These deficits need to be addressed going forward.

IntroductionThe addictive behaviors can be seen as attachment disorders. To our knowledge, the literature on the relationship between pathological gambling (PG) and attachment styles is still poorly represented. However, in addicted patients, the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo examine the clinical role of attachment styles in the PG patients.AimsTo study the relationships between the different attachment styles and PG and the severity of PG.MaterialsWe recruited 33 patients with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered to investigate attachment styles, the South Oaks Gambling Screen (SOGS) to investigate the severity of gambling.ResultsThe subjects showed the following attachment styles (Table 1). Ambivalent attachment style correlates with high scores to the SOGS (P < 0.001), and with a shorter period of abstinence from PG (P = 0.022). Patients with ambivalent attachment style have increased severity of PG at SOGS, correlating with higher raw score on the anxiety factor of ECR and lower raw score on avoidance factor (for both P = 0.036).ConclusionsPatients showed ambivalent attachment, and anxiety factor correlates with a greater severity of PG. Attachment style could be a severity index of PG. Our findings need to be replicated in larger groups, also widening the target of other addictions both chemical and behavioral.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe addictive behaviors can be seen as attachment disorders. In literature studies about the relationship between attachment styles and addictions are few. However, in addicted patients the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo study the relationships between different attachment styles and types of addiction (chemical or behavioral).AimsTo examine the role of attachment styles in patients with alcohol dependence (AD) or pathological gambling (PG).MaterialsWe recruited 29 with AD and 33 with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered for the study of attachment styles.ResultsPG compared to AD has higher raw scores both anxiety factor (P < 0.001) and avoidance factor (P = 0.003) at ECR. ECR ambivalent correlates with the diagnosis of PG (P = 0.010); ECR avoidant correlates with AD (P = 0.006); ECR anxiety shows a trend of correlation with the diagnosis of AD (P = 0.052). The subjects showed the following attachment styles (Table 1).ConclusionsThis is the first study that compares the attachment styles of patients AD and PG. We found differences in attachment styles of the two types of addiction, confirming the need of different approaches and then different types of treatment. Our findings need to be replicated in larger groups, also widening the target of other addictions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introductionstigma in mental illness is characterized by discrimination towards people affected by mental disorder. Consequence of the paradigm “stigma-injury-discrimination” is the social exclusion of these patients and the denial of their rights. Medical students, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesTo study the attitudes of medical students towards psychiatric patients.AimsThe present study analyzes gender differences in a sample of Italian medical students towards mental illness.MethodsA total of 339 Italian medical students completed a cross-sectional survey, in Rome and Foggia (Italy). We used the Italian version of Community Attitude towards the Mentally Ill test (CAMI) to analyze the students’ attitudes.ResultsThere is a substantial difference among the attitudes towards mental disorders in female and male students. Female students have obtained less stigmatizing results in 9 of the CAMI test items (P < 0.05), in Benevolence (P = 0.001) and Social Restrictiveness subscales (P = 0.043) and in the total score (P = 0.013).ConclusionsThese results are in line with those achieved in scientific literature, confirming that women tend to show more humanitarian attitude towards the mentally ill. Even in the original article of the validation of the CAMI test, the authors found better attitudes in women in all subscales, with the exception of Social Restrictiveness subscale (that in our analysis also correlates with the female gender).Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDiscrimination and stigmatization cause an important burden for people suffering from psychiatric disorders. The medical doctors, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesIt is extremely important to study and to know the attitudes of undergraduate medical students towards psychiatric disorders, since these individuals will be involved in the care of these patients throughout their careers.AimsThe present study analyzes the attitudes of a group of Italian medical students towards mental illness, highlighting the differences between the students who would choose surgical specialties from those who prefer medical ones.MethodsA total of 339 medical students of different medical schools, in Rome and Foggia (Italy), completed a cross-sectional survey. The Italian version of community attitude towards the mentally Ill test (CAMI) was used to evaluate the students’ attitudes.ResultsThe students that would choose medical specialties reported less stigmatizing responses in 11 CAMI items (including five items with P < 0.01), in benevolence and community mental health ideology subscales (P = 0.003) and in the total score (P = 0.003).ConclusionsIt is evident that the students that prefer the surgical specialties have more stigmatizing attitudes towards psychiatric patients. Negative feedbacks on Psychiatry from non-psychiatrist colleagues may have a fundamental role in stigmatizing mental disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionEmpathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.Objectives and aimsTo determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.MethodsWe enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).ResultsWe found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.ConclusionsIn our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPathological gambling (PG) is currently included among Addictive Disorders (DSM-5). However, its phenomenology resembles features of Obsessive Compulsive Disorder. Several models of addiction conceptualize a progression from impulsivity to compulsivity transitioning from initial positive reinforcement motivations to later negative reinforcement and less pleasurable and automaticity mechanisms.Clinical presentationA 34-year-old male, since diagnosed with PG in 2013 and prescribed a group rehabilitation therapy, presented in 2015 complaining of intrusive thoughts and depression symptoms. During the psychiatric examination emerged: low mental concentration; dysphoria; hyporexia; irritability; insomnia; persistent ideas and excessive preoccupations to be betrayed by his girlfriend; and behaviours of hyper control on her life. He has been evaluated using MMPI-2 (obsessivity Tscore 70, depression Tscore 67) and BIS-11 (high score of non-planning impulsiveness).TreatmentIt appeared there was a shift from ego-syntonic novelty driven/impulsive behaviours focused primarily on gambling to ego-dystonic habit driven/compulsive behaviours focused on her girlfriend. He started an individual psychodynamic psychotherapy centred on dysfunctional beliefs and behavioural strategies for treating the compulsive features. As thought content was the most relevant aspect, he was prescribed olanzapine, not a SSRI (normally indicated for OCD), up to 10 mg/die. After a month obsessions and compulsions reduced, and he seemed to reach a good level of personal functioning, despite a rigid anankastic personality trait.ConclusionsAs the management of compulsive behaviours is complex, physician should better assess and recognize psychological personality aspect, collecting patients’ complete history, also testing them psychometrically, and paying more attention to an eventual treatment (both psychological and pharmacological).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Internet Gambling has become one of the most popular and lucrative internet business. The recent improvements in technology have changed betting habits with online poker, casinos, sport betting, bingo and lotteries. Liberalization of the Italian online gambling market gradually started in 2006, but only in 2010 foreign gambling operators have been able to launch online real money games. Our aim is to study the impulsivity and personality traits of an Italian sample of Pathological Gamblers (PG), showing the peculiarities of Online Gambling (OG). 69 patients affected by PG, who accessed to our clinical center, were asked to fill the following questionnaires: Temperament and Character Inventory-Revised (TCI-R) Europ-ASI (Addiction Severity Index) Barratt Impulsiveness Scale (BIS-11) we found significant statistical correlations between OG and: younger age (p<0,01), early onset of gambling (p=0,012), male gender (p=0,015), gambling exclusively with active games (p<0,001), gambling that involves different games (p=0,04) and PG familiarity (p=0,03). Considering gamblers'personality traits, OG significantly correlates with higher scores in TCI-R subscales NS1(exploratory excitability) and Persistence, while lower scores in HA2 (fear of uncertain) and ST3 (spiritual acceptance). There is no correlation between OG and impulsivity. internet gamblers' young age could explain the correlations between OG and higher scores in NS1, HA2 and ST3, and consequently risky behaviours and less spiritual believes/acceptance. Higher scores in Persistence indicate perseverance in spite of fatigue or frustration. Cloninger's research found that Persistence, like the other temperament traits, is highly heritable.

over the past few years Gambling has significantly increased in Italy, being considered as an acceptable form of entertainment and leisure activity. Our aim is to study personality traits and the psychiatric comorbidity of gamblers in relation to the different age and the onset of gambling. 71 patients affected by Pathological Gambling (PG), who accessed in our service (A. Gemelli Hospital, Rome- Italy), underwent the following assessment tests: -Addiction Severity Index (ASI); -Temperament and Character Inventory-Revised (TCI-R) to study personality traits; -MINI-International Neuropsychiatric Interview for psychiatric comorbidity. we found that younger gamblers have higher TCI-R scores in the subscales NS1 (exploratory excitability)(p<0,001) and NS3 (extravagance)(p=0,024) and lower scores in HA2 (fear of uncertainty) and ST3 (spiritual acceptance)(p=0,005). An earlier age of onset of PG correlates with higher scores in NS1 (p=0,003), NS3 (p=0,047), Novelty Seeking (p=0,016) and lower HA2 (p=0,034). Patients with gambling onset before age 20 have more probabilities of playing multiple kinds of games (p=0,004), while lower probabilities of playing passive games (p=0026); furthermore they exhibit antisocial personality disorder (p=0,033) and addiction familiarity (p=0,006). Late-onset gamblers (age > 45 years) prefer passive games (p=0,007) and usually don't play online games (p=0,02). gamblers are a heterogeneous population with regard to personality traits, psychiatric comorbidity, familiarity and type of games played. Paying attention to the gamblers' age and the age of onset of PG could be useful to a greater understanding of the individual differences of patients, and to a deeper knowledge of their disorder.

Introduction:Different questionnaires were formulated in order to assess the severity of gambling. The most used questionnaire is the South Oaks Gambling Screen (SOGS), based on DSM-III criteria for gambling, even though it has poor specificity, because overestimates the prevalence of the disorder when used in general population.Objectives:Try to overcome SOGS limits using a questionnaire based on DSM-IV criteria for gambling.Aims:Validate the questionnaire based on DSM-IV criteria, using as gold standard the clinical interview developed through the SOGS.Methods:The sample used is formed by 71 subjects, 58 men (81.7%) and 13 women (18.3%), recruited from the Psychiatric Department of Gemelli General Hospital in Rome, who were asked to fill out both questionnaires.Results:The sensitivity of our questionnaire was 93% (compared to 100% in the SOGS); the specificity was 100% (97.1% in the SOGS). False negatives were 7%, while they were absent in the SOGS ; false positives were absent in the DSM-IV questionnaire, while they were 2.9% in the SOGS.We also determined the prevalence of each item of DSM-IV questionnaire in all gamblers identified (66 subjects): the most relevant item was “chasing one's losses”(item6), instead the least one was “committing illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling”(item8).Conclusions:Our data confirm the greater specificity of the questionnaire of DSM-IV criteria for gambling compared to the SOGS. We suggest its use for the identification of gamblers in a sample formed by general population.

Introduction:Frequent and increasing relations among psychiatric and substance dependence disorders, have made, to date, more complex the treatment of this dependence, especially when the patient is facing the difficult task of maintaining abstinence, which requires a work of self-awareness, motivation to change and active modification of dysfunctional lifestyles.Objectives:Our study has the aim to detect patients’ changes in personality between the beginning of the rehabilitative therapy and its end, trying to get information on aspects of addiction on which the treatment affects the most.Methods:Our sample was formed by 153 patients, recruited at the Department of Psychiatry of Gemelli General Hospital, who were subjected to an integrated approach of treatment, both pharmacological and rehabilitative group-therapy, according to Minnesota rehabilitation model, that considers addiction as a bio-psycho-social problem.Patients, after a first psychiatric evaluation, were asked to fill out two psychometric tests, the SymptomCheckList-90 R and the Structural Clinical Interview for DSM-IV, in two times, at the first meeting and at the last one, after 20 meetings of group therapy.Results:At the end of the group therapy 39 patients dropped-out, 114 patients had a significant improvement in depressive symptoms (DEP item), greater responsibility perseverance and attention in their activities and habitual contexts (GSI, DIS, W/S items), as well as better management of compulsion and impulsivity (OC item) and a lower sense of inferiority, inadequacy and discomfort in interpersonal relationships (PAR, ANX, IS, SOC. A., PSY. A. items).

Aims:There is substantial evidence indicating that pharmacological treatments targeting glutamatergic transmission are of potential utility in the treatment of drug addiction. The aim of this study was to evaluate the long-term outcome of glutamatergic treatments in patients with pathological gambling.Methods:Fifteen patients fulfilling criteria for pathological gambling and receiving drugs with effects on glutamatergic transmission (amantadine, N-acetylcysteine, gabapentin, pregabalin and topiramate) were enrolled. Gambling craving (Gambling Symptom Assessment Scale, G-SAS, and visual analogue scale, VAS) and relapse (Gambling Timeline Follow Back, G-TLFB) rating scales were administered before and after treatment (1, 3, 6 months follow-up).Results:Gambling craving and behavior were significantly reduced (p < 0.001) during the study period. Glutamatergic medications also yielded an improvement in treatment retention.Discussion:Our results are discussed in the context of the glutamatergic hypothesis of addiction. Our data seem to confirm the utility of targeting the glutamatergic system for the treatment of PG, in particular by acting on craving and increasing treatment retention. in particular, glutamatergic medications may offer some advantages in preventing relapse.

Pathological gambling (PG) disorder occurs when a person gambles repetitively despite severe negative effects on important aspects of life. PG tends to be a heterogonous disorder in which patients differ with respect to type and intensity of gambling behavior, psychiatric comorbidity, family history, age at onset and gender. Gamblers may accordingly be classified into three subtypes: the “impulsive”, “obsessive-compulsive” and “addicted” subtypes. to characterize a sample of Italian PG pathological gamblers and assess the prevalence of the various gambling subtypes in this population. 52 outpatients (44 men, 9 women), diagnosed with PG according to DSM IV-TR and SOGS criteria, were administered the Dannon Ainhold Gambling Scale (DAGS), which assesses the presence of the disorder and is useful for patient subtyping. 37 gamblers enrolled in our study played one specific kind of game, while 15 played multiple games. 30 patients played slot machines, 18 sport betting, 11 casino and card games, 14 bingo and scratch cards. According to DAGS, 5 (9,6%) patients belonged to the “addicted” subtype, 4 (7,7%) to the “obsessive-compulsive” subtype and 9 (17,3%) to the “impulsive” subtype. 15 (28,8%) gamblers were classified as “addicted-impulsive” subtype, 10 (19,2%) as “addicted-obsessive-impulsive” subtype, while 9 (17,3%) did not belong to any specific subtype though they displayed a tendency for one of the subtypes. DAGS allows to identify three major subtypes of gamblers and also considers possible combinations between the different subtypes. An evaluation of these aspects could be useful in treatment options based on patient subtype.