OBJECTIVE:Air pollution is a major environmental risk to health. Ambient (outdoor) air pollution in both cities and rural areas was estimated to cause 4.2 million premature deaths worldwide in 2016. In this review, the authors sought to briefly summarize original research investigating the short-term effects of air pollution exposure on mental health.METHODS:A systematic search of the electronic databases PubMed, Scopus, and Web of Science was conducted (from any time until March 4, 2019) to identify research studies reporting associations between daily levels of air pollutants and daily admissions to hospitals or emergency departments (EDs) for psychiatric disorders and symptoms. A final set of 19 articles was reviewed.RESULTS:The results of all selected studies showed statistically significant associations between daily hospital admissions and ED visits for mental disorders and daily levels of some or all air pollutants considered, including particulate matter (PM) of variable sizes (in micrometers given in subscripts; PM2.5 and PM10), sulfur dioxide, carbon monoxide, nitrogen oxide, and ozone. The strongest and more consistent evidence across studies was found for PM2.5 and PM10.CONCLUSIONS:The results summarized in this review extend the evidence that air pollution may contribute either to worsening of psychiatric symptoms or to the decision to seek treatment for a large group of mental diseases and conditions, including severe psychiatric disorders such as schizophrenia and depression.

Abstract Background Air pollution is a major environmental risk to health. Exposure to xenobiotic heavy metals such as lead and cadmium—constituents of air pollution such as particulate matter and nitrogen and sulfur oxides, organic solvents, and other environmental pollutants—could be component causes for schizophrenia and other psychotic disorders. Long-term exposure to ambient air pollution could be an independent risk factor for mental health disorders. Recent studies analysing the association between daily levels of air pollutants and hospital admissions for mental disorders showed significant results for different pollutants considered both for admissions for generic mental disorders and for specific diagnoses such as schizophrenia, depression and substance abuse. Aim of the present study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy) Methods We collected data about daily admissions to psychiatric emergency services of two general hospitals, daily levels of respirable particular matter (PM10 and PM2.5), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and meteorological data (daily average temperature, pressure, humidity, and maximum and average wind speed) for the time period 1 January 2015 until 31 December 2016 (731 days). We used air monitoring data for the different types of air pollutants which were averaged across up to 16 monitor stations dispersed in the region. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. Results A total of 1860 cases of emergency department admissions for mental disorders were recorded over the study period. We observe a statistically significant impact of O3 levels on daily admissions. The estimated coefficient of O3 is statistically significant at the 1 percent level. According to our results, an increase of one µg/ m3 of O3 concentration (relative to the average concentration of the last 20 days) results in 0.013 more admissions to the hospitals. All other pollutants are not significantly associated with the number of daily admissions. Discussion We observed a statistically significant association of daily ozone levels and daily number of admissions to psychiatric emergency services. Ozone is a component of photochemical smog and a powerful oxidant, and is considered as one of the most important air pollutants. Ozone may have a relevant interference with CNS physiology, and its exposure may be linked to brain disease and contribute to inflammation and oxidative stress. Ozone exposure may be considered a potential environmental risk factor for impaired mental health. Epidemiological studies found evidence that ozone exposure may affect autism spectrum disorders, lead to motor disorders and cognitive impairment, and have an influence on the incidence of depression and suicide. In recent studies ozone air levels showed an association with increased risk of an emergency department visit for depression. This is one of the first studies worldwide investigating the association between daily concentration of air pollutants and the daily number of visits to a psychiatric emergency unit. Our results add to previous literature on existing evidence for air pollution to have a role in the cause or worsening of mental distress and psychiatric disorders. Contrary to our hypothesis, we did not find a positive association between most of the air pollutants considered in our study. This is in contrast with previous literature on this subject. This could be explained by the methodological limitations of our study.

Personality has long been studied as a factor associated with health outcomes. Investigations of large, generalizable clinical cohorts are limited by variations in personality diagnostic methodologies and difficulties with long-term follow-up.Electronic health records of a cohort of patients admitted to a general hospital were characterized using a previously developed natural language processing tool for extracting DSM-5 and ICD-11 personality domains. We used Cox regression and Fine-Gray competing risk survival to analyze the relationships between these personality estimates, sociodemographic features, and risk of readmission and mortality.Among 12,274 patients, 2379 deaths occurred in the course of 61,761 patient-years at risk, with 19,985 admissions during follow-up. Detachment was the most common personality feature. Presence of disinhibition was independently associated with a higher mortality risk, while anankastic traits were associated with a lower mortality risk. Increased likelihood of readmission was predicted by detachment, while decreased likelihood of readmission was associated with disinhibition and psychoticism traits.Personality features can be identified from electronic health records and are associated with readmission and mortality risk. Developing treatment strategies that target patients with higher personality symptom burden in specific dimensions could enable more efficient and focused interventions.

OBJECTIVE We conducted a systematic, qualitative review of risk prediction models designed and tested for depression, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder, and psychotic disorders. Our aim was to understand the current state of research on risk prediction models for these 5 disorders and thus future directions as our field moves toward embracing prediction and prevention. DATA SOURCES Systematic searches of the entire MEDLINE electronic database were conducted independently by 2 of the authors (from 1960 through 2013) in July 2014 using defined search criteria. Search terms included risk prediction, predictive model, or prediction model combined with depression, bipolar, manic depressive, generalized anxiety, posttraumatic, PTSD, schizophrenia, or psychosis. STUDY SELECTION We identified 268 articles based on the search terms and 3 criteria: published in English, provided empirical data (as opposed to review articles), and presented results pertaining to developing or validating a risk prediction model in which the outcome was the diagnosis of 1 of the 5 aforementioned mental illnesses. We selected 43 original research reports as a final set of articles to be qualitatively reviewed. DATA EXTRACTION The 2 independent reviewers abstracted 3 types of data (sample characteristics, variables included in the model, and reported model statistics) and reached consensus regarding any discrepant abstracted information. RESULTS Twelve reports described models developed for prediction of major depressive disorder, 1 for bipolar disorder, 2 for generalized anxiety disorder, 4 for posttraumatic stress disorder, and 24 for psychotic disorders. Most studies reported on sensitivity, specificity, positive predictive value, negative predictive value, and area under the (receiver operating characteristic) curve. CONCLUSIONS Recent studies demonstrate the feasibility of developing risk prediction models for psychiatric disorders (especially psychotic disorders). The field must now advance by (1) conducting more large-scale, longitudinal studies pertaining to depression, bipolar disorder, anxiety disorders, and other psychiatric illnesses; (2) replicating and carrying out external validations of proposed models; (3) further testing potential selective and indicated preventive interventions; and (4) evaluating effectiveness of such interventions in the context of risk stratification using risk prediction models.

Scopo. Il presente studio valuta le caratteristiche cliniche, sociali e comportamentali di pazienti psichiatrici ospedalizzati in regime di trattamento sanitario obbligatorio (TSO) e rivalutati a distanza di 6 mesi da una ospedalizzazione involontaria. Metodi. In tre differenti centri psichiatrici universitari (Bari n=57; Perugia n=42; Roma n=32) sono stati reclutati 131 pazienti affetti da un disturbo mentale acuto, ricoverati in regime di TSO. Al baseline sono state valutate le principali variabili sociali e cliniche, compresa l’eventuale storia di comportamenti etero- e auto-lesivi e il tipo di trattamento in corso. Inoltre, sono state misurate la gravità dei sintomi psicopatologici (BPRS-E), il funzionamento cognitivo (MMSE) e la capacità di prestare consenso al trattamento (MacCAT-T). Al follow-up, 6 mesi dopo la prima valutazione, sono state indagate la presenza di un nuovo ricovero in regime di TSO, l’adesione alle cure, la messa in atto di nuovi comportamenti etero- o auto-lesivi e il verificarsi di problematiche di tipo legale. Risultati. Centoventi pazienti sono stati rivalutati a distanza di 6 mesi (M=188±12,6 giorni); di questi, 15 (12,5%) erano andati incontro a un nuovo ricovero in regime di TSO durante il periodo di follow-up. I pazienti con ulteriore TSO presentavano maggiore incidenza di comportamenti etero-lesivi (p<0,05), ed erano andati più frequentemente incontro a problematiche legali di tipo penale (p<0,05); si è notata una tendenza nei pazienti con ulteriore TSO a interrompere le cure farmacologiche (p=0,06). Non si è evidenziata una differenza nella gravità della sintomatologia psicopatologica al baseline tra i due gruppi, né del funzionamento cognitivo. Al contrario, i pazienti con nuovo TSO entro 6 mesi presentavano al baseline più di 1 TSO nell’ultimo anno (p<0,05) e punteggi più elevati alla scala MacCAT-T “ragionamento” (p<0,05). Conclusione. I casi di riammissione precoce in TSO sono difficilmente prevedibili sulla base di variabili cliniche in pazienti già sottoposti a un recente TSO. Sulla necessità di nuovi TSO sembrano influire anche aspetti di tipo socio-giuridico, il che suggerisce un possibile ruolo di fattori legati alla percezione di pericolosità sociale del paziente in un sistema, come quello italiano, basato sulla necessità di trattamento.

BACKGROUND:Antepartum depression (APD) and postpartum depression (PPD) are a significant public health problem. Aim of the study was to determine which personality disorders features could be found in women with APD and PPD compared to women without perinatal depression.SUBJECTS AND METHODS:The Edinburgh Postnatal Depression Scale and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were administered during peripartum to a sample of 54 women recruited at the Obstetrics and Gynaecology Unit, Perugia (Italy).RESULTS:Results were grouped according to the EPDS ranges 0-8 and ≥9, and to the MMPI-2 scores on each clinical scale. Women with APD had high scores on the MMPI-2 Hypomania, Cynicism, and Antisocial Practices scales; women with early onset PPD (detected in the first week after childbirth) had high scores on the Paranoia and Low Self-Esteem scales; women with late onset PPD (detected up to three months after childbirth), had high scores on the Fears, Obsessiveness, and Depression scales.CONCLUSIONS:Based on the high scores of specific MMPI-2 scales, our study would suggest that: cluster B personality features may represent a vulnerability factor for APD; passive-aggressive personality features may be a vulnerability factor for early onset PPD; cluster C personality features may act as a vulnerability factor for late onset PPD.

BACKGROUND:The purpose of this longitudinal observational study is to evaluate the course and impact of clinical, social, and behavioral variables on the involuntary readmission of psychiatric patients, during a 6-months follow-up after discharge from a prior involuntary hospitalization.METHODS:N=131 involuntarily committed psychiatric patients were enrolled in three university hospitals (Bari n=57; Perugia n=42; Rome n=32). At the first assessment cognitive functioning (MMSE), psychiatric symptoms severity (BPRS-E), capacity to consent to treatment (MacCAT-T) as well as principal socio-demographic and clinical variables were collected. At 6-months follow-up, we collected data concerning involuntary psychiatric readmissions, pharmacotherapy adherence, new deliberate self-harm or harm to others as well as having been legally prosecuted.RESULTS:N=120 patients were reevaluated at follow-up (M=188 days, SD=12.6); among these n=15 (12.5%) have had a new involuntary psychiatric admission due to an acute mental disorder. Re-hospitalized patients showed higher rates of harm to others (p<0.05) and legal prosecution (p<0.05); there was moreover a trend toward higher pharmacological dropout rates in involuntarily rehospitalized patients. We found no differences between the two groups in baseline psychiatric symptoms severity and cognitive functioning, whereas involuntary re-hospitalization was associated with more frequent involuntary hospitalization during last year (p<0.05) and higher MacCAT-T reasoning (p<0.05).CONCLUSIONS:Involuntary psychiatric readmission rates proved to be poorly associated with clinical features assessed during previous hospitalization. Our data suggest that social and legal factors, including those connected to patients' dangerousness, could play a role also in a civil commitment system based solely on the need for treatment.

This is the first cross-language study of the effect of schizophrenia on speech as measured by analyzing phonetic parameters with sound spectrography. We hypothesized that reduced variability in pitch and formants would be correlated with negative symptom severity in two samples of patients with schizophrenia, one from Italy, and one from the United States. Audio recordings of spontaneous speech were available from 40 patients. From each speech sample, a file of F0 (pitch) and formant values (F1 and F2, resonance bands indicating the moment-by-moment shape of the oral cavity), and the portion of the recording in which there was speaking ("fraction voiced," FV), was created. Correlations between variability in the phonetic indices and negative symptom severity were tested and further examined using regression analyses. Meaningful negative correlations between Scale for the Assessment of Negative Symptoms (SANS) total score and standard deviation (SD) of F2, as well as variability in pitch (SD F0) were observed in the Italian sample. We also found meaningful associations of SANS affective flattening and SANS alogia with SD F0, and of SANS avolition/apathy and SD F2 in the Italian sample. In both samples, FV was meaningfully correlated with SANS total score, avolition/apathy, and anhedonia/asociality.

BACKGROUND:The term 'schizo-obsessive disorder' was coined to describe schizophrenia (SCZ) patients who are also affected by obsessive-compulsive symptoms (OCS) or also meet the criteria for obsessive-compulsive disorder (OCD). Several studies have investigated the clinical and epidemiological features of OCS/OCD in SCZ, but the neuroimaging literature is sparse. The aim of this brief report is to describe some of the most important neuroimaging findings regarding schizo-obsessive disorder.METHODS:A literature search of the PubMed electronic database was conducted up to July 25, 2015. Search terms included 'schizo-obsessive' combined with the names of specific neuroimaging techniques.RESULTS:Neuroimaging studies suggest that there may be a specific pattern of neuroanatomic dysfunction in schizo-obsessive patients, but the number of studies is limited and conclusions are preliminary because reports are of an exploratory nature.CONCLUSIONS:Further neurobiological research is needed to definitely determine whether schizo-obsessive disorder might have unique neuroanatomical and functional alterations.

The aim of this study was to understand which of a number of factors are most associated with psychiatric inpatient length of stay (LoS). We hypothesized that a longer LoS would be predicted by: older age, male gender, unmarried marital status, foreign nationality, more than one hospitalization, being hospitalized involuntarily, psychotic symptoms and behavioral dyscontrol at admission, discharge diagnosis of psychotic and personality disorders, not having a substance use disorder, treatment with more than one class of medications, and being discharged to a community residential facility. All admissions to the Psychiatric Inpatient Unit of Santa Maria della Misericordia, Perugia Hospital, Umbria, Italy, from June 2011 to June 2014, were included in a medical record review. Bivariate analyses were performed and a multiple linear regression model was built using variables that were associated (p < .05) with LoS in bivariate tests. The study sample included 1236 patients. In the final, most parsimonious regression model, five variables independently explained 18 % of variance in LoS: being admitted involuntarily, being admitted for thought disorders, not having a substance-related disorder, having had more than one hospitalization, and being discharged to a community residential facility. LoS on this inpatient psychiatric unit in Umbria was associated with a number of sociodemographic and clinical characteristics. Knowledge of these and other predictors of LoS will be increasingly important to, when possible, reduce the length of restrictive, costly hospitalizations and embrace community-based services.

OBJECTIVE:To evaluate if somatic symptoms of Eating Disorders and Migraine reflect similar aspects of personality and temperament.METHODS:The clinical notes of 27 migraineurs and of 26 ED outpatients were reviewed; 40 medical students of the University of Perugia were recruited as healthy controls. TCI, DMI, SCID-II and TAS-20 were used.STATISTICAL ANALYSIS:performed by logistic regression, a cluster analysis that gave the weight for the three groups, and a logistic regression of the cluster analysis.RESULTS:Patients showed medium scores in almost all the scales of the different tests. High scores in HA and low scores in NS characterized both migraine and ED patients. Logistic regression of the cluster analysis underscored that ED patients, migraineurs, and controls differed for HA (435.424, p≤0.0001), TAS-20 F2 (difficulty in describing feelings to others; 7.087, p=0.029), and the defense mechanism turning against object (6.702, p=0.035).DISCUSSION:The temperamental aspects of low NS and high HA represent the core symptoms of a spectrum composed of somatizing patients who use affective and behavioral strategies that are not functional enough in affective regulation.

INTRODUCTION:Child maltreatment is a well-known condition that is currently considered to be associated with the development of severe psychiatric conditions. Consequently, the authors decided to review the current literature in order to give a complete scenario of the situation in the world and to give recommendations about prevention and treatment as well as research goals.METHODS:An electronic search was conducted through the means of MEDLINE database in order to find the most up to date peer-reviewed papers, including only those papers published in 2015.RESULTS:15 papers were included and analyzed the current situation in different countries: US (n.3), Australia (n.2), Ireland (n.2), Israel (n.2), China (n.2), Indonesia (n.1), Pakistan (n.1) and Norway (n.1).DISCUSSION:Even though sexual abuse has been studied extensively, both physical and emotional abuse and neglect appear to be more represented within the population of patients that had suffered from abuse. Psychiatric disorders (mainly personality disorders, depression and anxiety), interpersonal, social and legal outcomes are important consequences of child maltreatment.CONCLUSIONS:Interventions and strategies are needed at different levels, from prevention to treatment and further research is important in order to better understand the phenomenon.

This paper presents data on the mental health needs of men in an Italian prison and examines if mental health needs of inmates differ across key correctional subpopulations. Interviewers conducted semi-structured clinical interviews with 526 convicted males incarcerated in the Spoleto Prison from October 2010 through September 2011. Nearly two thirds (65.0%) of inmates had an Axis I or Axis II disorder. About half (52.7%) had an Axis I disorder. Personality disorders were the most common disorders (51.9%), followed by anxiety (25.3%) and substance use disorders (24.9%). Over one third of inmates (36.6%) had comorbid types of disorder. The most common comorbid types of disorders were substance use disorders plus personality disorders (20.1%) and anxiety disorders plus personality disorders (18.0%). Findings underscore a significant need for specialized mental health services for men in Italian prisons. Moreover, as inmates return to the community, their care becomes the responsibility of the community health system. Service systems must be equipped to provide integrated services for those with both psychiatric and substance use disorders and be prepared for challenges posed by patients with personality disorders.

BACKGROUND:There is current scientific debate in consideration of the possibility to consider the Borderline Personality Disorder (BPD) as a mood disorder within the bipolar spectrum furthermore, authors reported about the challenging differential diagnosis of BPD and Bipolar Disorder (BD).SUBJECTS AND METHODS:32 patients hospitalized in the Inpatient Psychiatric Unit in Perugia, discharged with a diagnosis of BD or BPD, were included. Factor analyses of BPRS and PANSS items were performed. Association between socio-demographic, clinical and psychopathological variables was tested using bivariate analyses.RESULTS:Factor analysis identified 6 Factors, explaining 67.6% of the variance, interpreted as follow: 1) Euphoric Mania, 2) Psychosis, 3) Inhibited Depression, 4) Disorganization, 5) Psychosomatic features, and 6) Mixed features. Bivariate analyses identified statistically significant differences between BPD and BD according to: PANSS positive symptoms domain, BPRS total score, Euphoric Mania and Disorganization. No statistically significant differences came up on socio-demographic and clinical aspects.CONCLUSION:Even though the sample is small, interesting findings came out from our investigation. Our findings are in line with the current literature. Euphoric mood, is one of the aspects which best differentiated BD from BPD. Higher scores in Disorganization, BPRS and PANSS positive symptoms in BD may be related to the fact that our sample is a group of patients from an acute inpatient unit, so the impact of the symptoms severity for BD may be remarkable.

BACKGROUND:Nonfatal suicidal behaviours (NSB), including suicide ideation, suicide plan and suicide attempt, constitute a serious problem for public healthcare services. Suicide gesture (SG) which refers to self-injurious behaviour with no intent to die, differs from NSB in a variety of important ways. The aim of this study was to investigate demographic and clinical characteristics of NSB and SG to examine whether self-injurers with intent to die differ significantly from self injurers without such intent.METHODS:All admissions for NSB and SG to the Psychiatric Inpatient Unit of University / General Hospital Santa Maria della Misericordia, Perugia, Umbria, Italy, from January 2015 to June 2015 were included in a medical record review. Basic descriptive statistics and distributional properties of all variables were first examined. Bivariate analyses were performed using Chi-square tests for group comparisons and t-test for independent samples used when appropriated.RESULTS:The study sample included 38 patients. Of these 23 had committed NSB (13.1%), 15 had commetted SG (8.5%). Number of married NSB was significantly higher than the number of married SG (p=0.08). We found a significant difference between NSB and SG related to the item of impulse control that was poorer in SG than NSB (p=0.010). BPRS items of hostility (p=0.082), suspiciousness (p=0.042) and excitement (p=0.02) were found to be significantly higher in SG than NSB. Borderline personality disorder (p=0.032) and Passive-Aggressive personality disorder (p=0,082) diagnosed by the means of the SCID-II, were more represented in SG than NSB (p=0.044). Schizoid personality disorder was significantly related to NSB (p=0.042). No others significant differences were found.CONCLUSIONS:NSB and SG are different for many psychopathological characteristics. These results confirm the importance of classifying individuals on the basis of the intent to die. Additional research is needed to understand and elucidate psychopatological and clinical characteristics of the different categories of self-injurers to find risk factors specific to suicide attempts.

The risk of suicide is one of the most important risk factors looked into for acute psychiatric assessments that influences the management plan. The prevalence of suicide is on a rise across European countries; as a consequence, the different countries have created specific guidelines and policies in order to prevent suicides in the acute settings. These guidelines are based on both different cultural aspects as well as the different organization of the mental health system in the different countries. This paper wants to present the comparison between the guidelines of two European countries, England and Italy, in order to evaluate the systems, understand differences and common contact points. The different European countries could learn one from the other and a European shared point of view may be a way forward to create better understanding and preventing the risk of suicide across the population.

Contemporary psychiatric nomenclature defines schizophrenia (SCZ) and obsessive-compulsive disorder (OCD) as distinct disease entities characterized by non-overlapping diagnostic criteria. Nevertheless, a complex association between SCZ and OCD exists on the psychopathological level. And although the relationship between obsessions and delusions has been widely studied and discussed, the relationship between obsessions and hallucinations has not received the same attention. This article presents an historical overview of the studies on the co-occurrence of obsessions and hallucinations. We also analyze the clinical significance of this overlap, as discussed in the early descriptions of these phenomena in the nineteenth century and continuing through the most recent, contemporary conceptualizations. In clinical practice today, we may encounter both SCZ patients with typical ego-dystonic obsessive-compulsive symptoms and SCZ patients affected by obsessions that intertwine with psychotic symptoms, generating complex psychopathological syndromes (e.g. "obsessive hallucinations"). A further complication is that some OCD patients show perceptual disturbances. Taking into consideration the possible coexistence of obsessive-compulsive symptoms and psychotic symptoms is crucial for proper diagnosis, prognosis, and treatment. Further investigations are required to fully evaluate the psychopathological interrelationships between obsessions and hallucinations.

The Authors report the data collected about the foreign patients, hospitalized in the Psychiatric Ward of the Santa Maria della Misericordia Hospital in Perugia, in the period of time 1 January – 31 December 2012. We have analyzed some items such as the socio-demographic and the clinical aspects, the reason for the hospitalization, the characteristics of the discharge program, then compared with the same items about the Italian patients, hospitalized in the same period of time. We have taken in consideration the cultural identity and we evaluated the cultural factors related to the psycho-social environment of origin, in order to study the foreign population.

To investigate significant association between various clinical and extra-clinical factors brought out the activities of Consultation-Liaison Service.