Introduction Suicide is the fourth leading cause of death among adolescents and young adults (AYA) (Czyz EK, King CA. J Clin Child Adolesc Psychol.2015;44(1):181-19), and psychiatric disorders are a major contributing factor (WHO Global Health Estimates 2000-2019). Studies focusing on suicidality in Italian inpatients samples are scant. Objectives The present cross-sectional study aimed to define clinical variables associated with suicidality related phenomena in a sample of young inpatients. The main objectives were to assess the prevalence of suicidal ideation and deliberate self-harm in inpatients aged 16–24 years and to determine the relationship between suicidal behaviours and psychiatric disorders. Methods This retrospective study was conducted in a naturalistic setting, at the Psychiatric Inpatient Unit, Perugia Hospital/Local Mental Health Unit 1, from January 2018 to December 2019. Sociodemographic information, clinical history, diagnostic and treatment features were collected. Descriptive and bivariate analyses were performed (p<0,05). Results Among 120 patients (14,2% of the overall 850 hospitalizations in the index period) admitted for suicidality-related phenomena, 21 (17,5%) were AYA. Admission was due to deliberate self-harm in 85,7% (n=18) and to suicidal ideation in 14,3% (n=3) cases. Personality disorders (p=0.006), were significantly more prevalent among AYA, while mood disorders were more frequent among adults (p=0.0018) (Tab.1). Tab.1. Differences in diagnostic features between AYA and adult population. AYAn (%) Adultsn (%) χ2 P PERSONALITY DISORDERS 10 (47.6) 17 (17,2) 7.547 0.006 Borderline personality disorder 7 (33.3) 9 (9.1) 6.838 0.009 MOOD DISORDERS 0 (0) 26 (26,3) 5.578 0.018 Conclusions Personality is under construction among youths, and affective symptoms may have unusual characteristics (Lack CW, Green AL. J Pediatr Nurs. 2009;24(1):13-25), as demonstrated by the fact that irritable rather than depressed mood is a core diagnostic mood symptom for adolescents (Rice F, et al. J Affect Disord. 2019;243:175-181). We hypothesized that symptoms of irritability, emotional dysregulation, and impulsivity could be linked to suicidality (Ghanem M, et al. Arch Suicide Res. 2013;17(3):262-274). Further investigations are needed for the characterization of AYA inpatients who experience suicidal thoughts or self-injurious behaviours, in order to redefine preventive tools and reduce suicide mortality rates. Disclosure of Interest None Declared

Aims. Aim of the current 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, air pollutants' levels and meteorological data for the time period 1 January 2015 until 31 December 2016. 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 emergency department admissions for mental disorders were identified. We observed a statistically significant impact of ozone levels on daily admissions. The estimated coefficient of O-3 is statistically significant at the 1% level. All other pollutants were not significantly associated with the number of daily admissions. Conclusions. Short-term exposure to ozone may be associated with increased psychiatric emergency services admissions. Findings add to previous literature on existing evidence for air pollution to have an impact on mental health. Ozone may be considered a potential environmental risk factor for impaired mental health.

Polygenic Risk Scores (PRS) are proxy values generated combining multiple genetic markers into a single score indicative of specific lifetime risk for a disease. The PRS approach has been increasingly implemented in psychiatry, especially for the study of schizophrenia. Although the majority of studies on PRS focused on possible associations with overt clinical features in patients with already diagnosed schizophrenia spectrum disorders, an emerging trend involves early phenotypic expression of genetic risk for schizophrenia in the general population. This article offers an update on this emerging trend, focusing on how the genetic risk for schizophrenia is early expressed at an endophenotypic level, through a broad range of soft non-psychotic neurocognitive and behavioral manifestations. These features might be integrated with other prediction paradigms, such as familial-high-risk, neurodevelopmental and clinical staging models, to empower and refine early detection strategies.

Objective The European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW) and the Italian Consultation-Liaison Group advice that the aim of the Consultation-Liaison Psychiatry is to provide hospital treatment using valid and universal medical approaches, in full respect of personalized care. This study describes the Consultation-Liaison Service of the Perugia University and investigates the significant associations between a many variables of the assessed population.Methods We used a clinical report derived from the Patient Registration Form in order to collect demographic and clinical data of hospitalized patients; the t-test, the Mann-Whitney U-Test, and the chi2-test-Fischer's test were used for statistical assessment.Results During the time from July 2008 to June 2009, 722 consultations were performed at the general hospital in Perugia. First examinations were 605; 462 were in hospital ward and 143 were in emergency. These 143 were excluded from the study. Most consultations involved European patients (95,2%) of female gender (56.3%); mean age was 55.77 (SD +/- 21.27) (Table I). Emergencies were 22.5%; one fifth of patients were not informed of having been referred to our service and half of interventions were requested by departments of internal medicine. The primary reasons for the referral were depression (18.6%), unexplained physical symptoms (12.3%) and anxiety (10.4%); most patients were already taking psychotropic medication before our intervention (58.8%). The most frequent ICD-10 (International Classification of Disease) diagnoses were the neurotic, stress-related and somato-form syndromes (29.0%), affective syndromes (23.4%), mental syndromes related to an organic illness (11.0%), but 15.4% of the patients did not have any psychiatric diagnosis; the most common liaison interventions were aimed at the staff of department (46.6%); drug treatment was suggest in 58.9% of cases. At discharge, 22.9% of patients were referred to community psychiatric services, 19.5% to our service and 11.9% to their own general practitioner. The significant associations are the following: associations between gender and social status (p < 0.01), social condition (p < 0.01), work (p < 0.01) and advice about the need of the consultation (p < 0.05) (Table II). The area (medical, surgical and specialized area) are related with the advice (p < 0.05), the reason (p < 0.01) and the type of the consultation (p < 0.01), the diagnostic explanations (p < 0.01), the liaison investigations (p < 0.01) and, at last, with the longrange plan after discharge (p < 0.01) (Table III). The main ICD-10 psychiatric diagnoses (Schizophrenia, Affective Syndrome and Neurotic-Stress-Somatoform Syndrome) are associated with social status (p < 0.01), social condition (p < 0.01), work (p < 0.01), hospitalization length (p < 0.01), consultation type (p < 0.01), advice (p < 0.01), reason of the consultation (p < 0.01), liaison investigations (p < 0.05) and long-range plan after discharge (p < 0.05) (Table IV).Discussion The results agree with ISTAT (National Statistics Institute) data and with the international literature. The need for better physical and psychological investigation is confirmed. Clinicians must pay attention to bio-psycho-social status of hospitalized patients for promoting their wellbeing and not only illness remission.

Primary progressive aphasia (PPA) is characterized by an isolated progressive impairment of word use and comprehension reflecting the distribution of pathological processes within the left hemisphere. We used proton magnetic resonance spectroscopy (1H-MRS) to study in vivo the integrity of axonal fibers connecting perisylvian language areas in 11 patients with PPA, 11 subjects with Alzheimer's disease, and 22 controls. Brain metabolites (N-acetylaspartate, myoinositol, choline, creatine) were measured bilaterally within a volume of interest located in the central portion of the superior longitudinal fasciculus, a long associative bundle connecting Broca's area with Wernicke's area, and other language regions of the temporal lobe. In the PPA group, there was an asymmetrical N-acetylaspartate to creatine ratio reduction compared with Alzheimer's disease and controls, with greater changes on the left side. The myoinositol to creatine ratio was increased in the PPA group bilaterally compared with controls. The choline to creatine ratio did not differ among the three groups. These results indicate an asymmetrical focal axonal injury within the language network in PPA. The marked difference in the distribution of N-acetylaspartate to creatine between PPA and Alzheimer's disease suggests that proton magnetic resonance spectroscopy may help to differentiate between these two conditions.

A case of pure amusia in a 20 year old left handed non-professional musician is reported. The patient showed an impairment of music abilities in the presence of normal processing of speech and environmental sounds. Furthermore, whereas recognition and production of melodic sequences were grossly disturbed, both the recognition and production of rhythm patterns were preserved. This selective breakdown pattern was produced by a focal lesion in the left superior temporal gyrus. This case thus suggests that not only linguistic and musical skills, but also melodic and rhythmic processing are independent of each other. This functional dissociation in the musical domain supports the hypothesis that music components have a modular organisation. Furthermore, there is the suggestion that amusia may be produced by a lesion located strictly in one hemisphere and that the superior temporal gyrus plays a crucial part in melodic processing.

A case of loss of psychic self-activation (LPSA) and serious amnesia, followed for a period of ten years, is reported. MRI examination documents a selective bilateral lesion of the globus pallidus. This clinical picture, which evokes a cognitive and behavioral deficit of frontal lobe lesions, is attributed to a dysfunction of the frontal cortical area as a result of the breakdown of the frontostriatal circuits.

Investigation of the relation between epilepsy and cognition presents serious methodologic problems because several factors may contribute to impair neuropsychological performances in epileptic persons. Benign epilepsy of childhood with rolandic paroxysmal discharges (EPR) may be a very useful model of investigation in relation to opportunity to examine subjects without brain damage, therapy, and negative environmental influences. Thus, neuropsychological dysfunction in patients with EPR may support the hypothesis that epilepsy itself prays a specific role in the genesis of cognitive disturbances. We assessed the impact of the laterality of the epileptogenic focus on cognition of children with EPR. All subjects performed a figure cancellation task, a test used to evaluate mainly attention mechanisms and abilities in processing visuospatial information. Results showed that children with right-sided (or bilateral) focus scored worse, whereas children with left-sided focus performed as well as the control subjects. Our data agree with those of studies suggesting that focal discharges may be related to poor cognitive performance. Evidence of a concordance between neurophysiologic and neuropsychologic findings may have great practical and theoretical implications in management of epileptic patients.

Language lateralization was assessed with a dual task procedure in 10 male right-handed patients with Down's Syndrome and relatively preserved linguistic skills. Their performance was compared with that of two control groups, with and without mental retardation, matched with Down's Syndrome individuals for sex, handedness and I. Q. Results did not support the hypothesis that mental retardation is related to specific pattern of cerebral lateralization.

Two forms of verbal fluency test, phonological (FF) and semantic (FS) sets, have been administered to four groups of demented patients: 11 with Alzheimer-type dementia (DAT), 13 with multi-infarct dementia (MID), 8 with Parkinson-Dementia (P-D) and 11 with adult chronic hydrocephalus (ICA). Patients were matched for age, educational level and neuropsychological impairment pattern. Further, ten neurologically healty subjects were selected as control group. Control subjects result to be different from all other groups in both FF and FS; moreover, FF test results to be more impaired in ICA than in DAT. Furthermore, FF is more impaired than FS in P-D and ICA patients. On the basis of our results, verbal fluency tests might represent an useful instrument to differentiate demented subjects from non-demented ones and within demented groups to characterize the different neuropsychological pattern of the cortical and subcortical type of cognitive deterioration.

Rolandic paroxysmal epilepsy (RPE) is a useful model for investigating the complex links between epilepsy and cognitive dysfunction. 44 children with RPE who met the following (among other) criteria: negative CT scan, freedom from drug treatment, and IQ≥80, were assigned to three subgroups by side of EEG focus: left, right and bilateral. A neuropsychological bactery elicited small differences in cognitive performance between the whole group and the controls and among the subgroups, only partially correlated with EEG side. A follow-up assessmt showed that the short falls has disappeared along with the seizures and EEG anomalies, thus confirming the benign nature of RPE. Our findings suggest too that the mere presence of paroxysmal cortical activity is enough to trigger cognitive dysfunction.

The present study has been designed to investigate the relationship between handedness and callosal function. Based on the previous finding of a greater anatomical connection between the hemispheres in left-handers than in right-handers and in order to test the possibility of greater functional communication, the efficiency of interhemispheric transfer of information has been measured using a finger localization task. Comparison of two groups of male right-handed and left-handed subjects shows no difference in the efficiency of interhemispheric transfer of information.