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Mental health interventions for Italian prisoners with mental disorder remain a problematic issue, despite radical changes in psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. Indeed, prison has increasingly become a place of severe psychological distress, where also serious mental illnesses sometimes occur. In this contribution, we commented on the recommendations recently proposed by the Emilia-Romagna Region on how structuring mental healthcare interventions in all regional jails. Moreover, starting from the findings reported in recent epidemiological studies examining the prevalence of mental disorders in Emilia-Romagna prisons, we proposed a new treatment model for mental health and pathological addictions in jail, which took into account the current incidence of inmates with severe mental illness, psychological distress due to incarceration, and substance use disorder. Perhaps, this new intervention model (specifically centered on clinical psychology and case management by intramural mental health professionals) requires a vision able to overcome the classical "medical-centered" approach, which still too often permeates many sectors of public mental healthcare services. In our opinion, if we decide to look at the moon, we shouldn't dwell too much on the finger pointing to it.

Purpose: Recently two instruments were developed to address the study of the cognitive biases in schizophrenia spectrum disorders (SSD): the Cognitive Biases Questionnaire for Psychosis (CBQ-P) and the Davos Assessment of Cognitive Biases Scale (DACOBS). Aim of this study was to validate the Italian version of the DACOBS., Methods: We investigated factor structure, reliability, discriminative and convergent validity of the instrument by comparing to the CBQ-P in an Italian sample of 102 patients diagnosed with SSD and 330 healthy controls (HC), matched by age, education and gender., Results: The second-order seven-factor solution provided the best results among the four models tested. Reliability proved to be very satisfactory, with ω coefficient ranged from 0.75 for Jumping to conclusions to 0.89 for Safety Behavior. The Italian version of DACOBS could discriminate psychosis from HC (Wilks' Lambda=0.64, F=34.284, p<0.001; h2=0.364). All seven DACOBS subscales were significantly correlated with the CBQ-P subscales (total sample: r=0.331-0.707; SSD group: r=0.424-0.735; HC group: r=0.177-0.460)., Conclusions: The Italian version of DACOBS is a valid instrument for measuring cognitive biases for patients with psychosis, confirming previous results regarding the psychometric properties of the tool.

Aim: Twenty years of research on the Ultra-High Risk (UHR) paradigm have shown the importance of early intervention in psychosis (EIP) in reducing its severity and persistence. From September 2012, the Reggio Emilia Department of Mental Health developed a specific care pathway (the Reggio Emilia At-Risk Mental States [ReARMS] protocol) as an diffused, "liquid" EIP infrastructure branched within the network of all its adult and child/adolescent mental health service, aimed to offer an evidence-based, expertise-driven protocol of care to young people with a First Episode Psychosis (FEP) or an UHR mental state. Aim of the current study was to investigate patterns of referral to the ReARMS protocol during the first five years of clinical activity., Methods: All participants (n=300) were help-seeking adolescents and young adults, aged 13-35 years, who completed an ad-hoc socio-demographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States (CAARMS)., Results: Among individuals who completed the baseline assessment, 95 (31.7%) did not comply with UHR/FEP defined criteria (UHR- subgroup), while 205 (68.3%) were offered the ReARMS protocol: of them, 154 (75.1%) accepted and were enrolled in the program, 19 (9.3%) refused, and 32 (15.6%) dropped out during the first year of treatment. In comparison with UHR- and UHR, FEP patients showed higher percentages of history of substance abuse and previous hospitalization, as well as higher levels of psychopathology and functioning. Individuals entering the ReARMS protocol were mainly referred by emergency room/general hospital, general practitioners, or they were self-referred., Conclusions: EIP on young subjects at UHR of psychosis (together with FEP patients) in Italian public mental health services is clinically relevant, feasible, and recommended, also in adolescence, where there is a specific high risk of falling through the child-adult service gap.

Aim: The aims of this study are to analyze psychopathological relations between obsessive-compulsive and psychotic symptoms in a group of patients with obsessive-compulsive disorder (OCD), and to verify if the obsessive subgroup with psychotic features can be considered as a distinct OCD subtype., Methods: The study sample included 68 patients with OCD who were divided into two different groups (OCD with and without psychotic features). All subjects completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Scale for the Assessment of Positive Symptoms (SAPS), the Hamilton Depression Rating Scale (HDRS), and the Structured Interview for DSM-IV Personality Disorders (SIDP-IV)., Result: Twenty subjects (29.4%) were affected by OCD with psychotic features. They were characterized by an earlier onset of obsessive illness (p<0.05), a more frequently chronic course (p<0.01), an "atypical" obsessive-compulsive symptomatology (with poor insight and anxiety) (p<0.001), higher levels of depression (p<0.05), and a higher prevalence of schizotypal personality disorder (p<0.01)., Discussion: Patients affected by OCD with psychotic symptoms appear to be a distinct subtype of obsessive-compulsive disorder, characterized by a set of specific psychopathological and personological features. However, the finding that these subjects have a higher prevalence of schizotypal personality disorder seems to suggest that they can be considered as a peculiar clinical subset belonging to the schizophrenia-spectrum disorders rather than a group of obsessive individuals placed on the most serious clinical extreme of the OCD spectrum.

Paraphrenia is a chronic psychotic disorder similar to paranoid schizophrenia, but with a better-preserved affect and rapport, and a much less personality deterioration. It was at first described by Kraepelin in 1913 as a group of patients who exhibited delusional symptoms typical of dementia praecox, but with minimal disturbances of emotion and volition. After the publication of Mayer-Gross's report in 1921, the view to differentiate paraphrenia from schizophrenia was considered to be unfounded and the term "paraphrenia" was not included in the current DSM-IV-TR and ICD-10 diagnostic criteria. Consequently, this disorder is now diagnosed relatively infrequently. However, several authors have recently suggested that the paraphrenia concept has not lost its usefulness. It seems to be that many psychiatrists recognize the illness, but labelled it as "atypical psychosis", "schizoaffective disorder" or "psychotic disorder not otherwise specified" for the lack of a better diagnostic category. Very few systematic studies on paraphrenia have been conducted in the past 70 years. Aim of this article is to underline the modernity of Kraepelin's thinking and his "paraphrenia" concept, suggesting that it could be possible to define and recognize the illness if practitioners would be induced to use a viable diagnostic entity.