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Background: Alcohol Use Disorders (AUD), affective disorders, and personality disorders are among the most prevalent mental health conditions observed in individuals exhibiting suicidal behavior, encompassing both completed and attempted suicides. A robust association between AUD and suicidal behavior has been established through retrospective and prospective cohort studies. Research on the relationship between alcohol consumption and self-harm has predominantly focused on Western and high-income countries, whereas approximately one-third of the global population, including half of the world's countries, lacks accessible suicide data. This study aims to present an updated review of empirical evidence regarding the risk of suicide associated with AUD in both developed and developing nations., Methods: We identified published meta-analyses, reviews, systematic reviews, randomized controlled trials, clinical studies, clinical trials, controlled clinical trials, observational studies, and case reports written in English and published between January 2004 and June 2024. Our search yielded a total of 312 papers. After reviewing titles and abstracts, 232 articles were excluded from the initial records. Following full-text review of the remaining 80 articles, a qualitative synthesis was conducted, highlighting the most representative 41 papers for inclusion in this overview., Results: Our analysis indicates that alcohol abuse is a significant risk factor for all forms of suicidal behavior. Alcohol consumption functions as both a predisposing and precipitating factor, contributing to maladaptive behaviors in both developing and developed countries. The clinical condition is exacerbated by alcohol use, which in turn increases the risk of suicide., Conclusions: Further research is essential to develop targeted psychological and pharmacological interventions aimed at preventing and treating these conditions, with the goal of reducing the risk of suicidal behavior associated with AUD. In developing countries, integrating public health and clinical strategies is crucial for effectively addressing suicide prevention.

Background: illegal drugs significantly contribute to global health issues, with health complications often occurring not only in regular users with Substance Use Disorders (SUDs) but also in first-time and occasional users., Methods: this study examines five clinical cases from a public hospital in Ibiza, Spain, where patients presented with acute psychiatric symptoms due to recreational drug use., Results: Contrary to previous studies on SUDs, our patients typically had higher education levels and stable employment. Most of them used multiple substances, with cannabis, cocaine, and alcohol being the most frequently used. There was also a common occurrence of consuming drugs with uncertain contents. Upon admission, typical symptoms included aggression, hallucinations, mood swings, and disorientation in time and space., Conclusions: Our findings underscore the significant mental health risks posed by illicit drugs, even for individuals with no prior psychiatric history. Factors like the drug's potency, frequency and amount of use, past mental health issues, personality traits, and previous traumatic experiences might influence the onset of these symptoms.

Abstract: The psychopathological manifestations associated with substance use, including induced psychotic experiences, are increasingly relevant but not well-understood within the medical community. Novel psychoactive substances and potentiated old compounds like cannabis and cocaine have emerged as a global concern, especially among adolescents and young adults. Transition rates from substance-induced psychosis (SIP) to persistent psychosis are significant, particularly in cases of cannabis-induced psychosis. Scientific inquiry into induced psychotic phenomena has revealed differences between SIP and primary psychotic disorders, highlighting the risk factors associated with each. The concept of exogenous psychosis, including its toxic variant known as lysergic psychoma, provides valuable insights into the role of external factors in psychosis development. A phenomenological approach characterizes this disruption in perception as a shift in temporal and spatial dimensions, leading to auditory and visual hallucinations. The "twilight state" of consciousness plays a crucial role in the transition from substance use to psychosis, with implications for spatiality, intersubjectivity, and temporality. This complex path to psychosis challenges traditional diagnostic models and underscores the need for a more nuanced understanding of substance-induced psychopathological experiences., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The article presents a systematic literature review on the use and the psychiatric implications of over-the-counter drugs (OTC), prescription-only-medications (POM), and new psychoactive substances (NPS) within custodial settings. The searches wer carried out on 2 November 2022 on PubMed, Scopus, and Web of Science in line with PRISMA guidelines. A total of 538 records were identified, of which 37 met the inclusion criteria. Findings showed the most prevalent NPS and OTC and POM classes reported in prisons were synthetic cannabinoids receptor agonists (SCRAs) and opioids, respectively. NPS markets were shown to be in constant evolution following the pace of legislations aimed to reduce their spread. The use of such substances heavily impacts the conditions and rehabilitation of persons in custody, with consequent physical and mental health risks. It is important to raise awareness of the use and misuse of such substances in prisons (i) from an early warning perspective for law enforcement and policy makers (ii) to prompt doctors to cautiously prescribe substances that may be misused (iii) to improve and increase access to treatment provided (iv) to add such substances to routine toxicological screening procedures (v) to improve harm reduction programmes., Competing Interests: Declaration of Competing Interest S.F. was a member of the UK Advisory Council on the Misuse of Drugs (ACMD; 2011–2019) and is currently a member of the EMA Advisory Board (Psychiatry). Se. F. is a member of the UK’s Independent Advisory Panel on Deaths in Custody. M.G. has been a consultant and/or a speaker and/or has received research grants from Angelini, Doc Generici, Janssen-Cilag, Lundbeck, Otsuka, Pfiser, Servier, Recordati. C.J.M. is a member of the ACMD’s Novel Psychoactive Substances and Technical Committees. C.S., V.G., M.A., Mi. A., S.G., G.G., d’A.G, D.C.F., C.R., C.C., P.M., G.A.: nothing to be declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Dissociative experiences are considered undesirable ketamine's adverse events. However, they might be crucial for ketamine's antidepressant effects, at least in some depression subtypes. Current understandings of ketamine's therapeutic potentials converge on the so-called "relaxed prior hypothesis," suggesting that glutamatergic blockage up-weights bottom-up surprising somatosensory/affective states. As a result, ketamine improves short-term plasticity in depression by enhancing sensitivity to interoceptive signals., Methods: We selected 2 case studies for their paradigmatic description of "depersonalized depression" (Entfremdungsdepression) symptoms. Patients were included in a 6-month-long esketamine program for treatment resistant depression, during which we collected their spontaneous experience with esketamine. According to a neurophenomenological approach, we combined subjective reports from unstructured clinical interviews and the review of previous objective neuroimaging results and neurocomputational models to unveil the relation between esketamine antidepressant effects and interoceptive sensitivity., Results: According to our clinical observations, esketamine-induced dissociation might be particularly effective in the depersonalized depression subtype, in which interoceptive awareness and interaffectivity are particularly compromised. Ketamine and esketamine's dissociative effects and particularly disembodiment might suspend previously acquired patterns of feeling, sensing, and behaving., Conclusions: Coherently with previous research, we suggest that esketamine-induced disembodiment allows for a transient window of psychological plasticity and enhanced sensitivity, where the body recovers its permeability to affective affordances., (© 2024 S. Karger AG, Basel.)

Introduction: Psychiatric urgency is defined as a situation of serious mental suffering and behavioral alteration, which promptly requires adequate treatment; we talk about emergency when the condition can be life-threating. Even if until now neglected by phenomenological psychopathology, the emergency issue faces a clinical management challenge in which the phenomenological method becomes fundamental. The purpose of this manuscript is then to explore the phenomenological perspective of psychiatric emergencies. The manuscript is organized into four sections: the first deals with the encounter in clinical phenomenology, the second with the life-word of the crisis, the third with the atmosphere of emergency; finally, a final section on the importance of the phenomenological method for the clinician., The Encounter in Clinical Phenomenology: The centrality of the encounter in clinical phenomenology cannot be stressed enough. It is not just the encounter between doctor and patient, but also and above all the encounter between two men, between two subjects. And it is in the affective space between them, in the intersubjectivity and intercorporeality of their encounter, that the transformative power of understanding emerges and reverberates from both sides. The approach to the other must be respectful, along the lines of the ethics of approximation, it must recognize the other as other and not overwrite it with one's own prejudices. Otherwise, if clinicians are not sufficiently trained in the encounter, the risk is to get stuck in the anguish of the instant, to be absorbed by it, to become its tools. It is precisely the atmosphere of the emergency room that is full of expectations, haste, anxiety, which actually hinders the possibility of encountering. Instead, this possibility must be recovered, because the encounter is the founding aspect of every clinical interview, of every diagnostic suspicion, of every therapeutic resolution., The Life-Word of the Crisis: Seizing the encounter in its immediacy and in its totality, through the atmosphere that characterizes it, means for the clinician to position himself not outside the crisis, in an observational position in front of the patient, but to position himself next to him, to immerse himself in his life-world. Only then will the explosiveness of his symptoms appear to us not only as a symptomatic cascade to be contained and extinguished, but as the expression of a life-world in crisis. To use Ey's terminology, the madness of an instant must be placed within the madness of a lifetime. The patho-gnostic structures of the psychiatrist must tune into the structures of the life-world of the crisis, with the perspective of giving meaning, of helping the subject to re-inscribe the crisis within his history, and to overcome it., The Atmosphere of Emergency: The experience of emergency is in fact detached from daily life of our being-in-the-world, both from the clinician's side and from that of the patient, who loses himself in this pathically charged and tense atmosphere and needs someone to walk alongside him to find the reins of his world. The context of the emergency room puts the clinician in the position of applying Strauss's sympathetic perception of the world, made up of atmospheres, sensations, profiles, and not of eidetic knowledge. The concept of atmosphere, inaugurated by Tellenbach and taken up in recent years by several authors, appears fundamental in understanding the amalgam of emotional tension, haste and immersiveness that characterizes the emergency room environment. An atmosphere that can become oppressive, if not thematized, and that can lead the clinician to defend himself in the haste and superficiality of the intervention., The Phenomenological Method: Psychiatric crisis is always a situation in which we are thrown, perhaps to the highest degree, and the unfolding of references between the self and the world and between the self and the others becomes an essential skill. Even in the absence of an adequate setting, in the intersection between several pressures, the phenomenological method retains its panoramic gaze intact. We define it panoramic because it does not aim only at the observation and description of the present phenomena, which are generally characterized by violence, anguish, chaos. It is through the suspension of the epochè that the clinician can distance himself from the oppressive atmosphere of the crisis and grasp the coordinates of the patient's life-world. Only with this attitude does an authentic encounter become possible even in the difficult situation of emergency, paving the way for the challenge of care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Goretti, Esposito and Di Petta.)

Introduction: Internet gaming disorder (IGD) is an emerging condition within the field of behavioural addictions. IGD has been demonstrated to be highly comorbid with many other mental health disorders. Among these, substance use has been associated with IGD, and there are underlying similarities between behavioural addictions and substance use disorders. The main aims of the present study were (i) to investigate the association between high-risk gaming and substance use among young adults drawn from the general Italian population; and (ii) to explore the psychopathological correlates of high-risk gaming., Methods: Lifetime substance use, type of substances consumed, and frequency of use were investigated through an online survey in a sample of 913 adults aged 18-40 years. High-risk gaming was assessed using the ten-item Internet Gaming Disorder Test (IGDT-10). Psychopathology was assessed using the Revised 90-item Symptom Checklist (SCL-90-R)., Results: High-risk gaming prevalence rate was 4.4%. High-risk gamers scored higher on all dimensions of psychopathology, confirming the association between high-risk gaming and psychiatric distress. Regarding substance use, high-risk gamers were more commonly polysubstance users and more commonly made use of psychodysleptic substances. High-risk gamers were more commonly frequent substance users, and 32.5% of high-risk gamers used or had used psychoactive substances often or everyday throughout their lives., Discussion and Conclusion: The findings are in line with the concept of a common neurobiological vulnerability for both gaming and substance use. There is the need for more research to examine the phenomenology of gaming and its interplay with substance use to help develop effective interventions and prevention strategies., (© 2023 S. Karger AG, Basel.)

Beyond the language of medicine and psychology, the essence of many psychopathological experiences remains something that cannot be explained, even if it is possible to perceive it. Phenomenological language in this case must adapt itself to the heart of the lived experience. The phenomenological attitude, in particular, allows us to grasp something that happens before (a priori) the distinction between subject and object. The application of the phenomenological setting to groups of human beings in a clinical and therapeutic context allows us, in spite of its descriptive-contemplative aura, the extreme richness of potentialities, applicative and transformative, of one of the greatest intuitions of modern thought: the disappearance of the fission between the subject, the others and the world-of-life, in the evidence of meaning that the mutual experience of one's own presence (Dasein) opens up. The Mitseindoes not represent the only existential structure that makes the Daseinable to exist with others, but the relationship between the "originary temporality" of the Daseinand the other as "you." Dasein is that entity that is structurally "with" others. And it is in this dynamic relationship that the theme of Sorge unfolds. Care becomes for Heidegger the existential of existential, fundamental ontological structure, indicating the original opening of being, And in this sense, a we-ness-which-cares. This phenomenological approach to group therapy is quite different from the psychoanalytical approach. Indeed, it is based on consciousness and not on the unconscious. The phenomenologist sees the essence of phenomena, he does not use interpretation, whereas the psychoanalyst is more interested in recording the hidden meanings beyond the phenomena. The particular group atmosphere is made up of the following elements: lack of pre-selection, free accessibility into the group unrestricted by rigid rules, less structured actions, the presence of addicts, psychotics and "normal" people side by side. It is very difficult to treat this existential situation, which is characterized by patients frequently dropping out of conventional treatment, the loss of the being-in-the-world structure, boredom, emptiness, dread, anger, lack of meaning, loneliness and isolation. Dasein group analysis (an original interpretation and application of Binswanger's Daseinsanalyse) is here proposed and discussed. Unlike Dasein analysis, this approach applies phenomenology, beyond the classic pair of therapist and patient, to a group of people, in which everyone is simply a human being in the world., (© 2019 S. Karger AG, Basel.)

Although semen analysis is routinely used to evaluate the male reproductive potential in the canine species, only a few authors have attempted to relate semen characteristics to donor traits, such as age or weight, and fertility. This study evaluated the effects of dogs' age (young: 0-24 months, adult: 25-84 months, old: >84 months), size (small: <15 kg, medium: 16-40 kg, large: >40 kg) and reason for semen collection (evaluation, artificial insemination, cryopreservation or research purposes) on the seminal characteristics and related the main seminal characteristics with fresh AI results. Overall, 251 semen examinations were performed from 140 dogs presented between 2000 and 2015 at the University of Pisa Veterinary Teaching Hospital. Conventional semen parameters (semen volume, sperm concentration and total number, subjective motility and sperm morphology) were evaluated. Overall, 227 (90.4%) samples contained spermatozoa. Azoospermic samples resulted from complete (n = 13, 9 dogs), or incomplete ejaculations (n = 11, 8 dogs), based on seminal alkaline phosphatase concentration and/or ancillary examinations. Reason for semen collection had a significant effect on semen volume, sperm total number and sperm concentration. The proportion of normal spermatozoa was lower in dogs presented for semen evaluation (P < 0.05). Dog size affected ejaculate volume and total sperm number, which was lower in small dogs compared to medium (P < 0.01 and P < 0.05, respectively) and large-sized dogs (P < 0.01). Age had no influence on volume, sperm number or motility. The proportion of normal spermatozoa was higher in young animals than in old ones (P < 0.05). There was a significantly higher proportion of midpiece defects in old dogs compared to young ones (P < 0.01). Total sperm number, motility and proportion of morphologically normal spermatozoa in the semen used in AIs resulting in a pregnancy were 627.6 × 10 6 , 83.9% and 64.9%, respectively, all significantly higher than in the unsuccessful AIs, where they were 389.4 × 10 6 , 66.5% and 42% (P < 0.05). In conclusion, age, size and reason for semen collection may affect main sperm parameters and must be taken into consideration during the interpretation of a routine semen evaluation. In turn, altered semen parameters may affect fertility after artificial insemination., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The objective of this study was to evaluate the efficacy of olanzapine (OLA) in heroin-dependent patients affected by comorbid schizophrenia spectrum disorders (SSD). Sixty-one patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for heroin dependence and the criteria for SSD (schizophrenia and schizotypal and schizoaffective-bipolar disorders) were treated in a 12-week prospective observational trial of substitution treatment in combination with OLA or typical antipsychotic haloperidol. Patients were included into 2 subgroups, in relationship with treatment, for the evaluation of the end points at week 12: group 1, SSD treated with OLA (35 patients); group 2, SSD treated with haloperidol (26 patients). Efficacy measures were retention in treatment, Symptoms Checklist-90 score changes, negative urinalyses results, and craving reduction. The rate of patients who remained in treatment at week 12 in group 1 SSD, treated with OLA, was significantly higher (32[91.4%]) than that of group 2 SSD (13 [50%]), treated with the typical antipsychotic (P < 0.001). The decrease in Symptoms Checklist-90 total scores from baseline, as expression of an improvement in comorbid psychopathology in the patients who completed the treatment, was significantly more consistent in group 1 than in group 2 patients (P < 0.01). Among the patients who remained in treatment, 64.4% achieved early full substance abuse remission, whereas 35.6% achieved partial substance abuse remission, with a significant difference between 1 (78.13%) and 2 (46.1%) treatment subgroups (P = 0.04). Although obtained by an observational-open clinical study with multiple limitations, our findings suggest that OLA may be able to increase retention and negative urinalyses rates during opioid agonist maintenance treatment in the patients with SSD and to improve psychopathology symptoms and tolerability in these dually diagnosed heroin addicts. Preliminary accurate diagnostic assessment and appropriate psychoactive medication in addicted patients affected by schizophrenia and schizotypal and schizoaffective-bipolar disorders seem to obtain less adverse effects and a more successful outcome of drug dependence treatment.

Hand deformities cause severe discomfort and functional limitations to patients with Parkinson disease (PD) and related disorders. In clinical practice the problem is often overlooked or misdiagnosed. This paper reports on four cases whose characteristics are discussed.