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Background: The standardization of outcome measures is needed for comparing studies and using common measures in clinical practice. We aimed to identify cognitive and patient-reported outcomes and timing of assessment for glioma, meningioma, and vascular surgery. Method: A consensus study was conducted. Participants selected cognitive and patient-reported measures among a list of instruments identified through a literature search. Results: Seventeen cognitive tests for the glioma and meningioma’s evaluation, 8 for the vascular diseases, and one questionnaire on quality of life and one on emotional distress were identified. The timing of outcome assessment selected was before surgery, at discharge, and after 3 and 12 months for glioma; before surgery and after 3 months for meningioma; before surgery, at discharge, and after 6 months for vascular diseases. Conclusion: The identification of common outcome measures is the first step toward a shared data collection improving the quality and comparability of future studies.

Background: The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment. Methods: A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation. Three workshops were organized during which a multidisciplinary group called Neurosurgical Outcome Network (NEON) was created and the methodology to select outcome measures, predictors, and timing of outcome assessment was established. Eight working groups were created for the different neurosurgical diseases (neuro-oncological, skull base, vascular, traumatic, spinal, peripheral nervous system, malformation, functional) and 8 workshops were organized to identify the outcome measures and predictors specific for each of the neurosurgical diseases based on the experts' clinical practice and the existing literature. Results: A total of 20 neurosurgical departments participated in this study. Specific outcome measures, predictors and the timing of outcome assessment were identified for each of the 8 neurosurgical diseases. Moreover, a list of variables common to all pathologies were identified by the NEON group as further data to be collected. Conclusions: A consensus on the minimum set of outcome measures and predictors and the timing of outcome assessments for 8 neurosurgical diseases was achieved by a group of neurosurgeons of the Lombardy region, called NEON. These sets could be used in future studies for a more homogeneous data collection and as a starting point to reach further agreement also at national and international level.

Background: The standardization of outcome measures is needed for comparing studies and using common measures in clinical practice. We aimed to identify cognitive and patient-reported outcomes and timing of assessment for glioma, meningioma, and vascular surgery. Method: A consensus study was conducted. Participants selected cognitive and patient-reported measures among a list of instruments identifed through a literature search. Results: Seventeen cognitive tests for the glioma and meningioma’s evaluation, 8 for the vascular diseases, and one questionnaire on quality of life and one on emotional distress were identifed. The timing of outcome assessment selected was before surgery, at discharge, and after 3 and 12 months for glioma; before surgery and after 3 months for meningioma; before surgery, at discharge, and after 6 months for vascular diseases. Conclusion: The identifcation of common outcome measures is the frst step toward a shared data collection improving the quality and comparability of future studies

Background:Agnosia for objects is often overlooked in neuropsychology, especially with respect to rehabilitation. Prosopagnosia has been studied more extensively, yet there have been few attempts at training it. The lack of training protocols may partially be accounted for by their relatively low incidence and specificity to sensory modality. However, finding effective rehabilitations for such deficits may help to reduce their impact on the social and psychological functioning of individuals. Objective:Our aim in this study was to provide clinicians and researchers with useful information with which to conduct new studies on the rehabilitation of object agnosia and prosopagnosia. To accomplish this, we performed a systematic and comprehensive review of the effect of neuropsychological rehabilitation on visual object and prosopagnosia. Methods:The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. In addition, the Single-Case Experimental Design (SCED) and the Critical Appraisal Skills Programme (CASP) scales were used to assess the quality of reporting. Results:Seven articles regarding object agnosia, eight articles describing treatments for prosopagnosia, and two articles describing treatments for both deficits were included. Conclusions:In the light of the studies reviewed, treatments based on analysis of parts seem effective for object agnosia, while prosopagnosia appears to benefit most from treatments relying on holistic/configural processing. However, more attempts at rehabilitation of face and object agnosia are needed to clarify the mechanisms of these processes and possible rehabilitations. Moreover, a publication bias could mask a broader attempt to find effective treatments for visual agnosia and leaving out studies that are potentially more informative.

Background: Prison mental health care is a significant topic which has been already studied and described in literature, particularly because of important implications both in the prison and in the health care system. It's not uncommon that inmates suffering from mental disorders are referred to high security forensic services (HSFS) but, to date, studies assessing factors associated with relevant referrals to these services are missing. So, the aim of our study is to investigate socio-demographic, criminological, psychopathological and toxicological variables among those who were referred to HSFS as compared to their non-referred counterpart. Methods: We conducted a cross-sectional study recruiting 159 subjects receiving prison inpatient care in an Italian jail, between January 2010 and August 2015. No subjects were excluded from the study. The mean age was 39. Results: About half of included prisoners suffered from personality disorder while one-third from psychotic disorders. >60% of the subjects had comorbid substance use disorders. The odds of being referred to HSFS were related to previous admission (odds ratio [OR] = 5.34, 95% confidence interval [CI] 1.66–17.16), diagnosis of psychosis (OR = 2.79, 95% CI 1.11–7.04) and cannabis use disorder (OR = 2.68, 95% CI 1.14–6.28). Personality disorder was inversely associated to the referral to forensic facilities (OR = 0.37, 95% CI 0.14–0.97). Conclusions: Mental health services should improve preventive measures for vulnerable prisoners in order to reduce criminal recidivism and forensic readmission.

La recentissima approvazione della normativa di superamento degli Ospedali Psichiatrici Giudiziari (OPG) ha posto il clinico psichiatra che opera in carcere di fronte a nuovi interrogativi e a nuove sfide sul trattamento intra ed extra-murario dei detenuti affetti da patologia psichiatrica grave (SMI). Gli studi Italiani condotti sull’argomento sono pochi e quelli internazionali di riferimento riportano percentuali in crescita di detenuti affetti da SMI ed una crescente difficoltà dell’istituzione a farsene carico. Lo studio apre ad indagini esplorative tese ad individuare un modello di caratteristiche di fragilità intrinseca alla sotto-popolazione di detenuti inviati al Reparto di Osservazione Psichiatrica per l’accertamento delle infermità psichiche. Nello specifico sono state ricercate delle caratteristiche associate all‘invio in strutture alternative alla detenzione ordinaria per quei detenuti con esito positivo dell’osservazione.Lo studio è stato condotto in maniera retrospettiva sui dati di tutti i 159 detenuti transitati presso il Reparto di Osservazione Psichiatrica della C.C. di Monza tra il 1 gennaio 2010 e il 31 agosto 2015 e valutati dagli psichiatri del Servizio di Psichiatria Penitenziaria dell’ Ospedale San Gerardo operante all’interno dell’istituto. Sono state raccolte ed analizzate una serie di variabili relative a caratteristiche socio-demografiche, criminologiche, tossicologiche cliniche e di modello comportamentale. Sui dati, raccolti in uno specifico database sono state condotte le analisi statistiche.Le evidenze maggiormente significative nella lettura dei risultati sono state le correlazioni tra l’esito positivo dell’osservazione psichiatrica con la diagnosi di psicosi in asse I, i gesti autolesivi e suicidari compiuti prima dell’ingresso in carcere e un’anamnesi positiva per pregressi accessi in l’Ospedale Psichiatrico Giudiziario. Non si sono evidenziate significatività invece nelle categorie di variabili tossicologiche né in quelle legate a

Objective: To examine the association between posttraumatic stress disorder (PTSD) and obesity in the literature to date. Data Sources: We systematically searched PubMed, Embase, Scopus, Web of Science, and ProQuest from database inception until September 2013. Search phrases combining the terms Obesity and Post-Traumatic Stress Disorder were used. Study Selection: We selected observational studies estimating obesity prevalence in samples of people with PTSD, as well as in comparison groups without PTSD. Data Extraction: Obesity rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. Results: A total of 113, 395, 59, 115, and 400 records were generated from PubMed, Embase, Scopus, Web of Science, and ProQuest, respectively. Thirteen studies were eligible according to inclusion criteria. The pooled crude odds ratio (OR) and 95% confidence interval (CI) for obesity among people with PTSD, based on 589,781 subjects, was 1.55 (1.32-1.82). A large heterogeneity was found (I2 = 90%), and risk of publication bias was statistically significant (P = .002). However, subgroup and sensitivity analyses including only studies with most accurate methods to assess obesity (OR = 1.35; 95% CI,1.05-1.74; I2 = 47%) and PTSD (OR = 1.82; 95% CI, 1.33-2.50; I2 = 75%) also confirmed the association between PTSD and obesity. Conclusions: Despite some limitations, individuals suffering from PTSD seem more likely, relative to controls, to suffer from obesity. As such, individuals with this comorbidity should be targeted for intensive prevention and treatment focused on both disorders. Future research is needed to identify the role of unknown factors and mediators that might clarify the nature of this association.

Introduzione: La schizofrenia è una patologia psichiatrica con sintomi positivi, negativi e compromissione delle funzioni neuro e socio-cognitive1. Tale patologia si associa frequentemente al disturbo da uso di sostanze2. Disegno Studio descrittivo-osservazionale Metodologia Sono stati reclutati 25 soggetti con diagnosi di Schizofrenia secondo il DSM-IV (Structured Clinical Interview for DSM-IV, SCID I) presso la Clinica Psichiatrica Universitaria dell’Azienda Ospedaliera San Gerardo di Monza. Per ogni paziente sono stati raccolti i dati socio-demografici e clinici e ad ognuno sono stati somministrati l’Alcohol e la Drug Use Scale (AUS e DUS), la Positive and Negative Syndrome Scale (PANSS) e il Test di Ekman (per la valutazione delle funzioni socio-cognitive tramite il riconoscimento delle emozioni faciali). Il campione è stato quindi suddiviso in due gruppi: con abuso di sostanze (Ab+) e senza (Ab-); i gruppi sono stati confrontati per quanto riguarda le caratteristiche cliniche e le capacità socio-cognitive (social cognition). Risultati Al test di Ekman il gruppo Ab+ mostra minor compromissione delle capacità socio-cognitive (Ab+: 47.8 ± 5,3; Ab-: 40.5 ± 8,3; p<0.007). Inoltre all’aumento della gravità clinica si associa un peggioramento della performance nel riconoscimento delle espressioni (p=0.03). L’abuso incide sull’esito al test di Ekman maggiormente rispetto alla gravità clinica (coeff di regressione 7.45 p=0,006 vs coeff di regressione -0.20 p=0.013). Conclusioni Nei soggetti affetti da schizofrenia la social cognition è meno compromessa se tale condizione è associata ad abuso di sostanze. Bibliografia (1) Bora E, Yucel M, Pantelis C. Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study. Br J Psychiatry. 2009 Dec;195(6):475-82. (2) Yücel M, Bora E, Lubman DI, Solowij N, Brewer WJ, Cotton SM, Conus P, Takagi MJ, Fornito A, Wood SJ, McGorry PD, Pantelis C. The impact of cannabis use on cognit

Introduction: An analysis of the literature on eating disorders (ED) indicates that Eds are often comorbid with the diagnosis of Personality Disorder (PD). This seems to be a psychopathological feature, characteristic of this patient population. However, the double classification seems to be often insufficient when describing a very complex psychopathological picture. These observations have informed our intention to investigate these two distinct nosographic groups by means of a single construct. Aims: The aim of this study is to identify and describe (through tests that evaluate defense mechanisms) the defensive styles that characterize the two groups of patients, in order to outline a defensive profile that can assimilate or differentiate the psychopathological groups. Materials and methods: The study was carried at the Department of Psichiatry of the San Gerardo Hospital in Monza. The Defence Style Questionnaire-40 (Farma Cortinovis, 2000) was administered and analysed. The sample consisted of 40 participants with eating disorders, recruited among the outpatients for eating disorders, and 40 patients with personality disorders recruited from two Psychiatric Outpatient Services. Results and conclusions: The data analysis showed a statistical significance in the use of Immature defense mechanisms and Neurotic defence mechanisms in both clinical samples.The patients with PD used a significantly higher number of psychotic defense mechanisms than patients with ED. These results may suggest that in ED patients, the symptoms can be themselves considered as defense mechanisms, or a defensive style that characterizes and makes specific the psychopathological picture

Objectives The alexithymia construct has been a remarkable feature of EDs: these patients have significant difficulty in identifying, distinguishing and describing emotions – especially anger and negative affect; they try to avoid frightening and unpleasant feelings and restrict the full emotional experience. Some authors have suggested that alexithymia is one of the factors responsable for poor response to treatment, relapse and chronicity in EDs. Since most studies are cross-sectional, it is difficult to understand the direction of causality between alexithymia and EDs; furthermore, literature is unable to provide conclusions on the usefulness of the concept in the clinical field, on its role in the maintenance of disease, and about the influence of usual treatments or the related needs to find alternative approaches to the classical setting. Aim of this preliminary study is to assess the prevalence of alexithymia in a clinical sample with eating disorders and to consider its relation with epidemiological variables, psychological characteristics, symptom severity, and with the general psychopathology dimensions. Methods The study has been performed in the Eating Disorders Centres of San Gerardo Hospital, Monza, and San Paolo Hospital, Milan. A sample of 125 patients with eating disorders was evaluated with the self-rated questionnaires Toronto Alexithymia Scale for the assessment of alexithymia, Eating Disorder Inventory-2 for the evaluation of relevant symptoms and psychological characteristics of EDs, and Symptom Checklist-90 for the assessment of general psychopathology.Results Our results show an about 38% prevalence of alexithymia in our sample, less than that reported in literature. The higher rate of alexithymia was found in patients with bulimia, but the diagnostic subgroups (anorexia, bulimia, binge eating disorder, not otherwise specified) did not significantly differ. TAS20 did not correlate with clinical or epidemiological variables. Alexithymia is mor

Here we report the case of Mrs. O., a 57 years-old woman presenting with mood disorder with psychotic symptoms developing strange skin lesions, ultimately leading to the suspected diagnosis of varicella-zoster encephalitis. The later appearance of a post-infectious acute inflammatory demyelinating polyradiculoneuropathy further confirmed the suspect. This case stresses the importance for not discarding a priori neurological diagnoses when facing with psychiatric patients, especially when atypical details are present

Il costrutto di alessitimia è stato usato in letteratura in maniera approssimativa, conducendo — nel corso del tempo — a un offuscamento del significato e al conseguente inevitabile abbandono dello stesso, pur all’interno di un costrutto concettualmente ancora valido. Il problema è derivato dall’uso indistinto di modelli diversi che si sono intersecati a causa di circostanze storiche. Questo contributo si propone di rivedere il concetto dell’alessitimia, da un punto di vista storico e teorico, riconducendolo ad altri costrutti più attuali (Codice Multiplo, Intelligenza Emotiva, Mentalizzazione, Attaccamento Insicuro) che presentano alcune affinità con esso. Il lavoro si propone di valutare, attraverso la mediazione della teoria della regolazione affettiva di Taylor, il complesso ruolo dell’alessitimia all’interno dei disturbi del comportamento alimentare. L’alessitimia correla con i tratti psicologici dei DCA secondo un modello di causalità complessa e non lineare; questo aspetto, visto nel contesto della relazione terapeutica, è uno dei fattori responsabili della scarsa risposta al trattamento, delle ricadute o della cronicizzazione dei disturbi. Nel contributo vengono trattate le relazioni tra alessitimia, disturbi del comportamento alimentare e stile di attaccamento insicuro, nonché la relazione alessitimia-anoressia nervosa da un punto di vista dinamico. Vengono posti in discussione aspetti neurobiologici relativi al tratto alessitimico, nonché una revisione dei principali articoli degli ultimi anni sul tema dell’alessitimia nei DCA a partire da un’accurata revisione della letteratura esistente sui principali database internazionali e la pubblicistica ad essi correlata. Si discutono, infine, le possibilità di trattamento idonee per pazienti alessitimici, rimandando al lettore la valutazione sull’eventuale recupero, nel contesto dei DCA, del senso e dell’utilità del costrutto stesso., A rough and confused use in literature of the concept of alexithymia has led, over time, to blur the meaning and consequently to the inevitable dismission of an even valid concept. Perhaps the problem was caused by a vague use of the term, associated to a mixture of different models, merged accordingly to the historical context. This paper proposes to revise the concept of alexithymia, from an historical and theoretical perspective, highlighting the connections of this construct with others (Multiple Code, Emotional Intelligence, Mentalization, Insecure Attachment) of higher actuality, showing affinities. Furthermore, it proposes to evaluate, with the help of Taylor affect regulation theory, the complex role of alexithymia within eating disorders. Alexidiymia relates the basic psychological traits of eating disorder patients according to a non-linear model of complex causality; Alexithymia is characterized by the object relation, defined by neurobiological findings and in the therapeutic relationship connected to a poor response to treatment, to relapses or to chronic disorders. The relationship among alexithymia, eating disorders and insecure attachment style, and the relationship between alexithymia and anorexia from a dynamic point of view are discussed. The neurobiological points of view of alexidiymia and a review of the key articles of recent years related to alexithymia in eating disorders are proposed. The possibility of appropriate treatments for alexithymic patients are reviewed, leaving the reader to the evaluation on whether to retrieve, in the context of the DCA, the meaning and the usefulness of a construct.

BACKGROUND: Age-related physiological changes in the gastrointestinal tract, as well as modifications in lifestyle, nutritional behaviour, and functionality of the host immune system, inevitably affect the gut microbiota, resulting in a greater susceptibility to infections. METHODOLOGY/PRINCIPAL FINDINGS: By using the Human Intestinal Tract Chip (HITChip) and quantitative PCR of 16S rRNA genes of Bacteria and Archaea, we explored the age-related differences in the gut microbiota composition among young adults, elderly, and centenarians, i.e subjects who reached the extreme limits of the human lifespan, living for over 100 years. We observed that the microbial composition and diversity of the gut ecosystem of young adults and seventy-years old people is highly similar but differs significantly from that of the centenarians. After 100 years of symbiotic association with the human host, the microbiota is characterized by a rearrangement in the Firmicutes population and an enrichment in facultative anaerobes, notably pathobionts. The presence of such a compromised microbiota in the centenarians is associated with an increased inflammatory status, also known as inflammageing, as determined by a range of peripheral blood inflammatory markers. This may be explained by a remodelling of the centenarians' microbiota, with a marked decrease in Faecalibacterium prauznitzii and relatives, symbiotic species with reported anti-inflammatory properties. As signature bacteria of the long life we identified specifically Eubacterium limosum and relatives that were more than ten-fold increased in the centenarians. CONCLUSIONS/SIGNIFICANCE: We provide evidence for the fact that the ageing process deeply affects the structure of the human gut microbiota, as well as its homeostasis with the host's immune system. Because of its crucial role in the host physiology and health status, age-related differences in the gut microbiota composition may be related to the progression of diseases and fr

This study aims to present the Italian version of the "Coping Responses of Rescue Workers Inventory" (CRRWI) developed by Beaton and colleagues (1999) for measuring coping strategies used by emergency workers. Participants to the study also filled in the Los Angeles Symptom Checklist (King et al., 1995), in order to have an independent measure of stress levels related to coping strategies. Two hundreds and eighty-seven health emergency workers participated to the study, 60% voluntary rescuers and 40% professional rescuers; they belonged to a variety of services and infrastructures of extra-hospital first aid. Through factor analysis six coping factors were identified, and differences due to the role during the rescue, years of service and gender were examined. In addition, LASC stress scores were correlated to the coping factors from the CRRWI. Finally, the "Coping Responses of Rescue Workers Inventory" demonstrated good psychometric properties and to be well suited to the Italian emergency health service.

Research surveys on the impact of work in emergency conditions has increased significantly in Italy over the last ten years, due to the fact that many research groups and intervention teams relating to emergency scenario psychology themes have became institutionalised. This review therefore represents an operative contribution to the research net that is gradually becoming organised in Italy. The analysis of international literature has identified a fairly uniform methodological format that characterises the majority of the surveys to assess the impact of work in emergency conditions. We have provided a detailed description of the instruments in the annexed tables, in particular, focussing on the points of strength and the points of weakness, the psychometric properties, the format, the operating instructions, and the presence of validation studies, if any, referred to Italy. A number of instruments specific to emergency workers, frequently cross-dimensional and created ad hoc for individual study contexts were also presented. The review closes with a critical examination of the dominant methodology applied in studies on emergency workers and with a description of new research horizons.