Correction: Messina et al. Knowledge and Practice towards Alcohol Consumption in a Sample of University Students. Int. J. Environ. Res. Public Health 2021, 18, 9528.

Gemma Battagliese was not included as an author in the original publication [...].

Knowledge and Practice towards Alcohol Consumption in a Sample of University Students.

Objective: Alcohol affects many human systems and is involved in the pathogenesis of other diseases. Particular attention must be paid to alcohol consumption among young people. It has been shown that 25% of young people's deaths are attributable to alcohol, and around 35 million people aged over 11 had consumed at least one alcoholic beverage in 2015. Study Design: Young people aged 18-24 were the most vulnerable to binge drinking in Italy, and 50.6% of teenagers drunk alcohol. Only a few studies in the literature have investigated those habits in university students. This study aims to examine alcohol use habits in a population of university students in Italy. Methods: Between 2018 and 2019, an anonymous online questionnaire was randomly sent to university students from 17 different universities in a network of research centres to study alcohol use disorders. The survey included socio-demographic information, questions about alcohol use, knowledge about alcohol consumption, and related risks. Used questionnaires were the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Drinking Motive Questionnaire-Revised (DMQ-R). Results: the AUDIT-C revealed that 53.3% of students were high-risk drinkers. Regarding binge drinking habits, 13.1% of students admitted to binge drinking behavior at least once a month. In our sample, male students are more likely to be low-risk drinkers than female peers (p < 0.008). Students from northern Italy are more likely to be high-risk drinkers (p = 0.003). Beer (65.9%) and wine (60.9%) were the most consumed alcoholic beverages. The most common places to drink alcohol were pubs (85.5%). The most likely motivations to drink alcohol were enhancement (40.43%), social (38.39%), coping (15.63%), and social pressure or conformity (5.55%). Only 43.8% of participants reported having attended an educational course on alcohol. Conclusions: University students were not fully aware of the implications of alcohol misuse and will be part of the adult society as critical figures and future leaders. It is imperative to inform students about alcohol consumption risks and investigate the motivations to drink. Stress, anxiety, and social pressure are only a few issues young people are exposed to. Special attention must be paid to young people and their coping strategies that involve substance abuse by using educative, preventive, and motivational approaches.

Developmental trajectories in psychiatric disorders: does substance/alcohol use moderate the effects of affective temperaments as moderators of age at onset? A study in post-acute, hospitalized patients with psychotic or DSM-5 bipolar or major depressive disorders.

BACKGROUND: Age-at-onset (AAO) affects psychiatric disorder outcome; substance (SUDs) or alcohol use disorders (AUDs) may influence their onset. Affective temperaments may affect early AAO and drug-use proneness. Objectives: To investigate whether SUD/AUD moderated temperamental effects in determining AAO of mental disorders. Methods: We included 300 post-acute inpatients with schizophrenia-spectrum and other psychotic (SSOPDs), major depressive (MDD) or bipolar (BD) disorders (168 men; mean age, 40.63 years ± 11.82 men, 43.21 years ± 12.69 women) with (N = 110) or without (N = 190) SUD/AUD. Patients completed cross-sectionally TEMPS-A. We carried moderation analysis with each regression-significant TEMPS temperament as independent variable, SUD/AUD presence/absence as dichotomous moderator, and AAO as dependent variable. Significance was set at p < 0.05. Results: AAO was lower in patients with SUD/AUD diagnosis than in patients without (23.74 ± 10.09 vs. 27.73 ± 10.35, respectively, p = 0.001, η2 = 0.034). SUD/AUD patients scored higher on the hyperthymic (10.22 ± 4.08, p < 0.001, η2 = 0.069) and irritable (8.26 ± 4.69, p < 0.01, η2 = 0.026) temperaments than nonSUD/AUD patients. Moderation analysis showed only direct effects of irritable (ß = -0.55, p < 0.005) and hyperthymic (ß = -0.95, p < 0.001) temperaments on AAO and no significant SUD/AUD and interaction effects. Limitations. Cross-sectional design. Conclusions: When irritable and hyperthymic traits prevail over other temperaments, AAO is earlier in SSOPDs, MDD, and BD. SUD/AUD presence/absence does not moderate the relationship between temperament and AAO.

Fetal alcohol spectrum disorders awareness in health professionals: implications for psychiatry.

Fetal Alcohol Spectrum Disorders (FASD) are a plethora of malformative conditions leading to mental retardation that affect newborns and children who have been exposed to alcohol during pregnancy or breastfeeding. FASD is a relevant topic for public health in Europe: European area is first in ranking for alcohol use during pregnancy with a prevalence of 25.2%. Italy ranked third among European countries with higher prevalence of FASD (45.0 per 1000 population). Furthermore, FASD could still be underestimated because of numerous undiagnosed and misdiagnosed cases. Aims of the study were to briefly summarize existing evidences about FASD and its psychiatric aspects to assess knowledge, attitudes and practice towards alcohol drinking during pregnancy in an Italian sample of health care professionals in order to provide information about FASD prevention. An anonymous online questionnaire containing the AUDIT-C, T-ACE model and the Drinking Motive Questionnaire was sent to 400 Italian healthcare professionals and students. The survey included socio-demographic information, questions about drinking habits and about knowledge, attitude and practice towards alcohol assumption during pregnancy. Among 320 respondents, 96.3% were women. AUDIT-C revealed that 52.4% were low risk drinkers but 27.6% were hazardous drinkers. The 90.6% of participants denied to ever attended a course about the fetus damage induced by alcohol consumption during pregnancy but 91.3% were willing to participate to professional update initiatives on the topic. Only 19.1% of participants talk regularly about the deleterious effects for the fetus of prenatal alcohol drinking to women and only 51.1% advise the 'zero alcohol' policy. Around 41% of participants tolerates the assumption of low-alcohol beverages. No differences were found between no drinkers and low and hazardous drinkers. In conclusion, data show that only specific and continuing updating for health care professionals about drinking habits may have impactful actions to prevent gestational alcohol intake in order to prevent the main cause of mental retardation in western countries.

Fetus morphology changes by second-trimester ultrasound in pregnant women drinking alcohol.

Fetal alcohol spectrum disorders (FASDs) are a group of negative conditions occurring in children exposed to alcohol during gestation. The early discovery of FASD is crucial for mother and infant follow-ups. In this study, we investigated in pregnant women the association between urine ethylglucuronide (EtG-a biomarker of alcohol drinking) and indicators of the physical characteristics of FASD by prenatal ultrasound in the second trimester of gestation. We also correlated these data with the AUDIT-C, T-ACE/TACER-3, TWEAK, and food habit diary, screening questionnaires used to disclose alcohol drinking during pregnancy. Forty-four pregnant women were randomly enrolled and examined for ultrasound investigation during the second trimester of gestation. Urine samples were provided by pregnant women immediately after the routine interviews. EtG determinations were performed with a cutoff established at 100 ng/mL, a value indicating occasional alcohol drinking. Fifteen of the enrolled pregnant women overcame the EtG cutoff (34.09%). Analysis of variance (ANOVA) revealed that the fetuses of the positive EtG pregnant women had significantly longer interorbital distance and also significantly increased frontothalamic distance (P's < 0.02). Quite interestingly, no direct correlation was found between EtG data and both food diary and AUDIT-C. However, a significant correlation was observed between urinary EtG and T-ACE (r = 0.375; P = 0.012) and between urinary EtG and TWEAK (r = 0.512; P < 0.001) and a concordance with all questionnaire for EtG values higher than 500 ng/mL. This study provides clinical evidence that the diagnosis of maternal alcohol consumption during pregnancy by urine EtG may disclose FASD-related damage in the fetus.

Behavioral responses in people affected by alcohol use disorder and psychiatric comorbidity: correlations with addiction severity.

AIM: In this study, we investigated in people suffering from alcohol use disorder (AUD) with or without dual diagnosis (concomitant psychiatric disability) how they feel their dependence condition. We predicted that AUD people with a dual diagnosis could feel potentiated their addiction. METHODS: Alcohol habits and psychiatric conditions of 183 AUD men and 62 AUD women were measured by using the DSM-5, the severity of alcohol dependence questionnaire (SADQ), the alcohol anamnesis and psychiatric examination by the symptom check list 90-R (SCL-90-R). RESULTS: We have shown that alcohol drinking does not correlate with both psychiatric examination and self-reported psychopathology. SADQ shows that severe alcohol dependence correlates with highest psychiatric symptoms and with the levels of alcohol consumption. CONCLUSIONS: This finding suggests that high SADQ scores may represent a tool to early disclose only patients with dual diagnosis. SADQ may provide information to address pharmacological interventions because revealing aspects of the dark side of addiction potentiated by AUD associated psychopathology.

Drop-out, relapse and abstinence in a cohort of alcoholic people under detoxification.

The Obsessive Compulsive Drinking Scale (OCDS) was developed to reflect obsessionality and compulsivity related to craving and drinking behaviour for revealing in the long-term drop-out, abstinence and relapse. This study evaluates the early OCDS predictive value in drop-out, abstinence and relapse of patients suffering from Alcohol Use Disorders (AUD) for discovering an OCDS total score cut-off capable of disclosing patients most at-risk of relapse during the beginning of the therapeutic intervention in the Day-Hospital period. The sample includes 263 AUD patients, with 192 men and 71 women. The OCDS scores were measured during the two-weeks Day Hospital treatment for detoxification and after 30, 60, 90 and 180 days after discharge. We also investigated the association between the all OCDS scores and abstinence and between craving, relapse and drop-out. We found that high values of OCDS during Day Hospital detoxification may predict a lower ability to maintain abstinence with elevated relapsing probabilities. Surprisingly, early dropping-out AUD people had lower OCDS total scores. However, significant differences in OCDS values in dropping-out AUD people were revealed mainly 90 and 180 days after discharge compared to no dropping-out AUD subjects. Craving measured also after 30, 60, 90 and 180 days from discharge in AUD relapsers, with OCDS values comprised between 6 and 10, could indicate a lower ability to continue abstinence. In conclusion, OCDS may be a useful tool to early discriminate AUD people at-risk for relapse and drop-out and for addressing the specialist to adjust both medical treatment and psychological support during crucial moments of patients' treatment and follow-up.

Treatment of alcohol dependence. Alcohol and homelessness: social point of view.

The phenomenon of homeless people is eliciting a devastating social impact with an estimated prevalence in the USA and in Europe between 5.6% and 13.9%. These persons have a poor quality of life, a limited or no social life. They are often unemployed or work only occasionally. They are at risk for problems with the law and often suffering from addiction to other drugs, psychiatric and other medical diseases. Alcohol is often not the cause of their social status, but only the result of other discomforts thus contributing to their bio-psycho-social degradation. In 2009 the US Department of Housing and Urban Development's Homelessness Assistance Programs and in 2010 the European Consensus Conference on Homelessness discussed about the social rehabilitation of these people, using the concept of case management. In particular, the Standard Case Management was able to improve the housing stability, to reduce the use of drugs and to remove the working barriers. The Assertive Community Treatment was able to improve the housing stability and had a better efficacy for patients suffering from double diagnosis.

Treatment of alcohol dependence. Alcohol and the young: social point of view.

Adolescents are the most vulnerable group for alcohol-related diseases, as starting to drink at a young age is associated with an increased risk of alcohol dependence in adulthood. Young people tend to drink large amounts of alcohol to seek out strong emotions and for reaching fun at all costs through the psychotropic properties of alcohol. The behavioural motivations of this kind of drinking (binge drinking) depend on the lack of awareness of the harmful effects of alcohol, in the rite of social conviviality (a condition for which alcohol is attributed to the function of facilitating the aggregation among young people), in the absence of personal interests, lack of controls and family habits. Actions to be taken to limit or stop harmful alcohol consumption in young people should be based on interventions aimed at delaying the age of first contact with alcoholic beverages through the implementation of educational campaigns aimed at young people, their families and the whole society.

Diagnosis of alcohol use disorder from a psychological point of view.

Alcohol use disorder (AUD) is one of the most common psychiatric disease in the general population, characterized by having a pattern of excessive drinking despite the negative effects of alcohol on the individual's work, medical, legal, educational, and/or social life. Currently, the bio-psycho-social model describes properly AUD as a multidimensional phenomenon including biological, psychological, and socio-cultural variables affecting the nature, maintenance, and expression of the disorder. The AUD diagnostic process is crucial since the treatment success depends heavily on the accuracy and the adequacy of the diagnosis. The diagnosis is based on a comprehensive assessment of the patient's characteristics and uses interviews and psychometric instruments for collecting information. This paper will provide insights into the most important psychological dimensions of AUD and on the best psychometric instruments for proposing AUD diagnosis.

Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: Comparison with four alcohol screening questionnaires.

Ethyl glucuronide (EtG) is an ethanol metabolite and EtG is used as a biomarker of alcohol drinking. EtG can be detected in the blood and in several biological matrices including urine, hair and nails. Alcohol consumption during pregnancy is a strong risk factor for fetus health so in the recent years different strategies to reveal alcohol use have been planning including the use of screening questionnaires as the AUDIT-C, T-ACE and TWEAK. The present study aims to investigate in pregnant women the specificity and predictive value of the AUDIT-C, T-ACE and TWEAK plus a food diary in use in Sapienza University Hospital compared with the results of urine EtG measurement. Seventy pregnant women were enrolled and examined. Urine samples were provided by pregnant women immediately after the interviews. EtG determinations were performed by Enzyme Immunoassay with a cut-off established at 100ng/mL. Data show that 34.28% of the enrolled pregnant women overcame the EtG cut off. No direct correlation was found between EtG data and the alcohol screening interviews showing lower levels of alcohol consumption, although T-ACE revealed the same at risk percentage. However, a significant concordance was observed with food diary data and T-ACE only in patients with higher EtG urinary concentration. This study provides clinical evidence that the diagnosis of maternal alcohol consumption during pregnancy only based on indirect methods, such as questionnaires and food diary, may significantly underestimate alcohol use.

Neurophysiological Measures and Alcohol Use Disorder (AUD): Hypothesizing Links between Clinical Severity Index and Molecular Neurobiological Patterns.

BACKGROUND: In 1987, Cloninger proposed a clinical description and classification of different personality traits genetically defined and independent from each other. Moreover, he elaborated a specific test the TCI to investigate these traits/states. The study of craving in Alcohol Use Disorder (AUD) assumed a greater significance, since ever more data seems to suggest a direct correlation between high levels of craving and a higher risk of relapse in alcoholics. Thus, our study aim is to explore the possible correlations among TCI linked molecular neurobiological pattern (s), craving and alcohol addiction severity measures in a sample of Italian alcoholics. MATERIALS AND METHODS: 191 alcoholics were recruited in a Day Hospital (DH) setting at the Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome. After 7 days detoxification treatment a psychodiagnostic protocol was administered, including TCI, VAS-C, ASI and SADQ. All patients signed an Institutional Review Board (IRB) approved informed consent. RESULTS: Principally, we detected a significant positive correlation between HA-scale scores and the VAS scale: increasing in HA-scale corresponds to an increase in craving perception for both intensity (r=0.310; p ≤ 0.001) and frequency (r=0.246; p ≤ 0.001). Moreover, perception of dependence severity, measured with SADQ was also found to be significantly associated positively to both HA-scale (r=0.246; p ≤ 0.001) and NS-scale (r=0.224; p ≤ 0.01). While, for character scales, Persistence (r=-0.195; p=.008) and Self-directedness (r=-0.294; p ≤ 0.001) was negatively associated with ASI linked to alcohol problems. Self-directedness was also negatively correlated with ASI linked to family and social problems (r=-0.349; p ≤ 0.001), employment and support problems (r=-0.220; p=0.003) and psychiatric problems (r=-0.358; p ≤ 0.001). Cooperativeness was a negative correlate with Legal Problems (r=-0.173; p=0.019). and Self-Transcendence was positive correlated with Medical Problems (r=0.276; p ≤ 0.001). CONCLUSIONS: In view of recent addiction neurobiological theories, such as the "Reward Deficiency Syndrome (RDS)" and the Koob model, our data could suggest that our cohort of patients could possibly be in a particular stage of the course of their addiction history. Thus, if our hypothesis will be confirmed, the TCI-based assessment of alcoholics would allow an optimization of the treatment. Clinicians understanding these newer concepts will be able to translate this information to their patients and potentially enhance clinical outcome (s), because it could suggest a functional hypothesis of neurotransmitter circuits that helps to frame the patient in his/her history of addiction.

Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness.

Externalizing disorders are the most common and persistent forms of maladjustment in childhood. The aim of this study was to conduct a meta-analysis evaluating the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce externalizing symptoms in two disorders: Attention Deficit Hyperactivity Disorder (ADHD) and Oppositive Defiant Disorder (ODD). The efficacy of CBT to improve social competence and positive parenting and reduce internalizing behaviors, parent stress and maternal depression was also explored. The database PsycInfo, PsycARTICLES, Medline and PubMed were searched to identify relevant studies. Twenty-one trials met the inclusion criteria. Results showed that the biggest improvement, after CBT, was in ODD symptoms (-0.879) followed by parental stress (-0.607), externalizing symptoms (-0.52), parenting skills (-0.381), social competence (-0.390) and ADHD symptoms (-0.343). CBT was also associated with improved attention (-0.378), aggressive behaviors (-0.284), internalizing symptoms (-0.272) and maternal depressive symptoms (-0.231). Overall, CBT is an effective treatment option for externalizing disorders and is also associated with reduced parental distress and maternal depressive symptoms. Multimodal treatments targeting both children and caregivers' symptoms (e.g. maternal depressive symptoms) appear important to produce sustained and generalized benefits.

Persistence of poor sleep predicts the severity of the clinical condition after 6months of standard treatment in patients with eating disorders.

Clinical evidence suggests that eating disorder (ED) patients experience poor sleep even if they rarely complain of it. However, direct empirical evidence supporting this relationship is still sparse. In order to provide direct evidence, poor sleep, severity of the ED symptoms and depression were obtained in 562 ED patients at treatment admission (T0). For 271 patients out of them, data were also available after 6months of standard treatment (T1). Results evidence that at T0 poor sleep predicts severity of ED symptoms through the mediation of depression. Persistence of poor sleep at T1 directly predicts the severity of the ED symptoms both directly and through the mediation of depression. These findings suggest that the treatment of ED may benefit from addressing poor sleep since its presence and persistence increase comorbidity and attrition to the standard treatment.

Validity of a figure rating scale assessing body size perception in school-age children.

This study aimed to provide data concerning the validity of a short sequence of face valid pictorial stimuli assessing the perception of body size in school-age children. A sequence of gender and age-appropriate silhouettes was administered to 314 boys and girls aged 6-14 years. The self-evaluations provided by the children correlated significantly with their actual BMI corrected for age. Furthermore, the children's self-evaluations always significantly correlated with the evaluations provided by the three external observers; i.e., both parents and the interviewers. The results indicate that this sequence of pictorial stimuli, depicting realistic human forms appropriate for children, is a valid measure of children's body image. Relevant differences across age groups were also found, indicating that before the age of eight, the correlations between the children's self-evaluations and their BMI or the judgments of the three observers are lower than in the other age groups.

Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies.

BACKGROUND: In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. METHODS: PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. RESULTS: Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). LIMITATIONS: The main limit is that included studies did not always consider the role of other intervening variables. CONCLUSIONS: Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.