Psychometric properties of the Quiet Ego Scale (iQES) within the Italian cultural context.

Introduction: The quiet ego indicates a more compassionate conception of self-identity that integrates others into the self by lowering the intensity of the ego and enhancing the awareness of the present moment. The Quiet Ego Scale (QES) is a 14-item self-report measure of quiet ego, and it is composed of the following four psychological domains: detached awareness, inclusive identity, perspective taking, and growth. The present study aimed to test the psychometric properties of the Quiet Ego Scale within the Italian cultural context (iQES). Methods: A total of 160 Italian university students aged between 20 and 42 years, with a mean age of 22.85 years (SD = 3.41), completed the measures of the iQES and of other psychological dimensions. The psychometrics properties of iQES were assessed based on its internal consistency, test-retest reliability, and construct validity through comparisons with other correlated psychological measures. Results: Analyses confirmed the psychometrics properties of iQES. As in previous studies, the quiet ego was positively associated with the indicators of resilience (p < 0.01), happiness (p < 0.05), self-esteem (p < 0.01), and psychological wellbeing (p < 0.01). Discussion: The study discussed the possible uses of the iQES in the field of mental health, specifically focusing on improving adherence to psychological therapies and enhancing psychological and social well-being. The results indicated strong psychometric properties of the iQES in measuring the quiet ego construct. Our findings enrich the literature on the validity of the iQES and highlight the multidimensional nature of the quiet ego construct.

Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study.

BACKGROUND: Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide-related behaviours, and little is known about its effect with offender-patients. AIMS: To evaluate DBT with a group of offender-patients in the Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014. METHODS: Twenty-one male forensic psychiatric in-patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS-20). RESULTS: Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS-11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores. CONCLUSIONS: Italy has innovative forensic psychiatric facilities with a new recovery-rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full-scale randomised controlled trial should follow.

A novel SCL-90-R six-item factor identifies subjects at risk of early adverse outcomes in public mental health settings.

To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure ("SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up.

Focus on aggressive behaviour in mental illness.

Background: Aggression is a behaviour with evolutionary origins, but in today's society it is often both destructive and maladaptive. Increase of aggressive behaviour has been observed in a number of serious mental illnesses, and it represents a clinical challenge for mental healthcare provider. These phenomena can lead to harmful behaviours, including violence, thus representing a serious public health concern. Aggression is often a reason for psychiatric hospitalization, and it often leads to prolonged hospital stays, suffering by patients and their victims, and increased stigmatization. Moreover, it has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Materials and methods: In this review, based on a selective search of 2010-2016 pertinent literature on PubMed, we analyze and summarize information from original articles, reviews, and book chapters about aggression and psychiatric disorders, discussing neurobiological basis and therapy of aggressive behaviour. Results: A great challenge has been revealed regarding the neurobiology of aggression, and an integration of this body of knowledge will ultimately improve clinical diagnostics and therapeutic interventions. The great heterogeneity of aggressive behaviour still hampers our understanding of its causal mechanisms. Still, over the past years, the identification of specific subtypes of aggression has released possibilities for new and individualized treatment approaches. Conclusions: Neuroimaging studies may help to further elucidate the interrelationship between neurocognitive functioning, personality traits, and antisocial and violent behaviour. Recent studies point toward manipulable neurobehavioral targets and suggest that cognitive, pharmacological, neuromodulatory, and neurofeedback treatment approaches can be developed to ameliorate urgency and aggression in schizophrenia. These combined approaches could improve treatment efficacy. As current pharmacological and therapeutic interventions are effective but imperfect, new insights into the neurobiology of aggression will reveal novel avenues for treatment of this destructive and costly behaviour.

Aripiprazole once-monthly as treatment for psychosis in Turner syndrome: literature review and case report.

Turner syndrome (TS) is a neurogenetic disorder characterized by partial or complete monosomy-X, usually resulting of a sporadic chromosomal nondisjunction. It is one of the most common sex chromosome abnormalities, affecting approximately 1 in 2,000 live born females. There are sporadic few case reports of concomitant TS with schizophrenia worldwide. No defined psychiatric condition has been traditionally related to TS, and it is not mentioned in DSM-IV. Although it is not associated with any psychiatric syndrome, several case reports in the literature describe a similar constellation of symptoms in TS that may represent a biologically-based entity. Aripiprazole once-monthly is a second generation antipsychotic recently developed. Its efficacy and non-inferiority to oral aripiprazole have been demonstrated in preventing relapse in patients with schizophrenia. Experience with oral aripiprazole and the current availability of the long-acting formulation suggest a potential benefit in a variety of clinical scenarios and therefore consideration as a treatment option in the treatment of schizophrenia and psychotic symptoms in several disease like TS.

[Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service]. / Il case management psichiatrico. Esperienza di applicazione dei modelli di Chronic Disease Management all'interno di un Centro di Salute Mentale.

AIM: Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. METHODS: Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. RESULTS: Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. CONCLUSIONS: There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

A second trial of clozapine in a case of granulocytopenia.

It is generally believed that agranulocytosis, a major problem with clozapine treatment, will tend to occur dose-dependently once it develops in an individual. Therefore, despite clinical progress obtained, the drug has to be discontinued and treatment shifts to another drug. We report on the case of a 29-year-old woman with DSM-IV undifferentiated schizophrenia who developed agranulocytosis after 5 years of 300 mg/day clozapine treatment. The drug was withdrawn and two trials with thioridazine and olanzapine were unsuccessful. Four months after clozapine suspension, we decided to make a further trial, reintroducing clozapine titrated up to 500 mg/day. The patient's symptoms improved and blood leukocytes remained within the normal range after eight months. Copyright 2000 John Wiley & Sons, Ltd.