Palatal tremor is a rare movement disorder characterized by rhythmic contractions of the soft palate. It is most often symptomatic, secondary to brainstem or cerebellar disease and, in rarer cases, is categorized as essential in the absence of documented brain lesions. There have also been reports in the literature of cases of palatal tremor described as psychogenic because they were associated with psychological or psychiatric disorders. We describe the case of a 12-year-old boy with palatal tremor presenting clinical features of symptomatic essential and psychogenic palatal tremor, thus suggesting a neuropsychopathological continuum between the different forms of disease

La questione dei JuvenileSexual Offenders (JSO) è divenuta oggetto di una maggiore attenzione e controllo istituzionale negli ultimi anni, venendosi spesso ad intrecciare con campagne di grande allarme sociale. Nella complessità di una tematica che intreccia competenze multidisciplinari e responsabilità giudiziarie, modalità di informazione da parte dei mezzi di comunicazione di massa e percezione più o meno carica di emotività da parte dell'opinione pubblica, è necessario fornire una comprensione del fenomeno JSO dal punto di vista degli aspetti descrittivi di carattere clinico e delle motivazioni strettamente psicologiche che sottendono il comportamento abusante. I minori abusanti sono soggetti spesso segnati profondamente da vicende traumatiche, le cui risorse personali per negoziare particolari stati interni ed interazioni interpersonali sono inadeguate. L'agito sessuale può rappresentare il segnale della difficoltà dell'adolescente di far fronte ai cambiamenti specifici della fase adolescenziale, caratterizzata dalla ricerca di un'identità ancora rudimentale nella sua organizzazione e dove la violenza sessuale può rappresentare una dimostrazione di forza, una specie di "rito di iniziazione" che legittima il passaggio dall'adolescenza all'età adulta. La ricerca condotta ed in fase di elaborazione è stata orientata alla valutazione degli adolescenti autori di reati sessuali ed articolata in tre settori di indagine scientifica con la finalità di studiare il fenomeno dal punto di vista psicosociale e psicopatologico, della comprensione degli antecedenti storici e della particolare dinamica del reato, anche in relazione agli assetti culturali e antropologici in cui sono maturati e dell'analisi dei fattori di rischio maggiormente coinvolti nell'innesco dell'aggressione sessuale. La studio si è svolto in collaborazione con gli Uffici del Servizio Sociale della Giustizia Minorile del Ministero Giustizia. Studi in letteratura hanno evidenziato una eterogeneità nella presenza di psicopatologia, tratti di personalità e funzionamento sociale nei minori Sex Offenders. Scopo dello studio è stato trovare la relazione tra tratti di personalità, cure parentali e stile di coping in minori Sex Offenders. Il campione è formato da 93 minori divisi in tre sottogruppi: Sex Offenders (N=31), Autori di Altro Reato (N=31) e Controllo (N=31). L’assesment ha previsto la somministrazione di una Scheda Raccolta Dati ad hoc, ed i seguenti strumenti psicodiagnostici: MMPI-2 o MMPI-A, PBI e CISS, Scala per la frustrazione ed aggressività di Caprare e coll.

OBJECTIVES: The objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible protective/risk factors which promote these negative feelings, analyzing the relationship between CPPs and their caregivers. METHODS: We enrolled a total of 208 patients, divided into CPPs and controls affected by internistic diseases. Assessment included collection of sociodemographic and health care data, pain characteristics, administration of visual analog scale (VAS), Modified Overt Aggression Scale (MOAS), Barratt Impulsiveness Scale Version 11 (BIS), Hamilton Depression Rating Scale (HDRS), and a caregiver self-administered questionnaire. All variables were statistically analyzed. RESULTS: A significant difference of VAS, MOAS-total/verbal/auto-aggression, HDRS-total/suicide mean scores between the groups were found. BIS mean score was higher in CPPs misusing analgesics. In CPPs a correlation between MOAS-total/verbal/auto-aggression with BIS mean score, MOAS with HDRS-suicide mean score and BIS with HDRS-suicide mean scores were found. The MOAS and BIS mean scores were significantly higher when caregivers were not supportive. CONCLUSION: In CPPs, aggression and impulsivity could increase the risk of suicide. Moreover, impulsivity, overt aggression and pain could be interrelated by a common biological core. Our study supports the importance of a multidisciplinary approach in the CPPs management and the necessity to supervise caregivers, which may become risk/protective factors for the development of feelings interfering with the treatment and rehabilitation of CPPs.

Patients with dementia often have neuropsychiatric symptoms. The objective of this study was to evaluate the relationship between neuropsychiatric symptoms and progressive cognitive decline by assessing cognitive impairment, depressive symptoms, and aggressive behavior in a sample of elderly subjects. The study sample consisted of 201 subjects admitted to nursing homes. For the purpose of the present study each subject was evaluated using the Mini-Mental State Examination, the Geriatric Depression Scale, and the Modified Overt Aggression Scale. The results show that aggressive behavior and depressive symptoms are associated with progressive cognitive decline in elderly subjects. Early assessment of these conditions can promote rational therapeutic strategies that may improve the quality of life and delay institutionalization for elderly patients

Objective: An association between streptococcal infections, ABGA positivity, and no comorbidity ADHD (nc-ADHD) has been little investigated. The aim of this study was to evaluate the streptococcal infection frequency, defined entitled serum antistreptolysin O (ASO), and frequency of serum ABGA positivity in a sample of patients with nc-ADHD. Method: In all 40 participants were investigated the ASO titer and ABGA. Results: The results showed that ABGA positivity was statistically significantly higher in patients affected by ADHD than in patients of a control group, and pathological values of ASO were statistically more frequent in the ADHD group than the control group. Conclusion: These data suggest that streptococcal infections and autoimmune reactions against the basal ganglia are more frequent in ADHD patients than patients in a control group.

Schizophrenia is considered a neurodevelopmental disorder with a multifactorial pathogenesis where autoimmune factors may play a significant role. The aim of this study was to verify the presence of anti-brain autoantibodies in the serum of schizophrenic patients compared to healthy controls. Autoantibodies against brain were detected by the immunofluorescence method, utilizing sections of rat hippocampus and hypothalamus and of monkey cerebellum. Three different fluorescence patterns were observed, staining the nucleus-cytoplasm of neurons, the neuroendothelial of blood vessel and the neurofilaments. Search for other organ-specific and non organ-specific autoantibodies was performed in all sera by indirect immunofluorescence method, enzyme linked immunosorbent assay and chemiluminescence immunoassay. Results showed a significant association between schizophrenia and anti-brain autoantibodies against the neuroendothelium of blood vessel in hypothalamus, hippocampus and cerebellum; a significant nuclear and cytoplasmic staining of neurons was assessed only for the hippocampus. No other significant association was found, except between schizophrenia and anti-nuclear autoantibodies on HEp-2 cells. In conclusion, these results support the hypothesis of a significant association between schizophrenia and circulating anti-brain autoantibodies, suggesting a diffuse reactivity against the neuroendothelium of blood vessel and highlighting a nuclear and cytoplasmic staining of the neurons of hippocampus.

BACKGROUND: The prevalence of chronic pain is about 30% in children and adolescents which suffer from severe emotional distress. The aim of this observational study is to investigate cognitive, emotional and behavioral consequences of benign chronic pain in children and adolescents suffering of reumathologic diseases. MATERIALS AND METHODS: A total of 49 participants, chronic pain participants (CPPs) and controls (CGPs), affected by rheumatic diseases, were enrolled. Assessment included collection of sociodemographic data, pain characteristics, and administration of Visual Analog Scale (VAS), Depression Inventory for Children and Adolescents (CDI), Conners' Parent Rating Scales-Revised (CPRS-R), Child Behavior Checklist (CBCL), and Screen for Child Anxiety-Related Disorders (SCARED). For the statistical analysis, Student's t-test for independent samples and Pearson's correlation were used. The significance value was set at p less than .05. RESULTS: A significant difference of mean scores of CBCL items and of CPRS items between the two groups was found. In CPPs, a significant correlation between VAS and mean scores of several CBCL items and between VAS and mean scores of several CPRS items was found. CONCLUSION: Chronic pain is a real syndrome in which an interdisciplinary treatment should be applied, considering the psychopathological risk, especially in developmental age.

Background: Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical investigation and so remains the major problem in the clinical practice. Aims: The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis. Patients and methods: We reported a retrospective study of 60 patients affected by depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the disorders, and 4 have been considered related problems. Results: The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories. Conclusion: The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an overlapping and dimensional concept. The spectrum approach could unify categorical classification that is essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment. Keywords: depressive

Questo articolo descrive i principali risultati del Modello Pragmatico Elementare (EPM). Il modello è stato sottoposto a sperimentazione utilizzando la procedura del test Sintesi e Scissione (SISCI test) descritto in questo lavoro. Abbiamo rilevato che nelle persone normali, prevale la tendenza a “mantenere il loro mondo” (F3) rispetto “al vuoto mentale” (F0) e al “caos” nel senso di incapacità a selezionare (F15). Al contrario, gli individui con disturbi mentali hanno mostrato una diminuzione nel “mantenere il loro mondo” (F3) e un più elevato livello di “vuoto mentale” (F0) e “caos” nel senso di incapacità a selezionare (F15). I risultati sono utili sia per lo sviluppo della creatività sia nel problem solving nelle aziende sia per migliorare i trattamenti dei disturbi mentali.

BACKGROUND: Genetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS). METHODS: We present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test. RESULTS: The results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02) and personality disorders (P = 0.003) in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008) and learning (P = 0.04); there is not a statistically relevant difference between cases and controls (P > 0.05) for any obstetric complications (pre, peri and postpartum). CONCLUSIONS: This study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease.

A deep understanding of the characteristics of sex offenders may serve to improve clinical prevention and treat- ment programs. Mostly, however, this knowledge can aid in the creation of better re-education and rehabilitation programs as well as criminological treatment. In prison systems outside of Italy, the use of treatment programs specifically designed for sex offenders is commonplace, whereas in Italy, there is only sporadic experimentation in this field which is aimed at evalu- ating adults. If this is true for adults, it is even more so for the minors who commit this type of crime that gives rise to worry and a great sense of alarm. The aim of this work is to show the preliminary results of an empirical study that explores the men- tal representations of the parents of minors who commit acts of sexual violence towards other. This study is an ongoing in col- laboration with the Juvenile Justice Center (Centro Giustizia Minorile) of the Region of Apulia, whose first data on 10 juve- nile perpetrators of such specific crimes are presented here

Obiettivo della ricerca, effettuare una ricognizione sulle modalità di tratta- mento degli autori di reato con disturbi mentali da parte dei Centri di Salute Mentale della Regione Puglia dopo la Sentenza 253/03 della Corte Costitu- zionale. Con i Dipartimenti di Salute Mentale pugliesi è stata approntata una sche- da di rilevazione in grado di fornire informazioni in merito ad aree conside- rate significative: socio-demografica(sesso, scolarità, stato civile, condizione abi- tativa, condizione lavorativa, caratteristiche famiglia di origine), clinica(diagno- si, numero di ricoveri, durata della presa in carico, operatori coinvolti nel trat- tamento, modalità e tipo trattamento, frequenza dei contatti, familiarità psi- chiatrica) ecriminologica(tipo di reato, modalità di invio al servizio, posizione giudiziaria, grado di giudizio, autorità inviante). Attraverso l’indagine, tuttora in corso, ci si propone di effettuare una ricognizione degli autori di reato af- fetti da disturbi mentali in carico ai servizi territoriali nel quinquennio 2003- 2007. Questi i primi dati emersi. Il 72% dei soggetti del campione è costituito da uomini, la maggior parte dei quali (51,8%) possiede il titolo di licenza media inferiore ed è celibe o nu- bile (63%). Gran parte dei pazienti vive con la famiglia di origine (55,6%), de- scritta nel 40% dei casi come “assente”. Circa il 44% del campione è affetto da disturbi dello spettro schizofrenico; il 75% del campione non presenta familiarità psichiatrica o antisociale.In merito alle modalità di trattamentoricevuto, per il 47% del campione ef- fettua solo controlli c/o presso il CSM; il tipo di trattamentoseguito dal 98% dei pazienti è costituito dalla psicofarmacoterapia, nel 43% dei casi associata ad al- tro tipo di trattamento (riabilitazione, psicoterapia). In maniera, cioè, del tut- to sovrapponibile a quanto viene garantito agli altri pazienti. Particolarmente interessanti, infine, i primi dati relativi all’area criminolo- gica. Il 69% del campione è costituito da soggetti inputabili, il 70% dei quali condannati a pena definitiva. Nel 25% dei casi si tratta invece di soggetti in at- tesa di giudizio. L’Autorità inviante è costituita in circa la metà dei casi (49%) dal Tribunale di Sorveglianza, per il resto da altri Giudici – GIP, per lo più – o collegi giudicanti, con i quali i servizi psichiatrici coinvolti non hanno in seguito mantenuto rapporti costanti e duraturi nel tempo.

Scope. The aim of this study is to gain a clear understanding of the level of knowledge and training of staff members from psychiatric rehabilitation hospitals in the Province of Taranto (Italy), where patients released from judicial psychiatric hospitals will be admitted. Case Studies A questionnaire taken from an earlier study on judicial psychiatric hospitals, conducted by The Ministry of Justice of the Department Penitentiary Administration – Superior Institute of Penitentiary Studies, was used in this study. Results. Many requests for information and training regarding the problems and challenges related to the management of individuals who are mentally ill, perpetrators of crimes, and persons who are held in protective custody are made by those who work in these institutions. Conclusions. Hospital workers are highly apprehensive with regard to working with a patient population quite different from that which they are normally accustomed to. In order to confront these challenges, they, together with other colleagues from both the private and public services sector, have turned toward the concept of teamwork. One element of contradiction seems to be a low level of knowledge regarding what will be required of them when their work will be connected to the world of criminal justice in the future. The workers who were interviewed who have experience in working with patients from Judicial Psychiatric Hospitals (OPG) seem to be up to the task of meeting the complex needs of the mentally ill and perpetrators of crimes within psychiatric rehabilitation facilities, as these patients must be kept under security.

Objectives: The existence of specific features of Metabolic Syndrome (MetS) in psychiatric population in comparison to not psychiatric patients has not been systematically investigated. The purpose of this study is to evaluate the differences of MetS among a group of psychiatric patients and a group of internal medicine patients in terms of anthropometric measurements, biochemical variables, and cardiovascular risk. Methods: We enrolled 83 psychiatric inpatients under pharmacological treatment (schizophrenia n = 24, bipolar disorder n = 27, major depression n = 14, other n = 18) and 77 internal medicine patients visited for supposed MetS as affected by overweight or arterial hypertension. Results: Psychiatric patients differed from control subjects by age (yrs) (47 ± 9 vs. 52 ± 8.6, p = 0.001), waist circumference (cm) (111.9 ± 10.9 vs. 106 ± 12.6,p= 0.02), HDL cholesterol (mg/dl) (36.8 ± 7 vs. 48 ± 11.3, p = 0.001), serum insulin (μU/ml) (26 ± 12.5 vs. 16.4 ± 8.8, p = 0.001), triglyceride/HDL cholesterol ratio (4.8 ± 2.7 vs. 3.3 ± 2.2, p = 0.01). Female psychiatric patients had higher levels of triglycerides (mg) (178 + 86 vs. 115 + 53, p = 0.002) and of HOMA index (7.8 + 5 vs. 3.8 + 3.3, p = 0.005). Triglycerides and triglycerides/HDL ratio levels were higher in Unipolar Depression. A positive association was found between antidepressant drug treatment with triglycerides and triglycerides/HDL ratio levels, neuroleptic treatment with the HOMA index, and antipsychotics drugs with the Framingham index. Limitations: Psychiatric study population numerosity and duration of psychiatric illness and drug treatment. Conclusions: Specific features of MetS in psychiatric population are mainly represented by young age of onset, hyperinsulinemia, increased abdominal adiposity, and low HDL cholesterol whose common denominator may be insulin-resistance

In the field of psycho forensics, any sexual behavior that occurs without consent, without, equality, or as a result of coercion is considered to be abusive (AACAP, 1999; Shaw, 2002). In order for sexual behavior to be considered consensual, certain criteria are necessary: comprehension of the nature of the proposal; an understanding of societal standards regarding sexuality; awareness of the potential consequences and alternatives; the presumption that agreement or disagreement will be respected in the same manner; the decision to engage is a voluntary one; and that those involved are mentally competent (AACAP, 1999). Equal relationship refers to situations in which the two people involved possess equal power within the relationship, and neither of the two is controlled or coerced by the other. Coercion refers to situations where one party abuses authority, offers bribes, makes threats, or uses intimidation tactics in order to win the cooperation or obedience of the other. Sexual conduct during adolescence must not be considered deviant if it involves non-coercive interaction between two peers. It is not always easy to demonstrate coercion, though expert testimony evaluations often focus on this critical aspect. At times it is also challenging to determine what age appropriate sexual behavior is, and if the two people involved are, in fact, developmental and/or chronological peers. Studies on the topic hypothesize the inability of the adolescent to recognize the other as different from him or herself, and the difficulties associated with entering into a sexual relationship with another person, where dysfunctional coping strategies are often employed. One pilot study from 2002 revealed that the parents of adolescent sexual offenders most often employ an overprotective-affectionless parenting style (Craissati J, McClurg G, Browne K). “Affectionless control” parenting style is a risk factor for the development of deviant behavior. Comorbidity rates in adolescent sexual offenders are high and involve behavioral disorders, personality disorders, and emotional-affective disorders. One recent study revealed that about two thirds of sexual offenders meet the criteria for personality disorder. Impulsivity is one of the characteristics typical of people who exhibit aberrant and violent behavior (Baltieri D.A., Andrade A.G., 2008). The aim of this study is to evaluate the relationship between personality, parental care, and coping style in adolescent sex offenders. Instruments: Clinical interviews; psychodiagnostic testing (MMPI, Minnesota for Adolescents, A/2; PBI-Parental Bonding Instrument; CISS-Coping Inventory for Stressful Situations; Questionnaire I-R, frustration-aggression by Caprara et al.; and healthcare, psychological, and judicial documentation. The sample studied thus far is comprised of 23 unmarried male adolescents between the ages of 15 and 20 years at the time of the interview. The average age was 17 years ± 1.6 (standard deviation), and almost all subjects were Italian (1 Albanian), and Catholic (1 atheist, and 1 agnostic). All were investigated for perpetrating sexual violence on other minors. The sample was taken from Judicial Juvenile Social Services, which intervenes following the commission of a crime by a minor. Preliminary results have revealed no particular pathologies on the part of the adolescent sexual offenders who were examined by the authors. The type of parenting style they received appears to have been intrusive-overprotective, which did not allow the adolescent to face typical life challenges, thus impeding his ability to develop coping skills. This type of parenting style includes intrusiveness, enmeshment, encouragement of dependence, and cutting the minor off from the outside world.

In recent years, studies have shown that parents of children with Neurodevelopmental Disorders (NDDs) experience more parenting stress than parents of typically developing children, but the relation between the type of disorders and parenting stress is far from clear. The purpose of this study was to compare the parenting stress experienced by parents of 239 children with Specific Learning Disorders (SpLD), Language Disorders (LD), Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and typical development (TD). Parents of children with NDDs experience more parenting stress than those of children who have TD. Although, parents of children with ASD or ADHD report the most high scores of parenting stress, also the parents of children with SpLD or LD report higher parental stress compared with parent of children without NDDs. Another interesting finding was that IQ level or emotional and behavioral problems are associated with the higher levels of parenting stress. This study suggest that parent, both mothers and fathers, of children with different type of NDDs should be provided with interventions and resources to empower them with the knowledge and skills to reduce their stress and to enhance their quality of life.

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder with extremely complex etiology, not yet well defined but certainly multi-factorial. This study investigated the possible etiopathogenetic role of ADHD symptoms and psychopathology disorders in parents of children with ADHD. We present a case-control study of parents of 50 children affected by ADHD and of 45 healthy children, matched to age and gender. Parents of ADHD children reported higher levels of ADHD symptoms, depressive disorders and Depressive Personality Disorders than parents of healthy children. Mothers displayed greater presence of depression, while fathers showed problems concerning alcohol use. The occurrence of ADHD symptoms, psychopathology and personality disorders in parents highlights the importance to integrate the treatment programs in the ADHD children with the screening and treatment for psychopathological symptoms of the parents.

The aim of this prospective observational study was to investigate the variations of serum prolactin hormone (PRL) in a sample of 34 drug-naive patients (mean age 13 years) who started risperidone therapy assuming that several factors may favor the increase in serum PRL. Serum PRL and hyperprolactinemia clinical signs were examined at baseline (T0) and after almost 3 months of treatment (T1). We considered sex, pubertal status, risperidone dosage, psychiatric diagnosis, and any personal/family history of autoimmune diseases. The mean serum PRL value increased between T0 and T1 (P=0.004). The mean serum PRL was higher in females in the pubertal/postpubertal stage and for risperidone dosage up 1 mg/day. Hyperprolactinemia was found in 20% of patients at T0 and in 38% of patients at T1 (P=0.03). The mean serum PRL increase was greater in early-onset schizophrenia spectrum psychosis patients compared with no-early-onset schizophrenia spectrum psychosis patients (P=0.04). The increase in PRL was higher in patients with a personal and a family history of autoimmune diseases. This study suggests that the increase in serum PRL in patients treated with risperidone may be linked not only to the drug and its dosage but also to several risk factors such as sex, pubertal stage, psychiatric disease, and autoimmune disorders.

In some tumors, psychosocial interventions may enhance health-related quality of life (HRQOL) of patients. The effects of psychological variables on HRQOL in hepatocellular carcinoma (HCC) patients have been rarely assessed. The aim of this work is to evaluate the psychopathological profile of HCC and cirrhotic patients and its effect on HRQOL. Twenty-four HCC patients (median age 71, Child A 21, Child B 3), 22 cirrhotic patients (median age 68, Child A 20, Child B 2) and 20 control subjects were included in this study. Each subject completes four questionnaires: medical outcomes study short form-36 (SF-36, HRQOL evaluation); Hamilton-D (quantitative evaluation of depression; positive ≥8); symptom check list 90-revised (SCL 90-R, general psychopathological profile; nine domains, each positive >1); Toronto alexithymia scale (TAS 20) (positive ≥60). SCL 90-R: cirrhotic patients differ from HCC subjects for somatization (SOM) (M ± SD 1.09 ± 0.6 vs 0.65 ± 0.6; p = 0.01) and anxiety (M ± SD 0.85 ± 0.46 vs 0.58 ± 0.38; p = 0.01) items. TAS 20: positive in 50 % of HCC patients, in 54 % of cirrhotic patients (p = n.s.) and in none of controls. Hamilton-D: higher scores in cirrhotic patients than in the HCC group (86 vs 46 %; p = 0.005). SF-36: each item, except bodily pain, is lower in both group of patients in comparison with controls. Pearson correlation analysis shows negative correlations on HRQOL of depression, SOM and anxiety both in cirrhotic and HCC subjects, also of obsessive-compulsive and hostility items in HCC. This is the first report on the psychopathological profile of HCC patients: the results open questions on the role of psychological interventions that may improve HRQOL of patients before treatment and in the follow-up

Abstract The aim of our study was to provide a psychosocial and psychiatric evaluation of patients with epidermolysis bullosa (EB; a rare genetic disorder characterized by skin fragility), to assess psychological status, ascertain the presence of any psychiatric disorders and understand the impact of EB on quality of life. Twenty-five patients were assessed using a case record form and several standardized instruments. In 82% of patients, EB had a negative impact on quality of life and 80% of patients experienced psychiatric symptoms. Our findings revealed a high prevalence of psychosocial problems and psychiatric symptoms in patients with EB and suggested that a combined biopsychosocial approach is the most appropriate therapeutic intervention.

BACKGROUND: Recurrent headache is common in childhood, but there is not a great amount of data on the associations between headaches and psychopathology in children. OBJECTIVE: The aim of this study is to examine the relationships between primary headaches and psychopathology in children, using both the categorical and dimensional assessment. METHODS: The sample consisted of 70 patients with primary headache compared to a matched sample of 50 healthy children. Psychiatric comorbidity was defined according to the diagnostic criteria of the Diagnostic and Statistical Manual of Disorders. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments. RESULTS: Internalizing and externalizing problems were significantly represented among children with headaches compared to the control group, respectively 63% and 27%, without significant differences between migraine and tension-type headache children. Moreover, a total of 26% of the children with a headache reported psychiatric comorbidity such as anxiety and mood disorders. CONCLUSION: The dimensional approach improves accuracy in the recognition of emotional and behavioral problems compared to the categorical approach; however, the use of both of these approaches could be useful for clinical practice, treatment and research.

Aim This study has the aim to represent the degree of information raining about the identification of possible stalking acts and their frequency, within the context of public and private National Healthcare and Social Assistance. Data and Methods Socio Demographic data both of victims and possible stalkers, circumstances of events and the emotional responses of victims are gathered up by a multiple choice questionnaire , made by 20 questions, given to a sample of 101 subjects, which are practitioners within Healthcare and Social Assistance area (doctors, psychologists, nurses, social-health operators) both of public and private health facilities. Results Considering our sample, subjects which point out harassments linked to stalking are 30/101 (29.7%). Female sex is mainly represented F =22/30 (73, 3%) compared to male sex M=8/30 (26, 7%). 30, 14% of female health operators (nr 22/73) and 28, 57% of male health operators (nr 8/28) affirm that they are victims of harassments. Discussion The results indicate a lack of attention towards the stalking phenomenon, a limited trust of victims to the institutions, but also the persistence of a backward culture, within social and health services, about stalking, preventatives strategies of it and counter-actions of the harassment. Only a small part of them, 16.1%, reports what is happened or turn to anti-violence centres Conclusion The study highlights that information about stalking and its psychological consequences on victims/operators are insufficient in social and health area. It is necessary the star up of awareness campaigns, which gives information to practitioners of public and private Healthcare and Social Assistance area about characteristics of stalking and the way by which avoid its risks and prevent it.

BACKGROUND: Poor adherence to pharmacotherapy negatively affects the course and the outcome of schizophreniaspectrum psychoses, enhancing the risk of relapse. Falloon and coworkers developed a Psychoeducation Program aimed at improving communication and problem-solving abilities in patients and their families. This study set out to evaluate changes in adherence to pharmacotherapy in patients diagnosed with schizophrenia-spectrum psychoses, by comparing one group exposed to the Falloon Psychoeducation Program (FPP) with another group exposed to family supportive therapy with generic information on the disorders. METHODS: 340 patients diagnosed with schizophrenia and related disorders according to standardized criteria from 10 participating units distributed throughout the Italian National Health System (NHS), will be enrolled with 1:1 allocation by the method of blocks of randomized permutations. Patients will be reassessed at 6, 12 and 18 months after start of treatment (duration: 6 months).The primary objective is to evaluate changes in adherence to pharmacotherapy after psychoeducation. Adherence will be assessed at three-month intervals by measuring blood levels of the primary prescribed drug using high pressure liquid chromatography, and via the Medication Adherence Questionnaire and a modified version of the Adherence Interview. Secondary objectives are changes in the frequency of relapse and readmission, as the main indicator of the course of the disorder.Enrolled patients will be allocated to the FPP (yes/no) randomly, 1:1, in a procedure controlled by the coordinating unit; codes will be masked until the conclusion of the protocol (or the occurrence of a severe negative event). The raters will be blind to treatment allocation and will be tested for blinding after treatment completion. Intention-to-treat will be applied in considering the primary and secondary outcomes. Multiple imputations will be applied to integrate the missing data. The study started recruitment in February 2013; the total duration of the study is 27 months. DISCUSSION: If the psychoeducation program proves effective in improving adherence to pharmacotherapy and in reducing relapse and readmissions, its application could be proposed as a standard adjunctive psychosocial treatment within the Italian NHS.

This article describes the Elementary Pragmatic Model (EPM), that focuses on the interactions and changes that can occur between two parties. The model has undergone experimentation using the "Synthesis and Scission Sentences" procedure (SISCI Sentences) described in this work. To develop a new psychotherapy method firstly it was assessed whether the SISCI Sentences revealed differences between normal and disturbed subjects, and then whether some sentences derived from the SISCI procedure - using a specific automated program - really do have an impact even on non clinical subjects. Finally, we report some examples of clinical use of the sentences obtained with the described procedure.

The migration process is cause of physical and social stressors that may lead to mental health problems, particularly in children. In Italy there are few studies about migrant children's mental health; thus the aim of this study is to compare the prevalence and types of emotional and behavioral problems in migrant schoolchildren to those of native Italy children. The research involved migrant (first- and second- generation) and native schoolchildren attending kindergarten, primary and secondary school. A questionnaire was administrated to parents to collect information about the socio-demographic characteristics. All teachers filled in the Teacher’s Report Form (TRF) for migrant and native children. The findings show that teachers detect the academic and adaptive problems more easily in migrant schoolchildren, but they probably are less aware of their psychological problems. The observations made in this study provide a starting point to understand the psychological status and the main problems among migrant children.

The aim of this prospective observational study was to verify the tolerability and safety profile of risperidone in a sample of antipsychotic-naive children/adolescent patients having a different psychiatric diagnosis. Twenty-two (mean age of 12±3.2) antipsychotic-naive patients who started therapy with risperidone were recruited. The assessment involved anthropometric data (weight, height, BMI, BMI z-score and BMI percentile), cardiovascular parameters (blood pressure and QTc interval) and blood tests (levels of glucose, triglycerides, total cholesterol, glutamic oxaloacetic and pyruvic transaminases, γ-glutamyl transferase, prolactin, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, thyroglobulin, antithyroid peroxidase and antithyroglobulin). After an average follow-up of 6 months of risperidone therapy, a statistically significant increase in weight and body composition was observed. Furthermore, an increase in serum levels of prolactin was observed in 50% of patients. No other significant changes in metabolic and cardiovascular parameters were found. Although an increase in these parameters was detected, it remained in the normal range. This study suggests the use of specific protocols for monitoring children/adolescents treated with second-generation antipsychotics to manage the metabolic long-term complications and progression to more severe disease states