Ester di Giacomo

The Italian Version of the Borderline Personality Disorder Severity Index IV: Psychometric Properties, Clinical Usefulness, and Possible Diagnostic Implications

Borderline personality disorder (BPD) has a core embodied in affective and behavioral dysregulations, impulsivity, and relational disturbance. Clinical presentation might be heterogeneous due to a combination of different symptoms listed in the DSM-5. Clinical diagnosis and assessment of the severity of manifestations might be improved through the administration of structured interviews such as the Borderline Personality Disorder Severity Index, 4th edition (BPDSI-IV). The psychometric properties of the Italian version of the BPDSI-IV were examined for the first time in 248 patients affected by BPD and 113 patients affected by bipolar disorder, proving to be a valid and accurate instrument with good internal consistency and high accuracy. The Italian version also demonstrates significant validity in the discrimination between these clinical groups (p < 5001).

Sexual abuse in adulthood: when psychic and somatic sufference blends

Sexual abuse is a traumatic event with heavy consequences in terms of clinical implications and quality or quantity of life. The mediation of the development of post-traumatic stress disorder accounts for many of the presented symptoms, but not for the whole range of them, especially if violence is suffered during childhood. From the analysis of its epidemiology and consequences, it can be derived that this disorder is dramatically widespread and cannot be any longer ignored but preventive efforts and early intervention are required. Current therapeutic options that have been proven to be effective are discussed, though further research is warranted to improve treatment strategies.

Family Inclusive Therapeutic Interventions

Given the improtance of the family in the etio-pathogenesis of psychopathology, family interventions have become a focus in therapeutic approaches in treating such mental disorders. This chapter covers the latest research in The Field of Family Interventions for Bipolar Disorders, Schizophrenia, and Depressive Illness. This area of research is advancing leading to new paragidm in “family-inclusive” therapeutic intterventions.

Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis

Importance Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge. Objective To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group. Data Sources Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. Study Selection Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified. Data Extraction and Synthesis Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated. Main Outcomes and Measures The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers. Results Thirty-five studies reported in 22 articles that involved a total of 2 378 987 heterosexual and 113 468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c2 = 3074.01; P < .001; I2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c2 = 825.20; P < .001; I2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c2 = 980.02; P < .001; I2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates. Conclusions and Relevance Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning.

Progresses about the Interplay among Clarithromycin, Immune and Central Nervous Systems

Dear Editor, Helicobacter pylori (H. pylori) is spiral in shape with a flagellum, gram-negative, micro aerophilic bacterium which colonizes in the human gastric mucosa and the infection may last for decades. It is thought that the H. pylori infection is the most common bacterial infection and influences approximately 50%–75% of the population worldwide (Lv et al. 2015). It is the main reason for the upper gastrointestinal diseases, including peptic ulcer (gastric and duodenal), chronic gastritis, gastric cancer and gastric mucosal-associated lymphoid tissue lymphoma (Tian et al. 2015). According to the Conference of Maastricht III, the first line of treatment is amoxicillin, omeprazole, and clarithromycin, as triple therapy, for 7 days, which results in an eradication rate of about 80% (75%–98%) (Malfertheiner et al. 2007). Clarithromycin, in particular, is a semi-synthetic macrolide antibiotic indicated for the treatment of many different types of bacterial infections affecting the skin and respiratory system as well as most Mycobacterium avium complex (MAC) bacteria. Beyond proofs of the efficiency of Clarithromycin in the treatment of many major and common infections, there is a Bdark^ aspect to this matter. Some antibiotics, in fact, are reported to stimulate adverse psychiatric effects with an onset within 7 days of initiation and resolution 24–48 h after its interruption (Shah et al. 2012). This phenomenon might be underestimated due to a low clinical incidence but it is being reported in a growing number of cases (Abouesh and Hobbs 1998; Brooks and Hoblyn 2005; Khalili 2014; Lally and Mannion 2013). Known as Antibiomania, it often develops in subjects with no personal or family psychiatric history; age and genetic influences have been excluded, even though some authors suggest a predisposition in elderly. Clarithromycin is among those more commonly associated with psychosis with few reported cases involving amoxicillin (Shah et al. 2012); it has an excellent CSF penetration (Schmidt et al. 1993), but no reports of interaction with central neurotransmitters were found so far in the literature (Shah et al. 2012). A case arrived at our clinical attention might contribute in filling that gap.We documented, for the first time to our knowledge, interactions between Clarithromycin, neurotransmitters and the immunological system. BThe patient had a negative psychiatric history except for two iatrogenic episodes developed during treatment for eradication of Helicobacter Pilory (Clarithromycin 1 g b.i.d + amoxicillin 2 g b.i.d for two weeks at the first episode and one week at the second one). She showed mood symptoms at the first episode and psychotic symptoms at the second. The last administration of Clarithromycin (1 g b.i.d for two days) dated back to a week before her admission to the ER due to low level of consciousness. All the results of clinical examinations as well as laboratory data were within normal limits. Drug abuse screening was negative and blood alcohol concentration was zero. A CT scan of the head was normal. A lumbar puncture was not done. During the Psychiatric * Ester di Giacomo ester.digiacomo@yahoo.com

Pregnancy denial or concealement: A case report highlighting risks and forensic aspects.

The study by Forbes et al. (2015) is important because it draws attention to the victim’s anger response in the course of disaster management. Data drawn from 1017 adult victims of bushfires across 25 communities was tested against three structural equation models. Anger and concurrent stressful life events were found to mediate mental health outcomes, most notably, the development of post-traumatic stress disorder (PTSD). The study did not control for financial compensation. That factor contaminates the mediation of outcomes at many levels (Lock et al., 2012). The authors correctly draw the conclusion that governments and communities should provide social and financial support for victims. However, the anger problem is equally a consequence of the failure of these agencies to provide appropriate disaster relief. They are far from shifting from being the problem to becoming the solution. In the interim, the authors suggest improving diagnostic screening and evidence-based cognitive behavioural therapy (CBT) for anger. The latter might reduce anger. The question is does it also reduce the assertiveness required to combat re-victimisation?