Luigi Attademo

Environmental pollution and risk of psychotic disorders: A review of the science to date

Environmental pollution is a global problem with diverse and substantial public health implications. Although many environmental (i.e., non-genetic) risk factors for schizophrenia and other psychotic disorders have been identified, there has been comparatively little research on pollution as a possible risk factor. This is despite the fact that gene-by-environment interactions and epigenetic mechanisms are now recognized as likely facets of the etiology of schizophrenia, and the fact that pollution could potentially mediate the association between urban birth/upbringing and elevated risk. We conducted a review of the literature to date in order to summarize and synthesize work in this area. We identified 13 research reports and 16 review articles. Based on the extant knowledge in this area and what is known about the pathophysiology of schizophrenia, it is feasible that exposure to xenobiotic heavy metals such as lead and cadmium, constituents of air pollution such as particulate matter and nitrogen and sulfur oxides, organic solvents, and other constituents of environmental pollution could be component causes. Further research-from the cellular to epidemiological levels-is clearly needed. If causation is proven, enhancements of policy intended to reduce human exposure to environmental pollution could reduce the burden of schizophrenia and possibly other mental illnesses.

Risk Prediction Models in Psychiatry: Toward a New Frontier for the Prevention of Mental Illnesses.

OBJECTIVE We conducted a systematic, qualitative review of risk prediction models designed and tested for depression, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder, and psychotic disorders. Our aim was to understand the current state of research on risk prediction models for these 5 disorders and thus future directions as our field moves toward embracing prediction and prevention. DATA SOURCES Systematic searches of the entire MEDLINE electronic database were conducted independently by 2 of the authors (from 1960 through 2013) in July 2014 using defined search criteria. Search terms included risk prediction, predictive model, or prediction model combined with depression, bipolar, manic depressive, generalized anxiety, posttraumatic, PTSD, schizophrenia, or psychosis. STUDY SELECTION We identified 268 articles based on the search terms and 3 criteria: published in English, provided empirical data (as opposed to review articles), and presented results pertaining to developing or validating a risk prediction model in which the outcome was the diagnosis of 1 of the 5 aforementioned mental illnesses. We selected 43 original research reports as a final set of articles to be qualitatively reviewed. DATA EXTRACTION The 2 independent reviewers abstracted 3 types of data (sample characteristics, variables included in the model, and reported model statistics) and reached consensus regarding any discrepant abstracted information. RESULTS Twelve reports described models developed for prediction of major depressive disorder, 1 for bipolar disorder, 2 for generalized anxiety disorder, 4 for posttraumatic stress disorder, and 24 for psychotic disorders. Most studies reported on sensitivity, specificity, positive predictive value, negative predictive value, and area under the (receiver operating characteristic) curve. CONCLUSIONS Recent studies demonstrate the feasibility of developing risk prediction models for psychiatric disorders (especially psychotic disorders). The field must now advance by (1) conducting more large-scale, longitudinal studies pertaining to depression, bipolar disorder, anxiety disorders, and other psychiatric illnesses; (2) replicating and carrying out external validations of proposed models; (3) further testing potential selective and indicated preventive interventions; and (4) evaluating effectiveness of such interventions in the context of risk stratification using risk prediction models.

Psychiatric needs of male prison inmates in Italy

This paper presents data on the mental health needs of men in an Italian prison and examines if mental health needs of inmates differ across key correctional subpopulations. Interviewers conducted semi-structured clinical interviews with 526 convicted males incarcerated in the Spoleto Prison from October 2010 through September 2011. Nearly two thirds (65.0%) of inmates had an Axis I or Axis II disorder. About half (52.7%) had an Axis I disorder. Personality disorders were the most common disorders (51.9%), followed by anxiety (25.3%) and substance use disorders (24.9%). Over one third of inmates (36.6%) had comorbid types of disorder. The most common comorbid types of disorders were substance use disorders plus personality disorders (20.1%) and anxiety disorders plus personality disorders (18.0%). Findings underscore a significant need for specialized mental health services for men in Italian prisons. Moreover, as inmates return to the community, their care becomes the responsibility of the community health system. Service systems must be equipped to provide integrated services for those with both psychiatric and substance use disorders and be prepared for challenges posed by patients with personality disorders.

History and conceptual problems of the relationship between obsessions and hallucinations.

AbstractContemporary psychiatric nomenclature defines schizophrenia (SCZ) and obsessive-compulsive disorder (OCD) as distinct disease entities characterized by non-overlapping diagnostic criteria. Nevertheless, a complex association between SCZ and OCD exists on the psychopathological level. And although the relationship between obsessions and delusions has been widely studied and discussed, the relationship between obsessions and hallucinations has not received the same attention. This article presents an historical overview of the studies on the co-occurrence of obsessions and hallucinations. We also analyze the clinical significance of this overlap, as discussed in the early descriptions of these phenomena in the nineteenth century and continuing through the most recent, contemporary conceptualizations. In clinical practice today, we may encounter both SCZ patients with typical ego-dystonic obsessive-compulsive symptoms and SCZ patients affected by obsessions that intertwine with psychotic symptoms, generating complex psychopathological syndromes (e.g. “obsessive hallucinations”). A further complication is that some OCD patients show perceptual disturbances. Taking into consideration the possible coexistence of obsessive-compulsive symptoms and psychotic symptoms is crucial for proper diagnosis, prognosis, and treatment. Further investigations are required to fully evaluate the psychopathological interrelationships between obsessions and hallucinations.

Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: A multicenter-observational study

Comorbidities between psychiatric diseases and use of traditional substances of abuse are common. Nevertheless, there are few data regarding the use of novel psychoactive substances (NPS) among psychiatric patients. Aim of this multicentre survey is to investigate the consumption of a number of psychoactive substances in a young psychiatric sample.

The aggressor at the mirror: Psychiatric correlates of deliberate self-harm in male prison inmates

BACKGROUND Deliberate self-harm (DSH) causes important concern in prison inmates as it worsens morbidity and increases the risk for suicide. The aim of the present study is to investigate the prevalence and correlates of DSH in a large sample of male prisoners. METHODS A cross-sectional study evaluated male prisoners aged 18+ years. Current and lifetime psychiatric diagnoses were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders - DSM-IV Axis I and Axis II Disorders and with the Addiction Severity Index-Expanded Version. DSH was assessed with The Deliberate Self-Harm Inventory. Multivariable logistic regression models were used to identify independent correlates of lifetime DSH. RESULTS Ninety-three of 526 inmates (17.7%) reported at least 1 lifetime DSH behavior, and 58/93 (62.4%) of those reported a DSH act while in prison. After multivariable adjustment (sensitivity 41.9%, specificity 96.1%, area under the curve=0.854, 95% confidence interval CI=0.811-0.897, P<0.001), DSH was significantly associated with lifetime psychotic disorders (adjusted Odds Ratio aOR=6.227, 95% CI=2.183-17.762, P=0.001), borderline personality disorder (aOR=6.004, 95% CI=3.305-10.907, P<0.001), affective disorders (aOR=2.856, 95% CI=1.350-6.039, P=0.006) and misuse of multiple substances (aOR=2.024, 95% CI=1.111-3.687, P=0.021). CONCLUSIONS Borderline personality disorder and misuse of multiple substances are established risk factors of DSH, but psychotic and affective disorders were also associated with DSH in male prison inmates. This points to possible DSH-related clinical sub-groups, that bear specific treatment needs.

Prevalence of personality disorders in patients with fibromyalgia: a brief review

Fibromyalgia (FM) is a complex musculoskeletal pain disorder characterized by widespread pain, fatigue, and other functional symptoms. Patients with FM are frequently affected by psychiatric disorders. Clinicians typically observe certain personality characteristics or traits associated with FM, but there is still a lack of studies about personality disorders (PDs) in patients with FM. Aim of our brief review is to summarize the literature to date on prevalence of PDs in FM. We searched the PubMed electronic database for all articles up to 1 February 2017, and identified a number of reports about prevalence of PDs in patients with FM. Most of studies show that the proportion of PDs diagnosed in patients with FM appears far greater than that found in the general population. We suggest that is very useful to evaluate PDs in patients with FM systematically, in order to improve the understanding, assessment, and treatment of this clinical condition.

Adult-Onset Case of Undiagnosed Neurodegeneration with Brain Iron Accumulation with Psychotic Symptoms

Neurodegeneration with brain iron accumulation (NBIA) is a collective term to indicate a group of neurodegenerative diseases presenting accumulation of iron in the basal ganglia. These disorders can result in progressive dystonia, spasticity, parkinsonism, neuropsychiatric abnormalities, and optic atrophy or retinal degeneration. Onset age ranges from infancy to late adulthood and the rate of progression is very variable. So far, the genetic bases of nine types of NBIA have been identified, pantothenate-kinase-associated neurodegeneration (PKAN) being the most frequent type. The brain MRI “eye-of-the-tiger” sign, T2-weighted hypointense signal in the globus pallidus with a central region of hyperintensity, has been considered virtually pathognomonic for PKAN but recently several reports have denied this. A significant percentage of individuals with clinical and radiographic evidence of NBIA do not have an alternate diagnosis or mutation of one of the nine known NBIA-associated genes (idiopathic NBIA). Here we present an adult-onset case of “undiagnosed” NBIA with the brain MRI “eye-of-the-tiger” sign, and with psychotic symptoms which were successfully treated with antipsychotic and mood stabilizer medications. Here, the term “undiagnosed” is used because the patient has not been screened for all known NBIA genes, but only for two of them.

S99. CANNABIS USE, PSYCHOTIC-LIKE EXPERIENCES AND ABERRANT SALIENCE IN A SAMPLE OF BELGIAN STUDENTS

Abstract Background Cannabis is the most popular illicit drug in the western world and its use seems to be strongly associated with an increased risk of developing schizophrenia and other psychotic disorders. Its use can induce transient psychotic symptoms in healthy individuals and increase rate of subclinical psychotic symptoms in the general population. Subclinical psychotic experiences (also called Psychotic Like Experiences: PLEs), such as magical thinking, paranoid ideation or hallucinations, could be considered as a phenotype qualitatively similar to the symptomatology of psychotic disorders but quantitatively less severe in terms of intensity, frequency and impairment. They are fairly common in the general population and usually transitory and self-limiting but they could become abnormally persistent and evolve to a full-blown psychotic disorder, especially if combined with certain environmental risk factors, such as trauma, urbanicity, cannabis use. PLEs may be considered as an early marker of a latent psychosis vulnerability and the frequently good outcome of subclinical psychosis can be turned in negative outcomes by the association with environmental risk factors, such as cannabis use. We focus our attention on aberrant salience, a peculiar psychotic experience, frequently reported during the prodromal phase that precede the onset of full-blown psychotic illness. Aberrant salience is the unusual or incorrect assignment of salience or significance to innocuous stimuli; it has been hypothesized to be an important mechanism in the development of psychosis. Methods Undergraduate students of ULB (Universitè Libre de Bruxelles) and INSAS (Institut national supérieur des arts du spectacle) of Brussels (Belgium) were invited to participate to the study. A self-report questionnaire, investigating socio-demographic characteristics, and cannabis use was administered, evaluating lifetime and current cannabis use. Aberrant Salience Inventory (ASI) is a 29 item Yes–No questionnaire developed to evaluate aberrant salience. French version of Community Assessment of Psychic Experiences (CAPE), was used to evaluate dimensions of psychosis and PLEs. CAPE is a 42-item, self-report questionnaire, developed to measure the lifetime prevalence of PLEs in the general population. The questionnaire assesses three symptom dimensions (positive, depressive and negative symptoms). All statistical analysis was carried out with Statistical Package for Social Sciences, Version 20.0. We evaluated individual correlations between years of cannabis use and days of cannabis use in the last month with the tools scores. We also explored correlation of ASI score with different CAPE scores and different types of PLEs. Correlations were carried out by using the nonparametric Spearman correlation test. Results The final sample was of 257 participants. 46,3% of subjects reported a lifetime cannabis use and 35.0% reported a current cannabis use (last 30 days). Compared with non-users, cannabis users showed significant higher ASI scores and also higher positive and negative dimensions CAPE scores. No significant association was found between cannabis consumption and the depressive dimension of CAPE. Years of cannabis use and frequency of use in the last 30 days showed a small positive correlation with ASI score; also, weaker positive correlations with CAPE positive and negative dimensions scores were observed. Discussion To some extent, our results support the evidences that cannabis use is associated with an increased rate of psychotic experiences in individuals without clinical form of psychosis. Future prospective longitudinal studies are required to better investigate the meaning of the association between cannabis use and PLEs.