University Psychiatric Clinic Research Articles

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem.

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.

Psychological distress among individuals with a suicide attempt or suicidal ideation and suicide attempts patterns: first two years of the pandemic.

The COVID-19 pandemic and related restrictions may have led to increased stress, particularly in people with mental health problems. Since stress factors play important role in the emergence of suicide attempts (SA) and suicidal ideation (SI), they may have been exacerbated by the pandemic, which could have led to an increased number of suicide attempts. Thus, we first investigated whether the pandemic affected personal stress experiences and appraisal of coping potential in individuals with and without SA and SI. In a second step, we analyzed the frequency and dynamics of SAs by patients admitted to a psychiatric university clinic over a period of four years. We examined stress experiences and appraisal of coping resources of inpatients recruited between March 2021 and February 2022 with SA (n=38), SI (n=27), and with mood disorder without SA or SI (n=45). In the second study, we investigated the time course of prospectively recorded patients with a suicide attempt (n=399) between January 1st 2018 and December 31st 2021 using interrupted time-series Poisson regression models. There was a significant main effect of group (F[2,107]=6.58, p=0.002) regarding psychological stress levels, which was significantly higher in the SA and SI groups than in the psychiatric control group. No significant differences were found in the appraisal of coping resources or in the frequency of SAs before and during pandemic. However, the pandemic had a significant impact on the seasonal pattern of SAs. The pandemic increased psychological stress levels in individuals with SA and SI, which may be related to SI and do not necessarily result in SA. The pandemic did not affect the overall frequency of SA between March 2020 and December 2021, but interfered with the seasonal pattern of SA occurrence. Effective intervention strategies during a pandemic should include programs to strengthen the psychological resilience of people who are susceptible to mental health problems.

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study.

The World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature. Barriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics "Personal difficulties and barriers to treatment," "Personal motivation to be treated," "Knowledge about the disease," and "Received information about the medicine." In-depth semistructured interviews were performed face-to-face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively. Interviews were performed with seven individuals (mean age: 48.3 years; range: 38-63 years; one woman) treated with oral direct-acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier "swallowing difficulties" emerged exclusively from the statements provided by the interviewees. Barriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.

Patient-reported experience measures (PREMs) in outpatient psychiatry - is there an association to perceived discrimination and devaluation?

Patient-Reported Experience Measures (PREMs) are gaining significance in the field of psychiatry, with patient satisfaction being a key measure. However, it is unclear if patient satisfaction in psychiatry is influenced by variables outside the treatment setting. This brief report thus examines the possible impact of perceived discrimination and devaluation (PDD) on patient satisfaction in the psychiatric outpatient setting. Data from 1,126 individuals who were undergoing or had recently completed treatment at 15 outpatient centers of the Psychiatric University Clinic in Basel, Switzerland, was analyzed. Patient satisfaction was assessed using the Münsterlingen Patient Satisfaction Questionnaire (MüPF), and perceived stigma was measured with the Perceived Discrimination Devaluation Scale. The results revealed a positive small effect size relationship between MüPF and PDD, suggesting that patients who perceived less stigma report higher treatment satisfaction. This relationship may affect most ratings, with the total MüPF score remaining relatively robust against this potential influence. Linear regression analysis indicated that a one-unit increase in PDD score could lead to a maximum change of 1.8 points on the 7-point Likert scale for the MüPF item correlating highest with PDD and 0.4 points on the total MüPF score. These findings highlight the importance of considering perceived stigma when evaluating patient satisfaction with psychiatric outpatient treatment. Future research should investigate associations between stigma, patient satisfaction, treatment outcome, as well as other external factors that may influence patient satisfaction in psychiatric settings.

P21: Intermittent theta burst stimulation for treatment of behavioral and psychological symptoms of dementia in Alzheimer’s disease and its effect on the use of antipsychotics – study protocol

Behavioral and psychological symptoms of dementia (BPSD), such as agitation, psychosis and depression, develop in the majority of patients with Alzheimer’s disease in the progression of the disease. The management of BPSD, especially in the hospital setting, frequently includes psychopharmacotherapy, particularly second-generation antipsychotics (SGAs). These are associated with significant side effects.In recent years, repetitive transcranial magnetic stimulation (rTMS) and its accelerated protocols, continuous and intermittent theta burst stimulation (cTBS, iTBS), have proven effective in treating depression. There have also been published studies that showed their effectiveness in Alzheimer’s disease, in both cognition and BPSD.We will conduct a 6 week, double-blind, randomized, controlled trial in patients with Alzheimer’s disease and BPSD, hospitalized at the University Psychiatric Clinic Ljubljana. The patients in the stimulated group will receive iTBS of the left dorsolateral prefrontal cortex for five days a week, for two consecutive weeks. The patients in the sham group will have the exact same procedural protocol, but will receive sham stimulation form the sham coil. We will evaluate BPSD before and after protocol using various clinical scales. We will look if the doses of the prescribe SGAs in the stimulated group differ from the placebo group and, if so, if the difference persists at the follow-up after four weeks.

Pure small fiber neuropathy in alcohol dependency detected by skin biopsy.

Alcohol overconsumption is well known to cause damage to the peripheral nervous system. The aim of this study was the functional and structural evaluation of the small nerve fibers in alcohol-dependent subjects, with or without symptoms of peripheral neuropathy. Twenty-six consecutive alcohol-dependent subjects treated for detoxification voluntarily in the specialized unit of the Athens University Psychiatric Clinic were enrolled in this prospective study over 18 months. Every subject was assessed by peripheral nerve evaluation using the Neuropathy Symptoms Score (NSS) and Neuropathy Impairment Score (NIS), followed by nerve conduction studies (NCS), quantitative sensory testing (QST), and skin biopsy. Twenty-nine normal subjects, age- and gender-matched, constituted the control group. Peripheral neuropathy was diagnosed in 16 subjects (61.5%). Among these 16 subjects, pure large fiber neuropathy (LFN) was found in two subjects (12.5%), pure small fiber neuropathy (SFN) was found in eight subjects (50%), and both large and small fiber neuropathy was diagnosed in six patients (37.5%). The intraepidermal nerve fiber density (IENFD) of the patients' skin biopsy was significantly lower than that of the control group. Additionally, QST results showed a statistically significant sensory impairment in the patients. Our study confirms small fiber neuropathy due to alcohol abuse with a high prevalence of pure SFN that might have remained undetected without QST and IENFD.

Psychoanalytic practice in the light of psychiatric patient records: The elusive history of Freudian-inspired psychotherapy (Strasbourg, 1940s–1970s)

This article delves into a problem that is still seldom addressed by historians—namely, the use of medical records testifying to the implementation of a psychoanalytically inspired treatment within a psychiatric institution for historical research. Based on publications, a broad spectrum of medical patient records, and interviews with former practitioners, it more broadly addresses issues related to the attention to patients’ voices at the University Psychiatric Clinic of Strasbourg, a central institution of psychiatric care in Northeastern France that was once considered a bastion of French Freudianism. Eventually, it contends with the fundamentally elusive nature of medical patient records when it comes to talking cures, highlighting the challenges and limitations inherent in the historical exploitation of this type of source.

Exploring risk factors for re-hospitalization in a psychiatric inpatient setting: a retrospective naturalistic study

BackgroundThe reduction of multiple psychiatric hospitalizations is an important clinical challenge in mental health care. In fact, psychiatric re-hospitalization negatively affects the quality of life and the life expectancy of patients with psychiatric disorders. For these reasons, identifying predictors of re-hospitalization is important for better managing psychiatric patients. The first purpose of the present study was to examine the readmission rate in a large sample of inpatients with a psychiatric disorder. Second, we investigated the role of several demographical and clinical features impacting re-hospitalization. MethodThis retrospective study enrolled 1001 adult inpatients (510 men and 491 women) consecutively admitted to the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome between January 2018 and January 2022. To identify risk factors for psychiatric re-hospitalization, we divided the sample into 3 subgroups: the Zero-Re group which had no readmission after the index hospitalization, the One-Re group with patients re-admitted only once, and the Two-Re with at least two re-admissions. ResultsThe groups differed according to previous hospitalizations, a history of suicide attempts, age at onset, and length of stay. Furthermore, the results of the regression model demonstrated that the Two-Re group was more likely to have a history of suicide attempts and previous hospitalizations.DiscussionThese results indicate the importance of assessing risk factors in psychiatric hospitalized patients and implementing ad hoc prevention strategies for reducing subsequent re-hospitalizations.

Der Fremdling im Therapiegarten – Cis chinensis (Coleoptera, Ciidae) und sein Umfeld

Samples of the tree fungus Antrodia xantha were collected on Pinus strobus in the therapy garden of the UPK campus (University Psychiatric Clinics) in Basel in summer 2021. The samples contained an alien Ciidae species new to Switzerland: Cis chinensis Lawrence, 1991, a species otherwise mainly known as a storage pest of commercially dried fungi. The adults and larvae of the Basel population are described and illustrated. When comparing the size of the adults of the two sample series collected two weeks apart, statistically significant differences were found. It appears that the above-average temperatures in June 2021 favoured the size of the second group. A number of (4–)5 larval stages are postulated for larval development. As an endoparasitoid of the eggs of C. chinensis, an unknown Mymaridae of the genus Cleruchus was found. Noteworthy was an unusually heavy infestation of Ciidae by phoretic mites (Histiostomatidae). During follow-up surveys in early 2022, additional individuals of C. chinensis were also found on the fruitbodies of other fungi growing in the immediate vicinity of the site where the population of the species was initially observed on A. xantha. A list of all Ciidae detected on the UPK campus is provided, and the spectrum of host-fungi of C. chinensis is discussed.

"Implementation of Multidisciplinary approach and Clinical pathway at the Geriatric Psychiatry Unit of University Psychiatric Clinic Ljubljana, Slovenia"

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Reforming University Psychiatry: A History of the Implementation of Sectorization at the University Psychiatric Clinic of Strasbourg (1960s–1990s)

Abstract This paper examines the impact of sectorization, a central feature of French psychiatric reform, on the University of Strasbourg Psychiatric Clinic. The analysis begins with the first considerations surrounding sectorization in the 1960s; from there, the paper investigates how the Clinic was integrated into the sectorization of the Bas-Rhin from 1973 onwards, before ending with the sectoral repartition and thoughts about the de-sectorization of the Clinic in the early 1990s. The following questions are examined: What demands were placed on the Clinic in the course of sectorization and how did it deal with them? How and in which phases did the areas of responsibility of the university Clinic change as a result of sectorization? How did the number of patients and the patient structure change? What new sectoral care structures were established outside the Clinic, and how did they influence the work of its staff? The study reveals that, despite recognizing the importance of the new tasks of the psychiatric sector, the Strasbourg Clinic was primarily concerned with maintaining its traditional activities and was very successful in doing so. At the same time, this individual path led to delays in the development of sector structures and to tensions with regional hospitals and authorities.

Is Lethality Different between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters.

According to the gender paradox in suicidology, an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide. Furthermore, females and males present different risk factors for suicide. The present study explored possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide. The study included 177 adult inpatients hospitalized following a suicide attempt at the University Psychiatric Clinic, Sant’Andrea Hospital, Sapienza University of Rome. Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk/Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay. The results found that males and females differed in the method used for the suicide attempt, the scores for risk and rescue, and the length of hospitalization post-suicide attempt. In conclusion, identifying gender characteristics of patients at higher risk of suicide is important for implementing specific suicide prevention strategies and reducing the risk of future suicidal behavior in psychiatric inpatients.

On the History of a Special Connection Between Academic and Non-Academic Psychiatric Institutions: Erlangen (1903-1974)

To examine the more than 70-year history of a special connection between academic and non-academic psychiatric institutions. Relevant archival material as well as primary and secondary literature were critically examined. As early as 1818, Johann Michael Leupoldt (1794-1874), an assistant professor in Erlangen, held a seminar on "madness". But the University Psychiatric Clinic was not established until 1903 as part of the association to the mental asylum on a contract agreement between the Friedrich-Alexander-University Erlangen and the County Senate of Middle-Franconia. Clinic patients were registered as "institutional residents", and the Clinic had no income of its own. Especially relevant is the fact that the Head of Department and Director of the Clinic was formally considered as a "senior doctor of the asylum". The efforts to gain more autonomy were not successful until the mid- 1970s because of the socio-political situation. The complicated dependent employment relationship of the Head of Department on the Director of the asylum undoubtedly contributed to their "mésalliance tradition" over several decades. A public scandal arose in 1978 with a supervisory complaint to the government of Middle-Franconia with accusations of failure to protect patient documentation and medications during the relocation of the departments of the mental asylum to the newly constructed Regional Hospital on the "Europakanal". The lack of documents concerning the separation between the university and the district may be due to these processes. Cooperation between the University Clinic and the Regional Hospital exists in an altered form today. The Psychiatric Clinic can thus include patients from the Regional Hospital in scientific studies. The present study can contribute to discussions on demand-controlled integrated psychiatric care in combined academic and non-academic psychiatric institutions and points out how interinstitutional psychiatric care can succeed.

From Anti-Freudianism to a Bastion of Psychoanalysis: A History of Psychoanalysis at the University Psychiatric Clinic of Strasbourg in the Twentieth Century

By contrast with a dominant part of the historiography of psychoanalysis in France, which tends to be dedicated to the history of the centres and the biography of the great theorists, this article focuses on the less well known history of psychoanalysis in a peripheral region, namely Alsace, and its capital, Strasbourg. It zooms in on the main central university hospital service in the mental health care system of northeastern France, the University Psychiatric Clinic of Strasbourg. On the basis of abundant and varied sources, it relates the passions, attractions and aversions that Freudian methods aroused among the major protagonists of Strasbourg psychiatry, especially Théophile Kammerer (1916–2005), the director of the Clinic from 1953 to 1982, and the various actors (physician or non-physician) that have circled the establishment throughout the twentieth century.

20 years of daily hospital for non-psychotic disorders, organisational structure and treatment modalities

IntroductionAnxiety and depressive disorders are among the most prevalent psychiatric disorders, yet there aren’t many studies adressing treatment modalities in daily hospitals.ObjectivesThe aim of our study is to present organisational structure and treatment modalities in Daily hospital for non-psychotic disorders in University Psychiatric Clinic “Sveti Ivan“, Zagreb, Croatia.MethodsAll patients in Daily Hospital attend 6 months programme. The treatment programme consists of psychodynamic group psychotherapy, cognitive-behavioral therapy, occupational therapy, antistress and mindfulness workshops, psychoeducational workshops, cinema therapy and sociotherapy. Along with clinical follow-up, all the patients are given sociodemographic questionnaire designed for our programme, World Health Organisation Quality of Life Questionnaire (WHOQoL BREF) and The Depression, Anxiety and Stress Scale 21 (DASS-21).ResultsAt discharge moderate to significant improvement was observed in different aspects of functioning among most of the participants, verified by clinical follow-up as well as by results obtained through questionnaires.ConclusionsOur data show that patients with anxiety and depressive disorders can be efffectively treated by such comprehensive treatment approach.DisclosureNo significant relationships.

The relationship between psychological characteristics of patients and their utilization of psychiatric inpatient treatment: A cross-sectional study, using machine learning.

High utilizers (HU) are patients with an above-average use of psychiatric inpatient treatment. A precise characterization of this patient group is important when tailoring specific treatment approaches for them. While the current literature reports evidence of sociodemographic, and socio-clinical characteristics of HU, knowledge regarding their psychological characteristics is sparse. This study aimed to investigate the association between patients' psychological characteristics and their utilization of psychiatric inpatient treatment. Patients from the University Psychiatric Clinics (UPK) Basel diagnosed with schizophrenia spectrum or bipolar affective disorders participated in a survey at the end of their inpatient treatment stay. The survey included assessments of psychological characteristics such as quality of life, self-esteem, self-stigma, subjective experience and meaning of psychoses, insight into the disease, and patients' utilization of psychiatric inpatient treatment in the last 30 months. The outcome variables were two indicators of utilization of psychiatric inpatient treatment, viz. "utilization pattern" (defined as HU vs. Non-HU [NHU]) and "length of stay" (number of inpatient treatment days in the last 30 months). Statistical analyses included multiple regression models, the least absolute shrinkage and selection operator (lasso) method, and the random forest model. We included 112 inpatients, of which 50 were classified as HU and 62 as NHU. The low performance of all statistical models used after cross-validation suggests that none of the estimated psychological variables showed predictive accuracy and hence clinical relevance regarding these two outcomes. Results indicate no link between psychological characteristics and inpatient treatment utilization in patients diagnosed with schizophrenia spectrum or bipolar affective disorders. Thus, in this study, the examined psychological variables do not seem to play an important role in patients' use of psychiatric inpatient treatment; this highlights the need for additional research to further examine underlying mechanisms of high utilization of psychiatric inpatient treatment.

Improving Knowledge on Pathways to Functional Outcome in Schizophrenia: Main Results From the Italian Network for Research on Psychoses.

The identification of factors associated with functional outcome of subjects with schizophrenia is a great challenge in current research oriented to the personalization of care. The Italian Network for Research on Psychoses (NIRP) is a network of 26 university psychiatric clinics and/or mental health departments aimed to carry out multicenter research projects to improve the standards of prevention, diagnosis, and treatments of schizophrenia. The network has promoted 2 main studies, a cross-sectional one and a longitudinal one and seven “add-on” studies. The cross-sectional study of the network included 921 subjects with schizophrenia, 379 unaffected first-degree relatives of these patients, and 780 healthy controls. Results from this study documented that social and non-social cognition, functional capacity, negative symptoms, resilience, and family or social incentives strongly influence a measure of global functioning. The follow-up study included 618 patients from the original sample and has produced evidence of the key role of cognition, functional capacity, the experiential domain of negative symptoms, and everyday life skills in predicting functional outcome. The longitudinal study demonstrated that social cognition and the experiential domain of negative symptoms had an impact on interpersonal functioning, while non-social cognition had an impact on everyday life skills. Both non-social cognition and social cognition predicted work skills. The research question concerning the relationships of cognitive impairment and negative symptoms has been investigated with an innovative approach, using a structural equation model (SEM) and a network analysis. Both analyses demonstrated that only the experiential domain of negative symptoms had a distinct direct effect on functioning. The network analysis showed that expressive deficit was connected to functional capacity, as were social and non-social cognitive variables, and to disorganization. These findings were confirmed by the follow-up study. The add-on studies showed distinct electrophysiological correlates of the two negative symptom domains and the partial overlap between disorganization and neurocognitive impairment. Moreover, they identified and characterized a specific subgroup of patients suffering from schizophrenia with autism spectrum symptoms. The NIRP studies have implications for personalized management of patients with schizophrenia and highlight the need for a careful assessment of several domains rarely evaluated in clinical settings.

A Comparison of Incidence of Patient Aggression in the University Psychiatric Clinic Ljubljana and at the Department of Psychiatry of the University Medical Centre Maribor

Purpose: Management of aggressive behaviour in patients with psychiatric diagnoses presents a challenge and burden for health staff. The present study compared two psychiatric institutions (the Department of Psychiatry of the University Medical Centre Maribor and the University Psychiatric Clinic Ljubljana) in terms of frequency and consequences of patient aggression. We compared frequencies of aggression between male and female patients, patients diagnosed with schizophrenia and other diagnoses, previously aggressive patients and patients who were aggressive for the first time. We also compared the use of special protective measures in both institutions.&#x0D; Methods: This study was retrospective and included the analysis of documentation of patients who were hospitalised at both institutions from 1 January 2012 to 31 June 2012. We identified patients with aggressive behaviour and acquired their sociodemographic data, diagnosis, number of hospitalisations, presence of alcohol or psychoactive substances and presence of aggressive behaviour. For assessment of aggressive behaviour, the Overt aggression scale was used. &#x0D; Results: One-hundred and forty-seven patients met the criteria for aggressive behaviour. There was no statistically significant difference in the frequency of aggression between genders or diagnoses. However, there was a statistically significant difference (p ≤ 0.01) in the frequency of aggression in patients who had previously been aggressive compared to those patients who had not exhibited such behaviour. There was no statistically significant difference in the use of special protective measures between the two institutions.&#x0D; Conclusions: Two hypotheses were confirmed: patients who had exhibited previous aggression were more frequently aggressive than those with no previous aggressive behaviour while the use of special protective measures between the two institutions was similar.

Antidepressants in bipolar disorder: Analysis of correlates overall, and in BD-I and BD-II subsamples

Background: Clinical therapeutic approaches to Bipolar Disorders (BDs) include diverse pharmacotherapies, targeting different symptomatic BD presentations. To date, guidelines about pharmacological treatment of BDs have focused on short-term treatment of mood episodes, at the expense of longer-term treatment, especially for (the most common) predominantly depressive polarity patients.Methods: A database of BD-I and BD-II patients was collected between 2013 and 2019 at the University Psychiatric Clinic of Ospedale Policlinico and Ospedale Luigi Sacco of Milan. Only patients in euthymic phases (no current mood episode) were included in the study. We then analyzed socio-demographic and clinical characteristic overall and in the subgroup BD-I and BD-II, comparing patients taking vs. not taking ADs.Results: Our results showed that approximately 1/3 of BD patients between acute episodes took ADs, also among patients from the subgroup with BD-I, especially those first presenting with a depressive episodes, and those with a most recent depressive (as opposed to elevated, irritable, or mixed) polarity episode.Limitations: Although patients included in our study were primarily in follow up for Bipolar Disorder, use of ADs could be explained by other comorbidities, such as Anxiety or Eating Disorders.Conclusions: These data shed light on how managing depressive symptoms is a very important aspect of treating BDs, highlighting the need for wider and more specific studies on the use of ADs in BDs.

Autism spectrum in patients with schizophrenia: correlations with real-life functioning, resilience, and coping styles.

Previous researches highlighted among patients with schizophrenia spectrum disorders (SSD) a significant presence of autistic traits, which seem to influence clinical and functional outcomes. The aim of this study was to further deepen the investigation, evaluating how patients with SSD with or without autistic traits may differ with respect to levels of functioning, self-esteem, resilience, and coping profiles. As part of the add-on autism spectrum study of the Italian Network for Research on Psychoses, 164 outpatients with schizophrenia (SCZ) were recruited at eight Italian University psychiatric clinics. Subjects were grouped depending on the presence of significant autistic traits according to the Adult Autism Subthreshold Spectrum (AdAS Spectrum) instrument ("AT group" vs "No AT group"). Other instruments employed were: Autism Spectrum Quotient (AQ), Specific Levels of Functioning (SLOF), Self-Esteem Rating scale (SERS), Resilience Scale for Adults (RSA), and brief-COPE. The "AT group" reported significantly higher scores than the "No AT group" on SLOF activities of community living but significantly lower scores on work skills subscale. The same group scored significantly lower also on SERS total score and RSA perception of the self subscale. Higher scores were reported on COPE self-blame, use of emotional support and humor domains in the AT group. Several correlations were found between specific dimensions of the instruments. Our findings suggest the presence of specific patterns of functioning, resilience, and coping abilities among SSD patients with autistic traits.