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LUCA PINGANI

Ricercatore t.d. art. 24 c. 3 lett. B
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze - sede Padiglione De Sanctis - Campus San Lazzaro


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Pubblicazioni

2022 - Can a negative religious causal attribution of mental illness affect the phenomenon of public stigma? [Articolo su rivista]
Pingani, L.; Pinelli, G.; Coriani, S.; Ferrari, S.; Fierro, L.; Giberti, S.; Mattei, G.; Nasi, A. M.; Evans-Lacko, S.; Wesselmann, E. D.; Galeazzi, G. M.
abstract

This study assessed, through an exploratory approach, how religion-based negative causal attributions of mental illness may be associated to stigmatising attitudes and behaviours that contribute to public stigma in an Italian convenience sample. All participants (N = 311; average age = 33 years, 38.6% male) completed a set of three questionnaires: Religious Beliefs and Mental Illness Stigma Scale, the Attribution Questionnaire 27 and the Mental Health Knowledge Schedule. The study found support for two specific models. The Responsibility model involved four key predictors: participant age, the influence of religious beliefs in everyday choices, religious beliefs about the connection between morality/sin and mental illness and having participated in seminars about mental illness stigma. The Dangerousness model involved three exogenous variables: participating in mental illness stigma seminars, religious beliefs about morality/sin and mental illness, and participant age. This study allows the identification of variables that seem to activate or attenuate the models of “Personal Responsibility” and “Dangerousness”.


2022 - DIFFERENZE DI GENERE NELLA COMORBILITÀ TRA SINTOMATOLOGIA ANSIOSO-DEPRESSIVA, SINDROME METABOLICA E ADENOMI COLORETTALI [Abstract in Atti di Convegno]
Rioli, Giulia; Bonamici, Caterina; Mancini, Stefano; Mattei, Giorgio; Alboni, Silvia; Sena, Paola; Roncucci, Luca; Fiore, Gianluca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract


2022 - Differenze di genere nella comorbilità tra sintomatologia ansioso-depressiva, sindrome metabolica e adenomi colorettali [Abstract in Rivista]
Rioli, G.; Bonamici, C.; Mancini, S.; Mattei, G.; Alboni, S.; Sena, P.; Roncucci, L.; Fiore, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.
abstract


2022 - Gender differences in Anxious-depressive symptomatology, Metabolic Syndrome and Colorectal Adenomas among outpatients undergoing colonoscopy: a cross-sectional study according to a PNEI perspective [Articolo su rivista]
Rioli, Giulia; Mattei, Giorgio; Bonamici, Caterina; Mancini, Stefano; Alboni, Silvia; Cannazza, Giuseppe; Sena, Paola; Roncucci, Luca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract


2022 - Historical micronutrient psychiatry: descriptive analysis of patients with pellagra admitted to the “San Lazzaro” asylum in Reggio Emilia (Italy) in the decade 1901-1910 [Articolo su rivista]
Pingani, L.; Garagnani, A.; Marchi, M.; Bombardieri, C.; Galeazzi, G. M.
abstract

This study aims at describing the socio-demographic and clinical characteristics of the patients affected by pellagra and admitted to the “San Lazzaro” psychiatric asylum (Reggio Emilia, Italy) from 1901 to 1910 besides exploring possible gender differences for the collected information. Data were collected from the admission register and clinical records of those patients who were admitted to the San Lazzaro Psychiatric Hospital receiving a diagnosis of pellagra at their first admission. The pellagrous patient population was characterised by a higher rate of hospitalisation for women (64.3%) and the number of hospitalised patients suffering from pellagra gradually decreased from 1901 (78; 8.3%) to 1910 (8;0.7%). The most common profession for men admitted with pellagra was farmer/agricultural labourer, while most of the women were housewives. A characteristic shared by both the male and female population of inpatients was very high rate of illiteracy: only one patient was recorded as being able to read and write. The generic diagnosis of “mental illness from pellagra” was predominant (70%), while “dementia from pellagra” accounts for 17.85% of the admission diagnoses: no statistically significant differences between men and women were found in the frequency of diagnosis. Half of the patients, both men and women, died while being inpatients. This study confirms previous findings about the case mix of pellagra patients admitted to psychiatric hospital at the beginning of the last century in northern Italy and highlights the significance of the relationship of psychiatry with other medical disciplines and the sociocultural milieu.


2022 - IL RUOLO DELL’INFIAMMAZIONE SISTEMICA CRONICA E DELLA VIA METABOLICA DELLE CHINURENINE NELLA COMORBIDITÀ TRA ANSIA, DEPRESSIONE E SINDROME METABOLICA: RISULTATI DI UNO STUDIO CROSS-SECTIONAL [Abstract in Atti di Convegno]
Rioli, Giulia; Bonamici, Caterina; Macini, Stefano; Mattei, Giorgio; Alboni, Silvia; Sena, Paola; Roncucci, Luca; Fiore, Gianluca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract


2022 - Il ruolo dell'infiammazione sistemica cronica e della via metabolica delle chinurenine nella comorbidilità tra ansia, depressione e sindrome metabolica: risultati di uno studio cross-sectional [Abstract in Rivista]
Rioli, G.; Bonamici, C.; Macini, S.; Mattei, G.; Alboni, S.; Sena, P.; Roncucci, L.; Fiore, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.
abstract


2022 - Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis [Articolo su rivista]
Musetti, Alessandro; Pingani, Luca; Zagaria, Andrea; Uberti, Daniele; Meli, Salvatore; Lenzo, Vittorio; Gori, Alessio; Franceschini, Christian; Galeazzi, Gian Maria
abstract

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients' ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety.


2022 - L'impatto dello stigma [Capitolo/Saggio]
Pingani, Luca; Coriani, Sandra; Ferrari, Silvia; Maria Nasi, Anna; Galeazzi, Gian Maria
abstract


2022 - Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles [Articolo su rivista]
Varallo, Giorgia; Pingani, Luca; Musetti, Alessandro; Galeazzi, Gian Maria; Pizza, Fabio; Castelnuovo, Gianluca; Plazzi, Giuseppe; Franceschini, Christian
abstract

Study objectives: The media are the primary source of information about health for the public. The media portrayal of narcolepsy might contribute to the stigmatization of people affected by this condition. This study aimed to describe how narcolepsy is portrayed in newspapers. Methods: We collected 257 newspaper articles from the digital archive of "La Stampa" published between 1980 and 2020 that mentioned key search terms. The content was assessed using an ad-hoc coding schema developed to evaluate the presence of sensationalistic title, negative language, stigmatizing content, stereotypical description, disclosure of a person diagnosed with narcolepsy, person with narcolepsy described as dangerous, presence of an accurate diagnosis, identifiable symptoms, indications about diagnostic and treatment services. The Chi-squared analysis was performed to identify changes over time in the type of content. Results: In 10.9% of the articles, there was a sensationalistic title; inappropriate, negative, and outdated language appeared in 10.5% of the articles. Stigmatizing and stereotypical content were reported in 19.5% and 14.8% of the articles, respectively. In 62.3% of the articles, it was disclosed that a person has narcolepsy, and in 5.1% of the articles patients with narcolepsy are described as dangerous. 30.4% of the articles referred to the presence of an accurate diagnosis, while 16.7% described identifiable symptoms. Services for diagnosis and treatment were mentioned in 24.1% of the articles. Changes over time in the content of articles are discussed. Conclusions: Our findings highlight areas for improvement in the media portrayal of narcolepsy and could help guide the development of new targeted antistigma campaigns.


2022 - The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis [Articolo su rivista]
Marchi, Mattia; Magarini, Federica Maria; Galli, Giacomo; Mordenti, Federico; Travascio, Antonio; Uberti, Daniele; De Micheli, Edoardo; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Background: It has been shown that ketamine can improve suicidality and depression. Evidence for other dimensions of psychopathology is lacking. We undertook a systematic review to investigate the effect of ketamine on cognition, anxiety, quality of life, and social functioning in adults with psychiatric disorders. Methods: PubMed (Medline), Scopus, PsycINFO, and EMBASE were searched up to April 2022. Randomized controlled trials (RCTs) on ketamine [or its S (+) enantiomer] reporting data on cognition, anxiety, quality of life, social functioning in adults with psychiatric disorders were included. Standardized mean difference (SMD) was used for summarizing continuous outcomes. Results: Twenty-two reports were included in the final selection, of which 20, corresponding to 1,298 participants, were included in the quantitative synthesis. Affective disorders were the predominant diagnostic category. Median follow-up time was 21 days. The evidence was rated moderate to very low. In most trials, ketamine was administered intravenously or as adjuvant to electro-convulsant therapy (ECT). Only 2 trials of intranasal esketamine were identified. The effect of ketamine on depression was confirmed (SMD: −0.61 [95% CI: −1.06; −0.16]). Furthermore, by pooling results of 6 RCTs, ketamine may be effective in reducing anxiety symptoms (SMD: −0.42 [95% CI: −0.84; 0.003]), particularly when administered not within ECT (5 trials; SMD: −0.58 [95% CI: −1.07; −0.09]). However, there was moderate heterogeneity of results. Patients treated with ketamine also had an improvement in social functioning (SMD: −0.31 [95% CI: −0.52; −0.10]), although the estimate was based only on 2 studies. No difference to comparators was found with respect to cognition and quality of life. Conclusion: Alongside the antidepressant effect, ketamine may also improve anxiety and social functioning in adults with affective disorders.


2021 - A theoretical guide for the integration of the clinical internships for interns and clinical tutors in the mental health professions [Articolo su rivista]
Dall'Aglio, Raffaella; Virga, Mariano; Catellani, Sara; Coriani, Sandra; Nasi, Anna Maria; Galeazzi, Gian Maria; Pingani, Luca
abstract

: The Degree Course in Psychiatric Rehabilitation Techniques from the University of Modena and Reggio Emilia (Italy) was established in 2001, with the aim of training health care workers with the competencies specified by the Ministerial Decree 182. Psychiatric Rehabilitation Technicians are graduated and qualified healthcare professionals who carry out rehabilitation and psychoeducational interventions with persons having mental health problems and related disabilities. The integration between theoretical knowledge and practical experimentation builds up professional competence and allows it to develop and consolidate profession-specific skills and to experiment with pre-socialisation for the job arena. Over the years, the necessity to develop an evaluation form of internship experience has arisen to provide detail in respect to the certification of competencies gained during the clinical internship, considering the complexity of the clinical services and of the service users that interns make contact with. The aim of this paper is to describe the Guide to Clinical Internships for Interns and Clinical Tutors, a useful instrument for interns to optimize their study and clinical internship experience for training as future mental health professionals with specific competencies in the technical and relational field and developing critical ability and autonomy of judgement.


2021 - Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study [Articolo su rivista]
Artoni, P; Chierici, M L; Arnone, F; Cigarini, C; De Bernardis, E; Galeazzi, G M; Minneci, D G; Scita, F; Turrini, G; De Bernardis, M; Pingani, L
abstract

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder.


2021 - Diagnostic agreement between physicians and a consultation-liaison psychiatry team at a general hospital: An exploratory study across 20 years of referrals [Articolo su rivista]
Marchi, M.; Magarini, F. M.; Mattei, G.; Pingani, L.; Moscara, M.; Galeazzi, G. M.; Ferrari, S.
abstract

Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.


2021 - Is Consultation-Liaison Psychiatry ‘Getting Old’? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years [Capitolo/Saggio]
Ferrari, S; Mattei, G; Marchi, M; Galeazzi, Gm; Pingani, L
abstract


2021 - L'associazione tra fumo di tabacco e crisi economiche in Italia [Articolo su rivista]
Mattei, G.; Leone, E.; Venturi, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.; De Vogli, R.
abstract

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.


2021 - Lo stigma associato alla malattia mentale: tipologie, conseguenze e strategie per contrastarlo [Articolo su rivista]
Pingani, Luca; Reali, Giulia; Carozza, Paola
abstract


2021 - Maladaptive Daydreaming in an Adult Italian Population During the COVID-19 Lockdown [Articolo su rivista]
Musetti, A.; Franceschini, C.; Pingani, L.; Freda, M. F.; Saita, E.; Vegni, E.; Zenesini, C.; Quattropani, M. C.; Lenzo, V.; Margherita, G.; Lemmo, D.; Corsano, P.; Borghi, L.; Cattivelli, R.; Plazzi, G.; Castelnuovo, G.; Somer, E.; Schimmenti, A.
abstract

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming (MD, i.e., a compulsive fantasy activity associated with distress and psychological impairment), psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale (MDS-16), and Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Based on an empirically derived cut-off score, 1,082 participants (17.2%) were identified as probable maladaptive daydreamers (MDers). A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress.


2021 - Time Waits for No One: Longitudinal Study on the Effects of an Anti-Stigma Seminar on the Psychology Student Population [Articolo su rivista]
Pingani, Luca; Evans-Lacko, Sara; Coriani, Sandra; Ferrari, Silvia; Filosa, Maria; Galeazzi, Gian Maria; Lorenzini, Mattia; Manari, Tommaso; Musetti, Alessandro; Nasi, Anna Maria; Franceschini, Christian
abstract


2021 - Translation and validation of an Italian language version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS) [Articolo su rivista]
Pingani, Luca; Giberti, Sara; Coriani, Sandra; Ferrari, Silvia; Fierro, Lucia; Mattei, Giorgio; Maria Nasi, Anna; Pinelli, Giorgia; Wesselmann, Eric D.; Galeazzi, Gian Maria
abstract

The aim of this study is to validate the Italian version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS): a self-report measure of religious beliefs that may contribute to stigma regarding mental disorders. Scale validation included: linguistic validation; pilot test for understandability; face validity; factor analysis as test of dimensionality; Kaiser–Meyer–Olkin test to evaluate sample sampling adequacy; internal consistency was assessed using Cronbach’s alpha; scale validity was assessed through concurrent criterion validity using as gold standard the Italian version of Attribution Questionnaire 27 and mental health knowledge schedule; A total of 311 people agreed to participate in the study. Face validity showed that 13 items out of 16 were completely understandable while only three items (4, 9 and 13) highlighted small lexical concerns. The average compilation time was under 4 min. Bartlett’s test for sphericity was statistically significant (Χ2 = 1497.54; df = 120; p < 0.001). Cronbach's alpha values were acceptable both for the entire questionnaire (0.80) and for the morality/sin subscale (0.73), whereas it was slightly below the standard cutoff for the spiritually oriented causes/treatments (0.68). Scale validity showed a positive correlation between I-RBMIS and AQ-27-I, and a negative correlation between I-RBMIS and MAKS-I. I-RBMIS demonstrated good psychometric properties to assess stigmatizing religious beliefs toward mental illness in general population.


2021 - What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews [Articolo su rivista]
Bala, M. M.; Pericic, T. P.; Zajac, J.; Rohwer, A.; Klugarova, J.; Valimaki, M.; Lantta, T.; Pingani, L.; Klugar, M.; Clarke, M.; Young, T.
abstract

Background Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour. Methods and findings This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up. Conclusions Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments. Study registration The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262. Update of the overview Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.


2020 - Affective and sexual needs of residents in psychiatric facilities: A qualitative approach [Articolo su rivista]
Landi, G.; Marchi, M.; Ettalibi, M. Y.; Mattei, G.; Pingani, L.; Sacchi, V.; Galeazzi, G. M.
abstract

Background: The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. Methods: Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). Results: Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them. Conclusions: RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.


2020 - Anxiety, depression and personality traits in Italian medical students [Articolo su rivista]
Bertani, Davide E.; Mattei, Giorgio; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian Maria
abstract

Background. Anxiety and depressive symptoms are common worldwide and, according to the World Health Organization, their prevalence has increased in the last decades. Further, dysfunctional personality traits are frequently coupled with anxiety and depressive symptoms. The prevalence of these symptoms is particularly relevant in medical students. Methods. This study assessed the prevalence of anxiety and depressive symptoms in Italian medical students from the University of Modena and Reggio Emilia, by using the Hospital Anxiety and Depression Scale (HADS). Personality traits were assessed as well by employing the Personality Inventory for DSM-5, Brief Form (PID-5-BF), to explore their association with anxiety and depressive symptoms. A self-administered questionnaire was sent by e-mail to all the 944 students and 459 (48.6%) were enrolled. Besides the HADS and the PID-5-BF, the questionnaire included items concerning everyday life activities such as sports and academic features such as the years of attendance and average marks. Results. A high prevalence of anxiety (n=92; 20%), depression (n=32; 7%), and comorbid anxiety-depressive symptoms (n=218; 47%) was reported. Multiple binary logistic analysis showed increased levels of anxiety and depression to be associated with personality traits, namely detachment and negative affect, and use of cognitive enhancers. On the other hand, sports activities, social activities and distraction were related to lower levels of symptoms. Conclusions. Symptoms of depression and anxiety are common among Italian medical students and specific interventions should be implemented to target them.


2020 - Can stigmatizing attitudes be prevented in psychology students? [Articolo su rivista]
Pingani, L.; Coriani, S.; Galeazzi, G. M.; Nasi, A. M.; Franceschini, C.
abstract

Background: Stigmatizing attitudes have been found among psychology students in many studies, and they are becoming more common with time. Aims: This study examines whether participation in clinical psychology lessons reduces levels of stigmatization in a population of psychology students and whether it leads to any change in stigmatization. Methods: The study is a pre/post evaluation of the effectiveness of clinical psychology lessons (63 hours of lectures) as a tool to fight stigma. The presence of stigmatizing attitudes was detected using the Italian version of the Attribution Questionnaire-27 (AQ-27-I). Stigmatization was described before and after the lessons with structured equation modeling (SEM). Results: Of a total of 387 students contacted, 302 (78.04%) agreed to be involved in the study, but only 266 (68.73%) completed the questionnaires at both t0 and t1. A statistically significant reduction was seen in all six scales and the total score on the AQ-27-I. The models defined by the SEM (pre- and post-intervention) showed excellent model fit indices and described different dynamics of the phenomenon of stigma. Conclusions: A cycle of clinical psychology lessons can be a useful tool for reducing stigmatizing attitudes in a population of students seeking a psychology degree.


2020 - Computer incursion in psychiatry via e-mental health: innovation and implications to keep in mind [Articolo su rivista]
Hardy, Sally; van Hessen, Fabian; Pingani, Luca
abstract


2020 - Is consultation-liaison psychiatry ‘getting old’? How psychiatry referrals in the general hospital have changed over 20 years [Articolo su rivista]
Ferrari, S.; Mattei, G.; Marchi, M.; Galeazzi, G. M.; Pingani, L.
abstract

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.


2020 - Stigma on Mental Health among High School Students: Validation of the Italian Version of the Attribution Questionnaire-27 (AQ-27-I) in a High School Student Population [Articolo su rivista]
Ferrari, Silvia; Bressi, Cinzia; Busnelli, Elisa; Mattei, Giorgio; Pozzoli, Sara; Oliva, Anna; Galeazzi, Gian Maria; Pingani, Luca
abstract


2020 - Validation of the Modena bleeding score in endoscopic sinus surgery [Articolo su rivista]
Alicandri-Ciufelli, M.; Pingani, L.; Maccarrone, F.; Anschuetz, L.; Mariano, D.; Galeazzi, G. M.; Presutti, L.; Molinari, G.
abstract

Introduction: The Modena bleeding score is a categorical rating scale that allows the assessment of the surgical field in relation to bleeding during endoscopic surgery. It has recently been presented and validated in the field of endoscopic ear surgery by the present authors. The Modena bleeding score provides five grades for rating the surgical field during endoscopic procedures (from grade 1 − no bleeding to grade 5 − bleeding that prevents every surgical procedure except those dedicated to bleeding control). Objective: The aim of this study was to validate the Modena bleeding score in the setting of endoscopic sinus surgery. Methods: Fifteen three-minute videos of endoscopic sinus surgery procedures (each containing three bleeding situations) were evaluated by 15 specialists, using the Modena bleeding score. Intra and inter-rater reliability were assessed, and the clinical validity of the Modena bleeding score was calculated using a referent standard. Results: The data analysis showed an intra-rater reliability ranging from 0.6336 to 0.861. The inter-rater reliability ranged from 0.676 to 0.844. The clinical validity was α = 0.70; confidence limits: 0.64 − 0.75, corresponding to substantial agreement. Conclusion: The Modena bleeding score is an effective method to score bleeding during endoscopic sinus surgery. Its application in future research could facilitate the performance and efficacy assessment of surgical techniques, materials or devices aimed to bleeding control during endoscopic sinus surgery.


2019 - Affective and sexual needs of residents in psychiatric facilities [Articolo su rivista]
Ettalibi, Mohamed Y.; Marchi, Mattia; Magarini, FEDERICA MARIA; Landi, Giulia; Mattei, Giorgio; Pingani, Luca; Galeazzi, Gian M.
abstract

INTRODUCTION: The expression of affectivity and sexuality are fundamental human rights. However, people diagnosed with severe mental disorders (SMDs) living in psychiatric facilities may find it difficult to fulfil their needs, which may be neglected and misunderstood by mental health professionals (MHPs). This paper summarizes current knowledge on this topic using a narrative review. EVIDENCE ACQUISITION: PubMed, PsycINFO, Web of Science and Scopus were searched for studies of the affectivity and sexual needs of service users with SMDs living in residential and other long-term-stay facilities. Of the 451 articles initially retrieved, 26 met the inclusion criteria of this review. EVIDENCE SYNTHESIS: The findings were reported under six main headings: sexual, affective and relational needs of mental health service users, views of MHPs on users’ sexuality, policies on the regulation and responses to users’ sexual and affective needs, sexual education and training aimed at both mental health service users and professionals, HIV/sexually transmitted diseases (STD) risk assessment and prevention programs, and contraception. CONCLUSIONS: Sexual relations are generally prohibited or discouraged within residential facilities, but it has nevertheless been found that many residents are sexually active. The denial of their sexual needs by residential staff and the absence of any dedicated setting for sexual relations within facilities are sources of substantial distress for residents. Studies have also found a lack of knowledge of STDs among users and discomfort of MHPs in dealing with the topic. Hence, educational and training interventions for both users and MHPs should be implemented. Specific policies and guidelines could be coproduced to enhance patients’ emotional and relational capabilities and encourage them to adopt healthier and safer sexual practices.


2019 - How to Measure Knowledge About Mental Disorders? Validation of the Italian Version of the MAKS [Articolo su rivista]
Pingani, Luca; Gaia, Sampogna; Sara, Evans-Lacko; Benedetta, Gozzi; Vincenzo, Giallonardo; Mario, Luciano; Galeazzi, Gian Maria; Andrea, Fiorillo
abstract

The aim of this study is to validate the Italian version of the Mental Health Knowledge Schedule (MAKS-I). The validation process included: linguistic validation; analysis of the feasibility; face validity; internal consistency; floor and the ceiling effects; divergent validity. Multiple linear regression was performed to examine the relationship between mental health knowledge and independent variables. MAKS-I was administered to 453 people. The linguistic validation was successful and face validity of the questionnaire showed no critical issues. The estimated composite reliability was 0.638. Divergent validity was supported by lack of statistical significant correlation between MAKS-I and RIBS-I with a positive correlation index. Participation in seminars or conferences related to the issue of mental health stigma, gender, qualification and having a first or second-degree relatives with a psychiatric disorder can be considered possible predictors of the MAKS-I score. MAKS-I is a reliable questionnaire to assess mental health knowledge and familiarity with psychiatric clinical conditions in Italian language.


2019 - Rating surgical field quality in endoscopic ear surgery: proposal and validation of the "Modena Bleeding Score" [Articolo su rivista]
Alicandri-Ciufelli, M; Pingani, L; Mariano, D; Anschuetz, L; Molinari, G; Marchioni, D; Bonali, M; Galeazzi, Gm; Presutti, L.
abstract

PURPOSE: To develop and validate a bleeding score that could be applied in endoscopic ear surgery (EEarS). METHODS: A prospective validation study was performed. A new bleeding score, called "Modena Bleeding Score" (MBS), was created by the authors. It provides five grades for rating the surgical field during EEarS procedures (from grade 1-no bleeding to grade 5-bleeding that prevents every surgical procedure except those dedicated to bleeding control). A preliminary "face validity" was performed by 18 ENT specialists to assess possible misunderstandings in interpreting the scale. Then, 15 videos of endoscopic ear surgery procedures, each divided into three parts (t0, t1, and t2), were subsequently evaluated by 15 specialists, using MBS. The videos were randomly selected and assigned. Intra-rater reliability and inter-rater reliability were calculated. The clinical validity of the instrument was calculated using a referent standard (i.e., four ENT experts whose ratings were compared to those obtained by the former sample). RESULTS: The face validity showed a good consensus about the clarity and comprehension of the scale; both intra and inter-rater reliability demonstrated good performance (intra-rater reliability ranged from 0.741 to 0.991 and inter-rater reliability was 0.790); clinical validity also showed positive values, ranging from 0.75 to 0.93. CONCLUSIONS: MBS has proved to be an effective method to rate surgical field during EEarS, with good-to-excellent performances. Its use would possibly help comparisons of groups in clinical trials or comparisons between studies.


2018 - Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence [Articolo su rivista]
Spattini, Ludovica; Mattei, Giorgio; Raisi, Francesca; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian M.
abstract

INTRODUCTION: Animal assisted therapy (AAT) is a structured form of animal assisted intervention (AAI), which specifically adopts animals in healthcare services and education facilities, to achieve therapeutic goals. Although such interventions are widely used, nowadays, evidence supporting them is still largely lacking. A previously published review of the literature highlighted some promising effects of AAT on people presenting psychiatric disorders, though the quality of the studies included was generally low. In order to provide an update of recent evidence, the aim of this study was to systematically review randomized controlled trials (RCTs) published since 2000, involving people affected by mental disorders and receiving AAT. EVIDENCE ACQUISITION: The following databases were searched: CINHAL, EBSCO Psychology and Behavioural Science Collection, PubMed and Web of Science. 115 papers were obtained and screened: 28 were from CINHAL, PsycINFO and Psychology and Behavioural Science Collection altogether, 15 from PubMed and 72 from Web of Science. In addition to this, grey literature and references of already published reviews and meta-analyses on the topic were searched, resulting in the addition of 6 further articles. After screening, 10 RCTs were included in this review. EVIDENCE SYNTHESIS: Studies involving outpatients were more frequent than those involving inpatients; sample size was generally low. The majority of studies adopted scales routinely used in clinical trials, with a good level of validity and reliability. Five out of ten studies reported significant differences in the main outcomes favouring AAT. Most of the studies did not include any follow-up; yet, where prospective data were available, the benefits of AAT appeared long lasting. Drop-out rates were higher in studies involving outpatients. However, the only trial which enrolled both inpatients and outpatients showed a higher drop-out rate among the inpatients group, possibly due to their more severe psychopathology. CONCLUSIONS: Though a paucity of available studies partly limits our findings, AAT seems to improve empathy, socialization and communication, and to favour therapeutic alliance among patients who have difficulties with therapeutic programs adherence. AAT appears to be a feasible and well-received intervention, potentially with few or no side effects reported. However there is a need for further studies with larger sample sizes and high-quality research standards.


2018 - How the use of the term “schizo*” has changed in an Italian newspaper from 2001 to 2015: Findings from a descriptive analysis [Articolo su rivista]
Pingani, Luca; Sampogna, Gaia; Borghi, Giulia; Nasi, Annamaria; Coriani, Sandra; Luciano, Mario; Galeazzi, Gian Maria; Evans-Lacko, Sara; Fiorillo, Andrea
abstract

The study aims to report the number of newspaper articles including the word “schizo” in the period 2001 – 2015 and to identify possible predictors reinforcing negative stereotypes about people with schizophrenia. The electronic archives of the Italian newspaper “La Stampa” have been searched for the term “schizo”. Selected articles were grouped in articles related to mental health (rMH) or article not related to mental health (nrMH). 946 articles were identified. Schizophrenia-related terms were used in 356 (36.03%) article rMH, which mainly reinforce negative stereotypes regarding mental illness both in rMH and nrMH groups. Over time, only in the rMH group a significant reduction of articles reinforcing negative stereotypes was found. Several factors have been identified as predictors of article reinforcing negative stereotypes: unnecessarily dramatic or sensational headline or content; inaccurate or not in the correct context use of medical terminology; emphasis to the illness rather than to the person; mental disorders are the same; disclosure of particular individual has a mental illness. Although there has been a significant reduction in stigmatizing articles, in the rMH group one article out of three reinforces negative stereotypes.


2018 - Linee guida per la diagnosi, il trattamento e il supporto dei pazienti affetti da demenza [Articolo su rivista]
Cartabellotta, A; Eleopra, R; Quintana, S; Pingani, L; Ferrarese, C; Starace, F; Masina, M; Mancardi, G
abstract

Il termine demenza descrive una serie di sintomi cognitivi, comportamentali e psicologici che possono includere perdita di memoria, difficoltà di ragionamento e di comunicazione e cambiamenti della personalità che compromettono la capacità di svolgere le attività quotidiane. Nel 2013 un rapporto della Alzheimer’s Society ha rilevato che nel Regno Unito erano circa 815.000 le persone affette da demenza (prevalenza 1/14 abitanti di età >65 anni), un numero destinato ad aumentare sino a 1.143.000 entro il 2025. Nel novembre 2017 erano 456.739 i pazienti con una diagnosi certa di demenza nei registri di medicina generale, rispetto ai 290.000 del periodo 2009-2010, la differenza in gran parte imputabile ad un aumento del numero di diagnosi. Nonostante questo miglioramento nella diagnosi della demenza, si stima che circa 1 caso su 3 non venga riconosciuto correttamente; inoltre, circa la metà delle persone affette da demenza non riceve un adeguato supporto dopo la diagnosi. Questo articolo riassume le raccomandazioni più recenti del National Institute for Health and Care Excellence (NICE) per la valutazione, la gestione e il supporto delle persone affette da demenza e dei loro caregiver. La linea guida (LG) aggiorna e sostituisce integralmente la LG NICE sulla demenza del 2006. Raccomandazioni, dettagli completi delle evidenze e il PDTA sono disponibili sul sito del NICE. Le raccomandazioni del NICE sono basate su revisioni sistematiche delle migliori evidenze disponibili e su una esplicita considerazione della costo-efficacia. Quando le evidenze disponibili sono limitate, le raccomandazioni sono basate sull’esperienza del gruppo che ha prodotto la linea guida – Guideline Development Group’s (GDG) – e sulle norme di buona pratica clinica. I livelli di evidenza delle raccomandazioni cliniche sono indicati in corsivo tra parentesi quadre.


2018 - Metabolic Syndrome, Anxiety and Depression in a Sample of Italian Primary Care Patients [Articolo su rivista]
Mattei, Giorgio; Padula, Maria Stella; Rioli, Giulia; Arginelli, Lodovico; Bursi, Roberto; Bursi, Serena; Epifani, Antonio Matteo; Pingani, Luca; Rigatelli, Marco; Rosato, Francesca Maria; Sacchetti, Andrea; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

This cross-sectional study aimed at measuring the correlation and association of anxiety, depression and comorbid anxiety-depression symptoms with metabolic syndrome (MetS) in a sample of Italian primary care patients who attended their General Practitioner clinics over a 1-month period in 2013. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms. The sample was made up of 129 patients (57% women; mean age, 61 ± 12 years). The prevalence of MetS varied from 40% (Adult Treatment Panel III-Revised criteria) to 48% (International Diabetes Federation criteria). The prevalence of symptoms of anxiety, depression and comorbid anxiety and depression was, respectively, 26%, 2%, and 15%. MetS (defined according to Adult Treatment Panel III-Revised criteria) was associated with comorbid anxiety-depressive symptoms (odds ratio [OR] = 3.84, 95% confidence interval [CI] = 1.26–11.71), but not with anxiety or depressive symptoms only. Out of the individual components of MetS, enlarged waist circumference was associated with anxiety symptoms (OR = 4.22, 95% CI = 1.56–11.44).


2018 - Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians [Articolo su rivista]
Mattei, Giorgio; Sacchi, Valentina; Alfieri, Salvatore; Bisi, Antonella; Colombini, Niccolò; Ferrari, Silvia; Giubbarelli, Giuseppe; Gobba, Fabriziomaria; Modenese, Alberto; Pingani, Luca; Rigatelli, Marco; Rossetti, Marisa; Venturi, Giulia; Starace, Fabrizio; Galeazzi, Gian Maria
abstract

The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services.


2018 - Use and Propensity to Use Substances as Cognitive Enhancers in Italian Medical Students [Articolo su rivista]
Pighi, Marcella; Pontoni, Giancarlo; Sinisi, Arianna; Ferrari, Silvia; Mattei, Giorgio; Pingani, Luca; Simoni, Elena; Galeazzi, Gian Maria
abstract

International media has paid attention to the use of substances by healthy subjects to enhance cognitive performance. Medical students are liable to use cognitive enhancers (CE) with the aim of improving academic performance. The study explored use and attitudes toward the use of CE in Italian medical students. The authors anonymously surveyed 433 medical students of the University of Modena and Reggio Emilia with an ad hoc 36-items questionnaire. CE were broadly defined as any substance taken with the purpose of improving cognitive functions, from readily available beverages and substances, such as coffee, tea, energy drinks, and supplements to prescription only medication, such as psychostimulants and modafinil. Response rate was 83.8% (n = 363). While the majority of the students (74.7%; n = 271) said that they had used substances to improvecognitivefunctions,only2students(0.6%)reportedtheuseofprescription-onlymedications in the last 30 days. Main reasons for not taking prescription-only drugs were concerns about safety and side effects, reported by 83.3% of students (n = 295). A positive attitude toward use was held by 60.3% (n = 219) subjects. The surveyed Italian medical students used many substances as CE, but this did not seem to apply significantly to psychostimulants. A multivariable analysis showed that the followingvariableswererelatedtothepropensitytousesubstancesasCE:malegender,self-reported memory impairment, concerns about worsening of cognitive performance, lifetime use of at least one illegal substance, use of any substance (both legal or illegal) in the last 30 days.


2017 - Effectiveness and acceptability of psycho-education group intervention for people hospitalized in psychiatric wards and nurses [Articolo su rivista]
Mattei, G.; Raisi, F.; Burattini, M.; Galeazzi, G. M.; Mazzi, F.; Pingani, L.; Reggianini, C.; Rigatelli, M.; Righi, A.; Starace, F.; Vallone, P.; Ferrari, S.
abstract

Objective: To assess effectiveness and acceptability of a Psycho-education Group Intervention (PGI) on a sample of patients admitted to a Psychiatric Inpatient Unit (PIU) and on ward nurses. Methods: Case-control study. PGI was delivered according to the model of Vendittelli and colleagues (2008). Male and female patients aged 18-70 were eligible. Cases attended the PGI, while controls did not. A 5-item ad hoc Likert-scale was used to record ward atmosphere. The Italian version of the Simple Feedback Question Form for people attending Cognitive Behaviour Therapy Group (SFQF-CBTG) was administered to each patient before discharge. The primary outcome was readmission rate after 6 months from discharge, secondary outcomes were ratings of ward atmosphere by nurses and feed-back from people hospitalized. All Statistics were performed with STATA 13.1. Results: Fifty-two patients were enrolled, 17 cases and 35 controls. No significant differences emerged in the primary outcome, though compulsory readmissions were noticeable only among controls. Ratings of ward atmosphere in relation to group activities did not differ. Seventeen SFQF-CBTG were filled in. Most cases reported at discharge to have found the group "helpful", stating that "they would attend it in the future again", and "group topics were not difficult". Conclusions: No evidence emerged in favour or against effectiveness of the PGI for patients and ward nurses, though the intervention was rated as acceptable and feasible.


2017 - Impact of the economic crisis on health-related behaviors in Italy [Articolo su rivista]
Mattei, Giorgio; DE VOGLI, Roberto; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.


2017 - Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis [Articolo su rivista]
Silva Ribeiro, Wagner; Bauer, Annette; César Rezende Andrade, Mário; York-Smith, Marianna; Mario Pan, Pedro; Pingani, Luca; Knapp, Martin; Silva Freire Coutinho, Evandro; Evans-Lacko, Sara
abstract

Background Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity). Methods We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377. Findings Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen’s d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01–0·11) for any mental disorder, and 0·12 (0·05–0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I2 89·3%; p<0·0001). Only one study investigated the association between income inequality and resilience; it found greater income inequality was associated with higher prevalence of depression only among individuals with low income. The only study of the role of income inequality as a determinant of the use of mental health services reported no association. Interpretation Income inequality negatively affects mental health but the effect sizes are small and there is marked heterogeneity among studies. If this association is causal and growing income inequality does lead to an increase in the prevalence of mental health problems, then its reduction could result in a significant improvement in population wellbeing.


2017 - Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital, Modena [Articolo su rivista]
Mattei, Giorgio; Laghi, Alessandro; Balduzzi, Sara; Moscara, Maria; Piemonte, Chiara; Reggianini, Corinna; Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian Maria
abstract

OBJECTIVE: The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation. METHODS: This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as "undergoing two or more psychiatric consultations". Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions. RESULTS: In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43-4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09-3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14-4.07), and female gender (OR = 1.77; 95% CI, 1.01-3.11) were significantly associated with an increased probability of being cases. CONCLUSIONS: Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation.


2017 - Never too late to be anxious: validation of the Geriatric Anxiety Inventory, Italian version [Articolo su rivista]
Ferrari, Silvia; Signorelli, M. S; Cerrato, F; Pingani, Luca; Massimino, M; Valente, S; Forlani, M; Bonasegla, P; Arcidiacono, E; De Ronchi, D; Rigatelli, Marco; Aguglia, E; Atti, A. R.
abstract

Aim – The aim of this work was to validate the Italian version of GAI (GAI-It) and its short form (GAI-It SF) in an over 65-population. Methods – In 3 recruitment areas across Italy, two raters reciprocally blind to results assessed eligible subjects; a semi-structured diagnostic clinical interview was performed by a psychiatrist. Results – Among the 76 enrolled subjects (mean age 72.7±6.8 years), anxiety symptoms were very common: 69.7% (moderate/severe HADS-Anxiety), 76.3% (moderate/severe STAI-state), 71.0% (moderate/severe STAI-trait), 61.8% (GAI), 55.3% (GAI-SF). Sensitivity, specificity and positive predictive value of GAI confirmed a good reliability of the Italian version, with Cronbach’s Alpha equal to 0.93 for GAI-It and to 0.77 for GAI-It SF, indicating a very good and good construct validity, respectively, of the scales. The Pearson correlation index demonstrated a moderately positive correlation among GAI, GAI-SF and STAI. Conclusions – Our data confirm the validity of GAI-It as a valuable instrument to assess anxiety in an elderly population, for clinical and research purposes.


2016 - Aspettative e opinioni di un campione di pazienti psichiatrici ricoverati rispetto a un'esperienza di musicoterapia recettiva. [Articolo su rivista]
Palmieri, Gaspare; Ferrazzi, Giulia; Pingani, Luca
abstract


2016 - Il Tecnico della Riabilitazione Psichiatrica e le sfide della Psicogeriatria [Articolo su rivista]
Pingani, Luca; Catellani, Sara; Crescenti, Paola; Vagnozzi, Stefania; Parigi, Debora; Cavalli, Enrico
abstract


2016 - Perceived insecurity, mental health and urbanization: Results from a multicentric study [Articolo su rivista]
Luciano, M; De Rosa, C.; Del Vecchio, V.; Sampogna, G.; Sbordone, D.; Atti, A. R.; Bardicchia, F.; Bertossi, F.; Calò, S.; Cava, L.; Ciafone, M.; De Fazio, P.; Di Iorio, G.; Fantini, E.; Ferrari, Silvia; Ginanneschi, A.; Gotelli, S.; Macina, A.; Mulè, A.; Papanti, D.; Pingani, Luca; Pinna, F.; Piselli, M.; Signorelli, M. S.; Tarricone, I.; Tarsitani, L.; Ventriglio, A.; Carrà, G.; Catapano, F.; Fiorillo, A.
abstract

Aims: This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in 'big cities' can influence the levels of patients' perceived insecurity and social contacts compared to living in a non-urbanized context. Methods: A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools. Results: The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found. Conclusion: Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients' psychological and physical well-being, contributing to high levels of distress.


2016 - Psychometric validation of the Italian version of the Reported and Intended Behaviour Scale (RIBS) [Articolo su rivista]
Pingani, Luca; Evans Lacko, S; Luciano, M; Del Vecchio, V; Ferrari, Silvia; Sampogna, G; Croci, I; Del Fatto, T; Rigatelli, Marco; Fiorillo, A.
abstract

Many instruments have been developed and validated to assess the stigma associated with mental disorders and its various domains across different populations. To our knowledge, the Reported and Intended Behaviour Scale (RIBS) is the only validated questionnaire to analyse the presence of reported and intended stigmatising/discriminatory behaviours towards people with mental health problems in the general population. The aims of the study presented herein are to translate and validate the RIBS in Italian language and to adapt it to the Italian socio-cultural background (RIBS-I).


2016 - Stigma in the context of schools: Analysis of the phenomenon of stigma in a population of university students [Articolo su rivista]
Pingani, L; Catellani, S; Del Vecchio, V; Sampogna, G; Ellefson, S. E; Rigatelli, Marco; Fiorillo, A; Evans Lacko, S; Corrigan, P. W.
abstract

Background: Students have stereotyped views about people with mental illness. In particular, they believe that these persons are incurable, dangerous, unpredictable and responsible for their condition. This study aims to investigate the levels of public stigma in an Italian university population. Methods: The Attribution Questionnaire 27 - Italian Version (AQ-27-I) was administered to a sample of students from the Faculty of Medicine and Surgery of the University of Modena and Reggio Emilia. After examining the psychometric characteristics of the AQ-27-I (Cronbach’s Alpha and Confirmatory Factor Analysis), multiple linear regression analyses were carried out to identify the predictors of stigmatizing attitudes in this population. Results: Three hundred and eleven students completed the questionnaire, with a response rate of 32.81 % (out of the 948 contacted by email). The AQ-27-I showed good psychometric properties with an α = .68, and the fit indices of the models that partially supported the factor structure and paths. The two variables identified as possible predictors of stigmatizing attitudes (total score of AQ-27-I) were age and time spent reading newspapers. Conclusions: Antistigma campaigns are needed in university contexts, targeted in particular to students in health professions.


2015 - Apple or pear? A cross sectional study on the association between body shape and symptoms of anxiety and depression in primary care female patients [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Ferrari, Silvia; Bursi, S; Rigatelli, Marco; Pingani, Luca; Galeazzi, Gian Maria
abstract

INTRODUCTION - "Apple" body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders, especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far. AIM - To explore the association between WHR and symptoms of anxiety and depression in a female primary care sample. METHODS - Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy Practice. Exclusion criteria: age <40 or >80; use of antidepressants or antipsychotics; previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA. RESULTS - 125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score (β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were found in older groups. CONCLUSION - 'Pear” body shape (WHR<1), with a peripheral distribution of fat, is inversely associated to symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple” model, with a central fat distribution, could explain the lack of correlations in women >60 years.


2015 - Association between anxiety and depressive symptoms with metabolic syndrome in primary care: Results of an Italian cross-sectional study involving outpatients [Abstract in Rivista]
Mattei, G; Rioli, G; Ferrari, Silvia; Galeazzi, Gian Maria; Bursi, S; Padula, Sm; Pingani, Luca; Rigatelli, Marco
abstract

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominal adiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation.


2015 - Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study [Abstract in Rivista]
Mattei, Giorgio; Rioli, G; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation.


2015 - Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Galeazzi, Gian Maria; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco
abstract

Background: Recent researches exploring the relationship between impaired glucidic tolerance, hyperglycemia or frank type II diabetes mellitus and symptoms of anxiety and depression, mostly conducted on in-patients or highly selected samples and on foreign populations, have reported conflicting results. Nevertheless, these medical and mental conditions are often comorbid in clinical practice. Chronic and systemic inflammation could represent the trait d\'union between these conditions. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. The aims of this research was to measure the association between hyperglycemia and symptoms of anxiety and/or depression in out-patients, and to fill the lack of studies on comorbidity between depression and anxiety disorders and medical conditions in Primary Care services. Method: The present was a cross-sectional study. We evaluated all consecutive patients undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis (schizophrenia, schizoaffective, bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major depression; pregnancy; previous stroke or heart attack; type I diabetes mellitus. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Blood Glucose measurements (BM) in the last 6 months were considered in our analysis. Hyperglycemia cutoff: blood glucose N100 mg/dl. The statistical analysis was performed using STATA with multiple linear regressions. Results: 209 subjects were recruited in our study (84 men and 125 women). Of those, 48 (22.9%) were affected by hyperglycemia: 22 were men and 26 women. Hyperglycemia was related to HADS-D score in the men sample (β = .44, p = .01). No association was found between hyperglycemia and HADS-A, either in men or in women. Conclusion: The presence of hyperglycemia, well-known cardiovascular risk factor, may have a clinical value in predicting the presence of depressive symptoms, especially in men. Further studies should examine whether our results are generalizable to other populations and whether they are applicable to clinical depression. Molecular researches could focus on clarifying the pathophysiological reasons for such association, also exploring reasons for sex differences.


2015 - Is low blood pressure always healthy? Evidence of an inverse association between depressive symptoms and arterial blood pressure in a primary care sample [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Galeazzi, Gian Maria; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco
abstract

Background: Common mental health problems, such as anxiety and depression, have been related to the imbalance of the autonomous nervous system, also involved in blood pressure regulation. Low blood pressure readings have mainly been regarded as positive, but recent studies suggest low blood pressure is correlated with depression. The aim of the present research was to investigate the relationship between symptoms of anxiety and depression and blood pressure measures in a primary care sample. Method: We conducted a cross-sectional study that received the approval of the local Ethical Committee. All consecutive patients undergoing a GP consultation in a Northern Italy practice were evaluated, with the following exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis or major depression; previous stroke or heart attack; type I diabetes mellitus; obesity related to hereditary conditions; pregnancy. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Arterial blood pressure was measured twice using a stethoscope and a sphygmomanometer at the right upper arm after 5 min of seated rest; the mean measure was considered. High Blood Pressure (BP) cut-offs: systolic BP ≥130 mm Hg and/or diastolic BP ≥ 85 mm Hg, according to IDF 2005 guidelines. The statistical multiple linear regression analysis was performed using STATA. Results: 209 subjects were enrolled in the study (125 women and 89 men). 122 subjects (58.1% of the whole sample) suffered from high blood pressure, and 98 of them (46.7%) followed an antihypertensive pharmacological therapy. A statistically significant inverse correlation between high diastolic BP and symptoms of depression at the HADS-D scale (β= −.28, p= .01) was found in the whole sample. The association was maintained in the male subsample, also after stratification by age, especially in the 40–60 years' group of patients (β=−.53, p =.04). On the contrary, no significant association was found between anxiety and BP measures. Conclusion: This study confirms an inverse association between high diastolic BP and depression at epidemiological level in an outpatients sample; longitudinal studies are needed in order to examine temporal occurrence and to explore the pathophysiology and the molecular mechanism at the basis of this association. Further researches should also investigate whether our results are generalizable to other populations.


2015 - Neuroenhancer use amongst Italian medical students: a survey [Abstract in Rivista]
Pighi, Marcella; Ferrari, Silvia; Pingani, Luca; Pontoni, G; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Introduction. Increasing use of substances by university students to improve cognitive performance ('neuroenhacement') has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco, but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy. Aims. To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose. Methods An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363). Results 271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3% ) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036). Conclusions Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research.


2015 - Occupational health physicians and the impact of the Great Recession on the health of workers: a qualitative study [Articolo su rivista]
Mattei, Giorgio; Ferrari, Silvia; Giubbarelli, C; Pingani, Luca; Uracci, Gm; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Background: Italy is one of the Eurozone members where the 2008 “Great Recession” struck worst, with a 9% drop in national GDP between 2008 and 2013. The negative effects of the recession on the health of the Italian population were documented on a nation-wide level. However, few local or regional studies are currently available in the scientific literature. Objectives: To assess the impact on workers’ health of the economic recession in the industrial area of Sassuolo (Modena, Northern Italy), and to provide recommendations for targeted interventions. Methods: Two focus groups were conducted, involving 8 occupational health physicians (OHPs) active in the area. Rough descriptions were analyzed using MAXQDA 11, according to the principles of grounded theory. Results: 261 segments were coded, divided into four areas. The first, “changes in contemporary world”, pointed out that the recession may have just made pre-existing problems worse, accelerating reductions in staff and workers’ benefits. The second, “social area”, highlighted a decrease in vertical social capital and the beginning of new trends in emigration. The third, “work area”, covered workers’ fear of losing their jobs if they were ill and a reduction in horizontal social capital, namely difficult relations between co-workers. The fourth, “medical area”, indicated a general worsening of workers’ health in the Sassuolo ceramic district compared to previous years. The OHPs reported an increase in muscular- skeletal complaints, gastritis, tension-type headache, irritable bowel syndrome symptoms, back pain, panic attacks, insomnia, tachycardia, and other medically unexplained symptoms. Anxiety problems seemed to prevail over depressive manifestations. An increase was reported for antidepressants and benzodiazepines consumption. Conclusions: The local impact of the economic crisis on health was mainly negative, consistent with available national data. Mental health professionals could work together with OHPs, e.g., through Balint Group-like meetings, to develop targeted psychosocial and clinical interventions addressing the medical, psychological and social needs of workers, also involving advocacy and fostering workers’ empowerment.


2015 - Ripensare la pratica psichiatrica: riflessioni sul ruolo della psichiatria nella società moderna [Shall psychiatry change its target? Reflections on the evolving role of psychiatry] [Articolo su rivista]
Pinna, F; Del Vecchio, V; Luciano, M; Sampogna, G; De Rosa, C; Ferrari, Silvia; Pingani, Luca; Tarricone, I; Volpe, U; Carrà, G; Roncone, R; Catapano, F; Fiorillo, A.
abstract

In this paper we will describe cultural, social and scientific changes occurred in psychiatry in the last years, identifying the new target for mental health professionals. Groups of young psychiatrists from the Italian Psychiatric Association, the European Psychiatric Association and the World Psychiatric Association have established an international network that launched a debate on the future role of psychiatry. In a rapidly changing world, there is the need to: 1) adapt training in psychiatry to the modern world; 2) identify the new target of mental health professionals; 3) enhance the image of psychiatry in the society; 4) overcome stigma towards people with mental disorders. In recent years, socio-cultural and scientific changes have had a significant impact on the psychiatrists' clinical practice. Mental health professionals should deal with these changes appropriately in order to overcome the current "crisis" of psychiatry, which should be considered as a developmental phase rather than a conceptual one. From time to time psychiatry is criticized both from inside and outside the profession. The current crisis was unavoidable due to the recent socio-cultural changes, but it should be considered an opportunity to adapt the profession to modern times.


2015 - University students' identification of stigmatizing schizophrenia in Italian newspapers [Articolo su rivista]
Pingani, L; Evans Lacko, S; Del Vecchio, V; Luciano, M; Catellani, S; Hamati, A; Rigatelli, Marco; Fiorillo, A.
abstract

Stigma associated with mental disorders represents one main obstacle to receive appropriate care for people with mental disorders. Compared to adults, university students have higher levels of stigmatizing attitudes toward patients with schizophrenia. The primary aim of this case-control study was to assess university students’ ability to identify stigma toward schizophrenia in Italian newspapers. Secondary aims were: a) to explore differences in stigmatizing attitudes among two different groups of university students (health professionals [HP] and nonhealth professionals [n-HP]) and b) to compare the attitudes of these two groups with those of a sample of expert psychiatrists. The electronic archives of two Italian newspapers were searched using the term “schizo” (as a word or part of it). One hundred seventy articles published between January and December 2011 were identified. Students from the HP group and expert psychiatrists had a higher ability to detect stigmatizing attitudes in newspapers. Students from the n-HP group had a higher concordance with the experts on the topics “characteristics of the article” and “services and rights.” Our findings highlight the importance of targeting university students with correct and updated information about schizophrenia and its psychosocial consequences.


2015 - Young and burnt? Italian contribution to the international BurnOut Syndrome Study (BOSS) among residents in psychiatry [Articolo su rivista]
Ferrari, Silvia; Cuoghi, Giulia; Mattei, Giorgio; Carra, Elena; Volpe, U; Jovanovic, N; Beezhold, J; Rigatelli, Marco; Galeazzi, Gian Maria; Pingani, Luca
abstract

The Burnout Syndrome (BS) is a common condition among health care professionals, yet data concerning its prevalence and associated factors among psychiatric residents are lacking. Objectives: To report the results of the Italian contribution to "BOSS", an international multicentre research project aiming at estimating the burden of BS among residents in psychiatry, and at identifying factors contributing to its development and prevention. Methods: Cross-sectional study. The BOSS online questionnaire, which collected socio-demographic data and five psychometric tools (MBI-GS, AWLS, PHQ-9, SIBQ, BFI), was administered electronically to 180 Italian residents in psychiatry. Simple and multiple linear regressions were performed to analyse data. Results: 108 questionnaires provided data for the study (response rate: 60%). Mean age: 30.5 +/- 3.7 years. Eighty percent of the sample were female. A moderate level of BS emerged, related to work conditions, absence of major depression, satisfaction with pay or less academic activity. Only 0.9% (N=1) of the sample showed PHQ-9 scores suggestive of major depression, while lifetime suicidal ideation was admitted by 16% of residents. For the three dimensions of the MBIGS, Italian sample scores were consistent with previously published results concerning pooled data in a FrenchCroatian sample, reporting moderate levels of BS. Higher workload, symptoms of depression and lower satisfaction predicted higher levels of Emotional Exhaustion and Cynicism. Conclusions: Italian residents in psychiatry showed overall moderate levels of BS, related to workload and work organization. Other alerts of psychic distress were found among participants, namely symptoms of depression, suicidal ideation and use of psychotropic medications.


2014 - Consultation-liaison psychiatry and the “Women Wellness Project”: analysis of the association between cardiovascular risk factors and psychiatric comorbidity [Abstract in Rivista]
Mattei, Giorgio; Simoni, Elena; Borghi, Ambra; Bursi, S; Capitani, C; Coppi, Francesca; Ferrari, Silvia; Gorlato, Giulia; Pingani, Luca; Rigatelli, Marco; Rossi, Rosario
abstract

INTRODUCTION The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes. AIM To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal. METHODS Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA. RESULTS 675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = -.26; p = .05) and heart rate (r = .33; p = .01). CONCLUSIONS Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.


2014 - Correlation of articular involvement, skin disfigurement, and unemployment with depressive symptoms in patients with systemic sclerosis: a hospital sample [Articolo su rivista]
Tedeschini, Enrico; Pingani, Luca; Simoni, Elena; Ferrari, D; Giubbarelli, C; Giuggioli, D; Lumetti, F; Rigatelli, Marco; Ferri, Clodoveo; Ferrari, Silvia
abstract

Background: Systemic sclerosis (SSc) is a connective tissue disease associated with increased functional impairment, body image distress due to skin lesions, and psychosocial comorbidity, particularly depression. Prevalence of depressive symptoms in SSc patients ranges from 36% to 65% and it contributes to the worsening of any aspect of the disease. The aim of this study was to investigate the prevalence and clinical and non-clinical correlates of depressive symptoms in a sample of outpatients with SSc. Methods: Seventy-eight consecutive SSc outpatients were recruited from February 2005 to July 2007. Sociodemographic and SSc-related clinical data were collected, including a modified Rodnan Skin Score, the Valentini Disease Activity Index and psycho-metric assessment of disability and pain. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Two questions on perception of support from relatives and impact of disfigurements were also directly addressed to subjects. Results: The BDI mean score was 10.5 ( 8.3), with 36 subjects (46.2%) scoring above clinical significance. Unemployment, increased disability, pain, disease activity and articular involvement were significantly associated with more depressive symptoms. Older age, unemployment and more depressive symptoms were also related with complaints of disfigurements due to skin involvement. Conclusions: Depression is an influential prognostic factor in SSc. The present study contributes to the knowledge of the relationship between depression and clinical features routinely collected in rheumatology settings in order to develop a standardized assessment of psychosocial distress in routine rheumatologic procedures.


2014 - Gli interventi psicosociali con i familiari: dalla teoria alla pratica clinica [Articolo su rivista]
Gibertoni, G; Seidenari, C; Guicciardi, Alessia; Carra, Elena; Brogli, Alice; Stefanetti, S; Pingani, Luca; Ferrari, Silvia
abstract

L'articolo descrive un'esperienza di lavoro psicoeducazionale con familiari di pazienti gravi in carico ad un Centro di Salute Mentale.


2014 - Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study [Articolo su rivista]
Mattei, Giorgio; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco
abstract

Purpose To report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities. Methods This is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions. Results After the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (-5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide. Conclusions The data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions.


2014 - The crisis in psychiatry: A public health perspective [Articolo su rivista]
Pingani, L.; Luciano, M.; Sampogna, G.; De Rosa, C.; Pinna, F.; Volpe, U.; Vecchio, V. D.; Fiorillo, A.
abstract

The role and responsibilities of psychiatry and psychiatrists have changed significantly in recent decades as a consequence of changes in society. The target of psychiatrists has moved from the treatment of specific mental disorders to the management of a wide range of psychological conditions. Following these changes, a public health approach has been claimed as necessary for psychiatric practice and research, given the current ongoing crisis in mental health. If we want to promote a public health approach, the following actions should be responsibly taken by modern mental health professionals: (1) the identification of causes of mental disorders, (2) the refinement of diagnoses, (3) the social inclusion of patients, (4) the involvement of users and carers in mental health research and practice, and (5) the improvement of psychiatric treatments and services. This crisis should represent a stimulus for all psychiatrists and a reconceptualization of psychiatry as public health is not in question. © 2014 Institute of Psychiatry.


2014 - Use of coercive measures in mental health practice and its impact on outcome: A critical review [Articolo su rivista]
Luciano, M.; Sampogna, G.; Del Vecchio, V.; Pingani, L.; Palumbo, C.; De Rosa, C.; Catapano, F.; Fiorillo, A.
abstract

Although coercive measures have always been part of the psychiatric armamentarium, the ethical dilemma between the use of a "therapeutic" coercion and the loss of patients' dignity is one of the major controversial issues in mental health research and practice. The aims of the present review are to explore the existing literature on predictors of use of coercive measures and to explore the relationship between coercive measures and patient outcome. A literature search was conducted using MEDLINE, PsychyINFO, Scopus, Web of Knowledge and the Cochrane Database. In all selected papers, references were cross-checked to identify other possible eligible papers. The use of coercive measures was predicted by patients' clinical and socio-demographic features, staff characteristics and ward-related factors. Coercive measures have only a limited impact on patients' clinical and social outcome. At the current level of knowledge, coercion is still a controversial issue in mental health practice. Only few studies with a solid methodology have been carried out. Large multicenter and rigorous studies, with long-term follow-ups, are highly needed. © 2014 Informa UK, Ltd.


2014 - Vertigo "In the Pink": The Impact of Female Gender on Psychiatric-Psychosomatic Comorbidity in Benign Paroxysmal Positional Vertigo Patients [Articolo su rivista]
Ferrari, Silvia; Monzani, Daniele; Baraldi, S; Simoni, E; Prati, G; Forghieri, M; Rigatelli, Marco; Genovese, Elisabetta; Pingani, Luca
abstract

BACKGROUND: Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). OBJECTIVE: The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. METHODS: Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. RESULTS: BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. CONCLUSIONS: Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.


2013 - A LITERARY WORKSHOP FOR INCREASING ASSERTIVENESS IN PATIENTS WITH EATING DISORDERS: A RANDOMIZED CONTROLLED TRIAL [Articolo su rivista]
Pingani, Luca; Fulvio, Arnone; Maria Laura, Chierici; Elena De, Bernardis; Sara, Donelli; DEL GIOVANE, Cinzia; Vera, Vinci; Giuliano, Turrini; Rigatelli, Marco; Ferrari, Silvia
abstract

Objectives: To assess the effectiveness of a literary workshop activity for increasing linguistic skills and assertiveness in patients with eating disorders (ED).Methods: Twenty-four patients consequently admitted to the ED In-patient Unit at the Private Clinic “Villa Maria Luigia” (Parma, Northern Italy) were enrolled in the study. Of these, 8 were randomly assigned to treatment and 16 to care as usual (being the difference between treatment and care as usual only represented by the literary workshop activity). The literary workshop consisted in 15 weekly 60-minute group sessions. Linguistic and expressive skills were provided and tested during the sessions. The Rathus Assertiveness Schedule and the Verbal Fluency Test (phonemic and semantic) were administered to all patients at the beginning and at the end of hospitalization. Results: A significant improvement of semantic skills, phonetic skills and assertiveness (p<.01) was registered in the treatment group. A positive correlation was also found between variations of linguistic skills and assertiveness in the treatment group, but not in the control group. Conclusions: Effectiveness of a literary workshop activity within a rehabilitation program for patients suffering from ED was suggested: improved communication and language skills might have a positive and significant impact on patients' levels of assertiveness


2013 - A step backward: the “Rough” facial nerve grading system [Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Grammatica, Alberto; Salafia, Francesca; Ciancimino, Cristel; Cunsolo, Eliomaria; Pingani, Luca; Rigatelli, Marco; Genovese, Elisabetta; Monzani, Daniele; Gioacchini, FEDERICO MARIA; Marchioni, Daniele; Presutti, Livio
abstract

Several modalities currently exist to rate the degree of facial function clinically but even though it has significant limitations, the most widely used scale is the House-Brackmann grading system (HBGS). A simplified scale is introduced here, the 'Rough' Grading System (RGS - Grade I: normal movement; Grade II: slight paralysis; Grade III: frank paralysis with eye closure; Grade IV: frank paralysis without eye closure; Grade V: almost complete paralysis with only slight movements; Grade VI: total paralysis). The aim of the present study was to verify the interrater reliability and the interscale validity of this simplified grading system. STUDY DESIGN: Scale validation study based on a prospective cohort. METHODS: Fifty patients with facial palsy, consecutively referred to our department were filmed while performing some codified facial movements. Then two independent groups (one rating using the HBGS, the other rating using the RGS) assigned a grade after reviewing the videos. The time required for the rating was also noted. RESULTS: The HBGS showed a mean value of interrater agreement of 0.46 while the RGS showed a mean value of 0.59. The concurrent validity between HBGS and RGS ranged from 0.86 to 0.90 (p < 0.001 for every comparison). There was no statistically significant difference between HBGS and RGS in the mean time taken for rating (p = 0.15). CONCLUSIONS: The RGS reached an adequate level of interrater reliability, higher than the HBGS. The correlation between the two scales is high and the times required for rating are similar. The present results may justify the use of the RGS in routine clinical practice. LEVEL OF EVIDENCE: N/A


2013 - International Study of Student Career Choice in Psychiatry (ISoSCCiP): results from Modena, Italy [Articolo su rivista]
Ferrari, Silvia; Reggianini, Corinna; Mattei, Giorgio; Rigatelli, Marco; Pingani, Luca; Bhugra, D.
abstract

Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian fi nal year medical students from the University of Modena and Reggio Emilia were asked to fi ll in an on-line questionnaire during the fi rst semester of two consecutive academic years (2009 – 2010, 2010 – 2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate 46.7%). Women constituted 66%, and mean age was 25.14 (SD 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p 0.01), believing that ‘ the problems presented by psychiatric patients are often particularly interesting and challenging ’ (p 0.01), and by accounts of personal/family experience with physical illness (p 0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specifi cities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry.


2013 - Internet as a tool to estimate psychiatrists’ opinions on consultation activity in the Emergency Room: a mix-method survey [Articolo su rivista]
Mattei, Giorgio; Tedeschini, Enrico; Pingani, Luca; Rigatelli, Marco; Ferrari, Silvia
abstract

OBJECTIVES This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the Emergency Room (ER). Considerations and suggestions concerning the use of Internet-based surveys for research purposes are also offered. METHODS A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was made up of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Surveymonkey was used to collect responses. Data collection went on for two weeks, from June 1st until June 15th 2011. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency. RESULTS Out of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data for the research since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). Social emergencies were indicated as a rare cause of consultation (1.7%), yet they were considered particularly challenging by the 36.2% of psychiatrists. A large amount of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by the ER personnel, “poor autonomy of the personnel working in the ER” (38.2%), and “poor perceived safety” (30.9%) by the consultant. Yet, it is noticeable that the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER. CONCLUSIONS The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, though limited external validity might be a problem only partially addressed by adopting mixed-method strategies of research.


2013 - Miglioramento delle abilità linguistiche e dell'assertività nei disturbi del comportamento alimentare: studio randomizzato controllato di un'attività di laboratorio letterario [Improving linguistic skills and assertiveness in eating disorders: A randomized controlled trial on a literary workshop activity] [Articolo su rivista]
Pingani, Luca; Arnone, F; Chierici, Ml; De Bernardis, E; Donelli, S; Del Giovane, C; Vinci, V; Turrini, G; Rigatelli, Marco; Ferrari, Silvia
abstract

Objectives: To assess the effectiveness of a literary workshop activity for increasing linguistic skills and assertiveness in patients with eating disorders (ED). Methods: Twenty-four patients consequently admitted to the ED in-patient unit at the private clinic "Villa Maria Luigia" (Parma, Northern Italy) were enrolled in the study. Of these, 8 were randomly assigned to treatment and 16 to care as usual (the only difference between treatment and care as usual was the literary workshop activity). The literary workshop consisted in 15 weekly 60-minute group sessions. Linguistic and expressive skills were provided and tested during the sessions. The Rathus Assertiveness Schedule and the Verbal Fluency Test (phonemic and semantic) were administered to all patients at the beginning and end of hospitalization. Results: A significant improvement of semantic skills, phonetic skills and assertiveness (p < 0.01) was registered in the treatment group. A positive correlation was also found between variations of linguistic skills and assertiveness in the treatment group, but not in the control group. Conclusions: The results of this study suggest that a literary workshop activity within a rehabilitation program for patients suffering from ED can aid in improving communication and language skills that might have a positive and significant impact on levels of assertiveness.


2013 - Who cares for it? How to provide psychosocial interventions in the community [Articolo su rivista]
Pingani, Luca; Fiorillo, A; Luciano, M; Catellani, S; Vinci, V; Ferrari, Silvia; Rigatelli, Marco
abstract

Background: Since the Mental Health Reform Law 1978/180, in Italy mental hospitals have been progressively closed and a community-centred psychiatric care oriented to rehabilitation began. After almost 35 years, the de-institutionalization process is now complete. However, psychosocial interventions in the community are provided only rarely, although a specific mental health professional, the psychiatric rehabilitation technician, has been established in Italy. Material: Training courses and the education of psychosocial rehabilitation technicians have been analysed and the university degree has been described. Moreover, the practical and theoretical skills needed at the end of the training course have been discussed. Discussion: Psychiatric rehabilitation technicians are trained to perform multidisciplinary rehabilitative and educational interventions for people with severe mental disorders and their carers. They represent an innovative professional workforce in mental health care, not yet established outside Italy, whose role and activities are essential in a communitybased mental health system model. Conclusion: The skills needed for properly performing psychosocial interventions are not available in other mental health professionals and it is not possible that these interventions, which require in-depth training, are performed by professionals with a different background. It is advisable that psychiatric rehabilitation technicians become an integral and permanent component of an efficient community psychiatric staff.


2012 - Mental illness and mass media: review of the literature since 1950 up to date [Abstract in Rivista]
Pingani, Luca; Vinci, V; Colavito, Mg; Rigatelli, Marco; Ferrari, Silvia
abstract

Introduction and aims: Mass media have become the main source of information on mental illness. In recent years, numerous studies documented a relationship between a stigmatizing presentation of psychiatric disorders and negative perception of mental illness by general population. This paper aims at analyzing how mental illness is described in scientific articles published by journals and magazines and delineating the average portrait of a psychiatric patient offered by media to the general population. Methods: Scientific articles published from 1957 until August 2010 were reviewed, collecting positive and negative expressions commonly associated to mental illness; a qualitative assessment method of these was then applied. Results: Negative descriptions of mental illness resulted by far more common than positive ones; generally, the tone and the negative attitude that describes mental illness are in the titles and in short articles, often sensational and dramatic, put on the front page, referring to stories of crime and danger. The titles are often inconsistent with the contents of the article. Moreover, there is a discriminatory and derogative language or a language of derision or pity. If there are positive descriptions, they are associated with the involvement of mental health experts, the active role of the psychiatric patient in the mass media or the effect produced by anti-stigma campaigns towards journalists. Conclusions: Although negative and stigmatizing depictions predominate, there are still opportunities for improving media reporting of mental illness, which should be taken up in future media strategies.


2012 - Opinions of general hospital ward staff on a consultation-liaison psychiatry service [Abstract in Rivista]
Ferrari, Silvia; Catellani, S; Pingani, Luca; Rigatelli, Marco; Simoni, E.
abstract

Objective: Consultation-Liaison Psychiatry is the application area of psychiatry dealing with psychosocially distressed patients in nonpsychiatric health care settings and providing integration of the psychosomatic and bio-psycho-social theories with clinical practice. The overcoming of sectorialization in contemporary medical care through the establishment of effective collaboration is its main theoretical framework. This study collects evaluations of doctors and charge nurses working in non-psychiatric wards of the Modena General Hospital, about the Psychiatric and Psychosomatic Consultation Service (PPCS). Method: 330 health professionals (medical doctors and charge nurses) were contacted by e-mail or in person, and required to compile an anonymous questionnaire over a two-week period, in June 2009. Results: 109/330 (33.03%) responded to the questionnaire, of these the vast majority (n=95, 87.20%) were medical doctors. The majority of respondents (84.39%) estimated a range of frequency of psychiatric referrals between 1 and 24% of their patients. The most frequent reasons for referrals were suspected depression (60.55%) or anxiety (53.21%). The PPCS intervention was rated as “very useful" particularly for psychopharmacotherapeutic advice (84.40%), to improve communication with patients and relatives (73.39 and 39.45% res-pectively) and to facilitate after-discharge care (33.94%). Half of the sample also recognized an improvement of their own knowledge and skills in the management of mentally ill patients. Conclusion: TheModena PPCS is perceived as effective and useful by its users. It is relevant to assess opinions of consultees and ward staff on Consultation and Liaison activities, to better focus clinical and training interventions as well as to improve organisational procedures.


2012 - Predictors of dropout from in-patient treatment of eating disorders: an italian experience [Articolo su rivista]
Pingani, Luca; Catellani, S; Arnone, F; De Bernardis, E; Ziosi, G; Turrini, G; Rigatelli, Marco; Ferrari, Silvia
abstract

Introduction. The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). Materials and methods. The present study consisted in a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in the a three-year period between (01/01/2006- and 31/12/2009). Socio-demographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQDA), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. Results. Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents’ divorcing, parents’ history of substance abuse and difficulties in interpersonal relationships. Discussion. Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.


2012 - Psychiatric comorbidity in benign paroxymal positional vertigo patients: a case-controlled study [Abstract in Rivista]
Baraldi, Sara; Simoni, Elena; Prati, G; Pingani, Luca; Monzani, Daniele; Ferrari, Silvia
abstract

Introduction: Vestibular disorders can trigger the onset of psychiatric disorders in predisposed individuals: these comorbidities are often underestimated, untreated and may consequently result in chronicization and poor quality of life. There are still few studies concerning the type and the prevalence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV). Aim: To evaluate psychiatric comorbidities, in particular anxiety, depression, somatisation disorder and alexithymia in a group of BPPV, patients compared to healthy subjects. Methods: Case-control study. We compared for psychiatric morbidity 92 BPPV patients and 141 controls (not suffering from BPPV) recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010. Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI) and Toronto Alexithymia Scale (TAS-20) were used to assess psychiatric symptoms. Results: BDI and STAI scores, BSI subscales for somatization, anxiety and phobic anxiety, DPCR subscales for disease phobia, functional somatic symptoms secondary to a psychiatric disorder and demoralization were significantly different between patients and controls. Conversely, significant differences between the two groups were not found for alexithymia scores. Conclusions: Affective disorders, such as depression, demoralization, phobia and anxiety, and somatisation appeared to be significantly prevalent in BPPV patients. Contrary to expectations, alexithymia was not found to be more common in these subjects. Further studies are needed, in order to identify psychiatric sufferings at early stages in this population.


2012 - Scoop or stigma? La psicopatologia sui quotidiani dal 1950 a oggi [Abstract in Rivista]
Pingani, Luca; Ferrari, Silvia; Vinci, Vera; S., Catellani; G., Ziosi; Rigatelli, Marco
abstract

Psicopatologia descritta da quotidiani negli ultimi anni in Italia


2012 - Stigma and discrimination toward mental illness: translation and validation of the Italian version of the Attribution Questionnaire-27 (AQ-27-I). [Articolo su rivista]
Pingani, L.; Forghieri, M.; Ferrari, Silvia; Ben Zeev, D.; Artoni, P.; Mazzi, F.; Palmieri, G.; Rigatelli, Marco; Corrigan, P. W.
abstract

The aim of this study was to translate the Attribution Questionnaire-27 (AQ-27) to the Italian language (AQ-27-I), and to examine the reliability and validity of this new Italian version.|The questionnaire was translated using the standard translation/back-translation method. Cronbach's alpha and intraclass coefficients were used to estimate instrument reliability. Confirmatory factor analysis was conducted to corroborate the original English version factor structure in the new measure, and to establish validity. Path analyses were meant to validate relationships found in the English version among Italian-speaking participants.|The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.82 for the total scale and ranging between 0.52 and 0.91 for the subscales. The test-retest reliability was also satisfactory, with intraclass correlation coefficients of 0.72 for the total scale and ranging between 0.51 and 0.89 for the subscales. Fit indices of the model supported the factor structure and paths.|The AQ-27-I is a reliable measure to assess stigmatizing attitudes in Italian.


2011 - Risk test for eating disorders: Factor analytic study [Articolo su rivista]
Giosue, P.; di Michele, V.; Pingani, L.; Roncone, R.; Casacchia, M.
abstract

Objective: Eating disorders (ED) are disabling, unpredictable, and difficult to treat. The high percentage of false negatives at screening test indicates that up to now the prevalence of ED in adolescents could have been underestimated. The aim of the study was to evaluate the Factor structure of "Risk Test" (RT), a 16-item questionnaire recommended by Italian Government for screening young people to assess the risk for ED by studying their behaviour style and emotional/ affective involvement related to eating attitudes and the need to apply the RT in a non clinical context. Method: 422 students, between 16 and 32 years, were assessed using RT. All participants spoke Italian as their mother- tongue or were fluent in Italian. Results: An exploratory Factor Analysis was used in order to generate hypotheses about underlying processes measured by the instrument. A five factor solution was generated by the analysis, accounting for 69.7% of the total variance. Conclusions: The RT was well accepted by the patients and needed very little supervision by the interviewer. Our data suggests the importance of the dimensions evaluation of RT ("Fear-emotional-impulsive factor", "Behavioural factor", "Physical and mood disruption", "Safe" and "Unsafe attitude"). The factor structure of the RT is consistent with the underlining cognitive structure of disturbed eating behaviour which is able to be treated with a preventive, cognitively oriented psychological approach. © 2011 Giovanni Fioriti Editore s.r.l.


2010 - Burn-out syndrome among Italian psychiatry residents: Results for Italy from the BOSS international study [Abstract in Rivista]
Ferrari, Silvia; Pingani, Luca; Cuoghi, Giulia; Jovanovic, N; Beezhold, J; Rigatelli, Marco
abstract

Background and aims: Acknowledged risk factorsfor burnout syndrome include being a mental healthworker, younger age (in the sense of less professionalexperience) and status as a residents. The aim of theBOSS International Study was to put all these and otherrisk factors together and study their associations, aspredictors of this undesirable condition. 20 countriesworldwide were involved. Results from the Italianparticipants are displayed and discussed here.Methods: An invitation to join in the study was sentto 193 residents in psychiatry from the whole nationalterritory of Italy, including a link to the BOSS onlinequestionnaire (Italian version); this collects data ondemographics, education, working circumstances, andfrom five psychometric instruments (Maslach BurnoutInventory – MBI-GS, Areas of Worklife Survey, PHQ-9,Big Five Inventory - 10, Suicide Ideation and BehaviourQuestionnaire).Results: A total of 113 residents completed the survey(58.5% response rate, 22/78% M/F, mean age 30.3-3.7). Mean scores at the three MBI components were2.9 (exhaustion), 1.9 (cynicism) and 4.8 (professionalefficacy), accounting for low levels of burnout amongthe respondents. 14% of respondents confessed theywere on daily medication, mainly antidepressants (42%)and self-prescribed (50%). Out of all respondents, 34.8%met criteria for PHQ-9 minor depression, and 8.9%. formajor depression. Only PHQ9-depression was found tobe a statistically significant predictor of burnout.Conclusions: Despite the low level of burnout amongItalian residents in psychiatry, other findings in theBOSS survey suggested the need for improved supportand tutoring of young psychiatrists-to-be. This presents asignificant challenge for training organisations.


2010 - Evaluation of HIV positive recipients of orthotopic liver transplant (OLT): an observational study in the modena consultation liaison psychiatric service [Abstract in Rivista]
Borsari, Lucia; M., Ferrara; V., Barbanti Silva; Pingani, Luca; S., Cocchi; Guaraldi, Giovanni; Gerunda, Giorgio Enrico; Rigatelli, Marco; Ferrari, Silvia
abstract

18th European Congress of Psychiatry


2009 - Family burden in bipolar disorders: results from the Italian Mood Disorders Study (IMDS) [Articolo su rivista]
Magliano, L; Orrico, A; Fiorillo, A; Del Vecchio, V; Castiello, G; Malangone, C; De Rosa, C; Capuano, V; Maj, M; Working Group, Imds; Torchio, E; Franzoi, V; Pingani, Luca; Curti, C; Spanarello, S; Scattina, M; Fuchs, H; Test, G; Ferrigno, J; Minciotti, E; Innocente, P; Bardicchia, F; Galli, A; La Rovere, R; Maroncelli, M; Iapichino, S; Pannozzo, M; Nuccetelli, F; Di Nunzio, R; Armellino, R; Palladino, C; Delcuratolo, V; Cadoni, M; Cannas, A; Caniglia, A; Cudia, M.
abstract

AIMS:To explore: a) the burden of care, and the professional and social support in relatives of patients with bipolar disorders; b) the psychosocial interventions provided to patients and their families by Italian mental health centres.METHODS:342 outpatients with a bipolar disorder and their key-relatives were randomly recruited in 26 Italian mental health centres, randomly selected and stratified by geographical area and population density. Family burden was explored in relation to: a) patient's clinical status and disability; b) relatives' social and professional support; c) interventions received by patients and their families; d) geographical area.RESULTS:In the previous two months, global functioning was moderately impaired in 36% of the patients, and severely impaired in 34% of them. Twenty-one percent of patients attended a rehabilitative programme, and 3% of their families received a psychoeducational intervention. Burden was higher when patient's symptoms and disability were more severe, the relatives had poorer psychological support and help in emergencies by the social network, and the family lived in Southern Italy. Differences in family burden in relation to geographical area disappeared when psychosocial interventions were provided.CONCLUSION:This study highlights the need to increase the availability of rehabilitative interventions for patients with bipolar disorders and of psychological support for their families, especially in Southern Italy.


2009 - Medical-psychiatric comorbidity [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca
abstract

Medical-psychiatric comorbidity


2009 - Metabolic syndrome and psychiatric comorbidity: the Modena protocol [Abstract in Rivista]
S., Po; Cameli, Michela; Forghieri, Matilde; C., Giubbarelli; Pingani, Luca; Ferrari, Silvia; Chiurlia, Emilio; Iaccarino, Daniele; Modena, Maria Grazia
abstract

Metabolic syndrome and psychiatric comorbidity: the Modena protocol


2009 - Psychiatric comorbidity in end-stage liver disease patients with and without HIV infection [Abstract in Rivista]
BARBANTI SILVA, Veronica; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco
abstract

Psychiatric comorbidity in end-stage liver disease patients with and without HIV infection


2008 - EACLPP conference in Bologna [Articolo su rivista]
Berardi, D; Bortolotti, B; Tarricone, I; Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca
abstract

A description of main features and peculiarities of the 2007 annual meeting of the european association for consultation liaison psychiatry and psychosomatic which was held in Bologna, Italy.


2008 - Suicide intervention skills in health professionals: A multidisciplinary comparison [Articolo su rivista]
Palmieri, G.; Forghieri, M.; Ferrari, S.; Pingani, L.; Colombini, N.; Rigatelli, M.
abstract

Aim of the study: Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian health professionals. Materials and methods: Two hundred and thirty two professionals completed the Suicide Intervention Response Inventory (SIRI-2) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Results and conclusions: Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups. Taken together, our findings suggest the necessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.


2008 - Suicide intervention skills in health professionals: a multidisciplinary comparison [Articolo su rivista]
Palmieri, Gaspare; Forghieri, Matilde; Ferrari, Silvia; Pingani, Luca; Coppola, P.; Colombini, N.; Rigatelli, Marco; Neimeyer, R. A.
abstract

Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian professionals. Two hundredand thirty two professionals (38 psychiatrists, 50 general practitioners, 34 psychiatric nurses, 60 doctors and nurses working in accident and emergency services, and50 medical students) completed the Suicide Intervention Response Inventory (SIRI-2) (Neimeyer & Bonelle, 1997) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups andpsychiatric nurses scored significantly higher than general practitioners in identifying appropriate responses to suicidal patients. Taken together, our findings suggest thenecessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.


2008 - Validity of the Italian adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus-sufferers [Articolo su rivista]
Monzani, Daniele; Genovese, Elisabetta; Marrara, A.; Gherpelli, Chiara; Pingani, Luca; Forghieri, M.; Rigatelli, Marco; Guadagnin, T.; Arslan, E.
abstract

The aim of this study was to determine the validity of the Italian translation of the Tinnitus Handicap Inventory (THI) by Newman et al. in order to make this self-report measure of perceived tinnitus handicap available both for clinical and research purposes in our country and to contribute to its cross-cultural validation as a self-report measure of perceived severity of tinnitus. The Italian translation of the Tinnitus Handicap Inventory (THI) was administered to 100 outpatients suffering from chronic tinnitus, aged between 20 and 82 years, who attended the audiological tertiary centres of the University Hospital of Modena and the Regional Hospital of Treviso. No segregation of cases was made on audiometric results; patients suffering from vertigo and neurological diseases were excluded. Pyschoacoustic characteristics of tinnitus (loudness and pitch) were determined and all patients also completed the MOS 36-Item Short Form Health Survey to assess self-perceived quality of life and the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. The THI-I showed a robust internal consistency reliability (Cronbach's alpha = 0.91) that was only slightly lower than the original version (Tinnitus Handicap Inventory-US; Cronbach's alpha = 0.93) and its Danish (Cronbach's alpha = 0.93) and Portuguese (Cronbach's alpha = 0.94) translations. Also its two subscales (Functional and Emotional) showed a good internal consistency reliability (Cronbach's alpha = 0.85 and 0.86, respectively). On the other hand, the Catastrophic subscale showed an unacceptable internal consistency reliability as it is too short in length (5 items). A confirmatory factor analysis failed to demonstrate that the 3 subscales of the THI-I correspond to 3 different factors. Close correlations were found between the total score of the Italian translation of the Tinnitus Handicap Inventory and all the subscales of the MOS 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale scores indicating a good construct validity. Moreover, these statistically significant correlations (p < 0.005) confirmed that the self-report tinnitus handicap is largely related to psychological distress and a deterioration in the quality of life. On the other hand, it was confirmed that the tinnitus perceived handicap is totally independent (p > 0.05) from its audiometrically-derived measures of loudness and pitch thus supporting previous studies that focused on the importance of non-auditory factors, namely somatic attention, psychological distress and coping strategies, in the generation of tinnitus annoyance. Finally the results of the present study suggest that the THI-I maintains its original validity and should be incorporated, together with other adequate psychometric questionnaires, in the audiological examination of patients suffering from tinnitus and that psychiatric counselling should be recommended for the suspected co-morbidity between tinnitus annoyance and psychological distress.


2008 - What is the biopsychosocial role of human immunodeficiency virus positivity in patients with end-stage liver disease who undergo orthotopic liver transplantation? [Articolo su rivista]
Barbanti Silva, Veronica; Ferrara, Maria; Mazzi, Fausto; Pingani, Luca; Cocchi, Stefania; Romano, Antonio; Masetti, Michele; Gerunda, Giorgio Enrico; Guaraldi, Giovanni; Rigatelli, Marco
abstract

INTRODUCTION: Since 2003 the National Research Program for Solid Organ Transplantation in patients with human immunodeficiency virus (HIV) is active at our liver transplantation center. Patients with HIV who enter this protocol are assessed by the Consultation Liaison Psychiatry Service. The aim of the present study was to evaluate their psychiatric comorbidity. METHODS: An observational prospective study was conducted comparing end-stage liver disease (ESLD) patients with and without HIV. After the assessment, the psychiatrist compiled the Transplant Evaluation Rating Scale (TERS) and the Montgomery Asberg Depression Rating Scale (MADRS). Baseline evaluation was made before inclusion on the OLT waiting list and the follow-up evaluation was made 12 months later. RESULTS: From January 2003 to December 2006 we assessed 553 patients: 39 (6%) with HIV and 361 (94%) without HIV. The 2 groups were homogeneous for gender (75% of male patients; P=not significant [NS]) but not for age (46+/-5 vs 56+/-9; P=NS). Psychiatric history was negative in 176 (49%) patients without HIV and in 6 (15%) patients with HIV (P< .001). At baseline psychiatric comorbidity was present in 33 HIV patients (85%) and in 148 non-HIV patients (41%; P< .001). At follow-up MADRS highlighted an improvement in all of the items for HIV patients. In the non-HIV group, the variation was as follows: baseline, 7.10; follow-up, 8.15. In the HIV group, the variation was as follows: baseline, 10.20; follow-up, 4.09 (P< .001). The average score at TERS was higher among patients with HIV (43+/-9 vs 35+/-9; P=NS). CONCLUSIONS: At baseline HIV patients with ESLD showed a higher rate of psychopathology, but they improved at follow-up; the contrary happened in the non-HIV group.


2006 - Early intervention in the pre-psychotic phase: a survey among expert and non-expert psychiatrists and general practitioners [Articolo su rivista]
Galeazzi, Gian Maria; Elkins, K.; Pingani, Luca; Rigatelli, Marco
abstract

Objectives: This study aimed at exploring views and comparing level of consensus across different groups of mental health professionals regarding the appropriateness of preventive interventions targeted at subjects with risk factors for the development of psychosis. Method: A survey was completed by 135 members of the International Early Psychosis Association ( IEPA), by 110 psychiatrists working in the Italian Region Emilia Romagna, and by 114 general practitioners working in the Province of Modena. The survey used three hypothetical case scenarios where a client, having tested positive for future psychosis to an imaginary infallible screening instrument, presents with either ( a) no symptoms and no interest in intervention; (b) no symptoms but requesting intervention; ( c) with some degree of anxiety and depression and requests assistance. Results: Mixed views prevailed on appropriateness of specific interventions across all groups regarding the hypothetical case scenario presented. Judgments varied according to clients' preferences and level of distress. IEPA members showed more inclination than other professionals to consider appropriate psychological and pharmacological intervention in an asymptomatic pre-psychotic state. The propensity for suggesting drug treatment was related to the belief that untreated psychosis causes neurotoxicity. Conclusions: Experts seem to have a more liberal view on the appropriateness of preventive interventions than community mental health psychiatrists and general practitioners. Further research addressing factors that influence experts' views seems warranted.


2006 - Views on psychosis and judgment of appropriateness of early interventions in pre-psychotic phase: A survey of members of the International Early Psychosis Association [Articolo su rivista]
Galeazzi, Gian Maria; Elkins, K.; Pingani, Luca; Rigatelli, Marco
abstract

Background: The evidence base for preventive interventions in psychosis during the pre-psychotic phase is still scarce. Professional views on this topic may be influenced by individual and professional background factors. Aims: To study factors that possibly influence judgmentsmade bymental health professionals dedicated to early psychosis on the appropriateness of early interventions during the pre-psychotic phase. Method: Members of the International Early Psychosis Association (IEPA) were asked general questions about concepts of psychosis and about three case scenarios describing a client in the pre-psychotic phase. Results: Views of 325 respondents were collected. About half the respondents thought that psychotic experiences exist on a continuum with normal experiences. Psychologists were more likely than other professional groups to endorse this view. A total of 52.6% of respondents (n¼171) believed that untreated psychotic episodes cause irreversible brain changes. Psychologists were less likely to endorse this view, which was associated with a willingness to offer pharmacologic interventions in pre-psychotic phases. More than 80% agreed, in most severe cases, on proposing lifestyle changes and psychological interventions. Conclusions: When challenged with case scenarios, mental health professionals with clinical and research experience with patients with early psychosis expressed varied opinions on the appropriateness of pre-psychotic interventions, especially concerning pharmacologic treatment. Professional views on this topic were related not only to the level of symptoms and degree of active request for help from the client, but also to the professional’s role and different conceptions of psychosis endorsed. These aspects warrant further study. Declaration of interest: G. M. Galeazzi and K. Elkins are members of the IEPA. Funding is detailed in Acknowledgments.