Background: Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction due to an increased central and peripheral serotonin activity, which usually presents as a triad of behavioral changes, neuromuscular excitability, and autonomic instability. Probably SS is often misdiagnosed, and its symptoms are mistaken for psychiatric symptoms or general medical issues: the true incidence of SS is not clear, and literature concerning potential risk factors is scarce. Our aims were to examine the prevalence of SS in a naturalistic sample of hospitalized patients and to evaluate potential factors related to the risk of developing the condition. Methods: The sample included 133 patients being treated with serotonergic medications admitted to the psychiatric inpatient unit of the San Luigi Gonzaga Hospital. All patients received a medical examination (including a neurological examination) within 24 hours of admission. Serotonin syndrome was diagnosed according to Hunter Criteria. Results: Sixteen patients (12%) were diagnosed with SS. In the subgroup of subjects with SS, we found a higher rate of male patients when compared with subjects with no SS (62.5% vs 33.3%, P = 0.023). Conclusions: SS probably is an underestimated condition, which should be carefully assessed in patients on serotonergic medications. Male gender was the only factor found to be significantly related to a higher risk of developing SS. Further studies on larger samples are needed, to gain more information on possible risk factors and to identify subjects more prone to developing SS, given the potential risk for patients' health.

Background and Objectives: Aripiprazole is a first-line agent in the treatment of bipolar disorder (BD) and available data demonstrates its efficacy on clinical symptoms in serotonin reuptake inhibitors-resistant obsessive-compulsive disorder (OCD) patients. Therefore, aripiprazole augmentation to mood stabilizers could represent a promising treatment in BD patients with comorbid OCD. The study examined the efficacy and safety of aripiprazole added to lithium or valproate for the treatment of obsessive-compulsive (OC) symptoms in euthymic BD patients with comorbid OCD. Materials and Methods: This is a 12-week prospective observational study. The efficacy of aripiprazole on OC symptoms was assessed through the mean change of Yale–Brown Obsessive-Compulsive (YBOCS) total score. Tolerability was assessed with the Utvalg for Kliniske Undersogelser (UKU) side effect scale and by reporting adverse events. Results: A total of 70 patients were included in the analyses. The withdrawal rate was 21.4%, mainly due to adverse events. Mean ± SD final aripiprazole dose was 15.2 ± 5.3 in the completer sample (N = 55). The Y-BOCS mean score decreased from 24.0 ± 4.1 at baseline to 17.1 ± 4.3 at 12 weeks. Treatment response rate (Y-BOCS reduction ≥ 35%) was 41.8%, while partial response rate (Y-BOCS reduction greater than 25% but less than 35% from baseline) accounted for the other 18.2% of patients. Overall, 91.4% of completers had at least 1 adverse effect (tremor, tension/inner unrest, reduced duration of sleep, akathisia). No significant differences emerged comparing aripiprazole efficacy and tolerability between patients treated with lithium or valproate. Conclusion: Our findings show that aripiprazole addition to lithium or valproate can reduce OC symptoms in real-world BD euthymic patients.

This cross-sectional observational study aimed to assess objective and subjective cognitive deficits in patients with unipolar (UD) and bipolar depression (BD), focusing on their insight into actual cognitive abilities. A total of 124 participants were recruited: 84 patients with a current major depressive episode (43 with UD, 41 with BD) and 40 age- and gender-matched healthy controls. Cognitive assessments were conducted using the Screen for Cognitive Impairment in Psychiatry (SCIP) for objective evaluation and the Perceived Deficits Questionnaire-Depression-5-item (PDQ-d-5) for subjective assessment. Comparisons were performed using χ² tests for categorical variables and ANCOVA for continuous variables (to compare the severity of cognitive complaints and impairment, while controlling for illness duration and age at onset). The Pearson correlation coefficient was used to examine the relationship between subjective and objective measures. In the objective assessment, 72.1 % of UD patients and 68.3 % of BD patients showed cognitive symptoms, with nearly half classified as moderate to severe. No significant differences were found between UD and BD in objective cognitive profiles. In subjective assessments, 39.5 % of UD patients and 46.3 % of BD patients scored below the median. BD patients reported worse subjective cognitive performance than UD patients, with lower total scores (11.1 ± 3.2 vs. 7.9 ± 4.4, p < < 0.001) and poorer performance in planning (2.8 ± 1.5 vs. 1.9 ± 1.4, p < < 0.001) and attention (3.4 ± 0.9 vs. 2.3 ± 1.5, p < .001) domains. This study confirms significant cognitive symptoms in both UD and BD patients. The discrepancy between subjective and objective cognitive performance in BD patients suggests a disconnect between perceived and cognitive abilities.

Background and Objectives: Predominant polarity (PP) may be a useful course specifier in at least a significant proportion of patients with Bipolar Disorder (BD), being associated with several clinically relevant correlates. Emerging evidence suggests that the concept of PP might influence the selection of maintenance treatments, based on a drug polarity index (PI) which measures the greater antidepressive vs. antimanic preventive efficacy of mood stabilizers over long-term maintenance treatment. In this study, we aimed to validate the PI in a large sample of Italian BD patients with accurate longitudinal characterization of the clinical course, which ensured a robust definition of the PP. Materials and Methods: Our sample is comprised of 653 patients with BD, divided into groups based on the predominant polarity (manic/hypomanic predominant polarity—MPP, depressive predominant polarity—DPP and no predominant polarity). Subsequently we calculated the mean total polarity index for each group, and we compared the groups. Results: When we examined the mean PI of treatments prescribed to individuals with DPP, MPP and no predominant polarity, calculated using two different methods, we failed to find significant differences, with the exception of the PI calculated with the Popovic method and using the less stringent criterion for predominant polarity (PP_50%). Conclusions: Future prospective studies are needed in order to determine whether the predominant polarity is indeed one clinical factor that might guide the clinician in choosing the right mood stabilizer for BD maintenance treatment.

Over the years, short term psychodynamic therapy (STPP) has been broadly researched in order to evaluate its efficacy in the treatment of major psychiatric disorders. In particular, a consistent number of studies focused on assessing clinical outcomes of the principal psychodynamic techniques in treating depressive disorders. We conducted a narrative review in which we aimed to evaluate the efficacy of STPP in monotherapy in major depressive disorder and to assess possible features that may correlate with its clinical use. Databases searched were PubMed, Ovid, Scopus, PsycINFO and Cochrane Libraries from inception to July 2022. Our research underlined that STPP in monotherapy is particularly effective in moderately severe depression and in preventing depressive relapses. Moreover, a case-by-case evaluation of its efficacy should be performed when considering STPP for the treatment of major depression with other comorbid psychiatric conditions. Although such key points emerged from scientific evidence, STPP should be better studied in the long-term perspective; further research is needed to define the clinical scenarios in which STPP can be considered a first-line approach as monotherapy in major depressive disorder compared to medications or other types of psychotherapy.

Introduction: Onychophagia, commonly known as nail-biting, is a chronic and repetitive behaviour disorder characterised by a compulsive/habitual nature. Obsessive–compulsive disorder (OCD) and onychophagia present a noteworthy intersection in clinical psychiatry. With a paucity of clinical investigations on this topic, we decided to perform a study on onychophagia in OCD. Materials and Methods: In this cross-sectional investigation, the sample comprised patients (aged 18 years and older) having a primary diagnosis of OCD (DSM-5) and a score on the Yale–Brown Obsessive–Compulsive Scale of at least 16 (moderate OCD). Individuals were referred to the Department of Neuroscience at the University of Turin. Analysis of the data was performed using JASP (Version 0.16.3), a freely available statistical programme created by the University of Amsterdam (JASP Team, 2022). Statistical value was set at p < 0.05. Results: Our sample consisted of 603 individuals with OCD, and onychophagia was present in 52 of the cases, with a prevalence of 8.6% (95% CI: 6.5–11.2%). Individuals with OCD and onychophagia had some specific clinical features compared to patients with only OCD. The main difference was detected in terms of the presence of autism spectrum disorder (ASD): in the group of patients having OCD and onychophagia, a prevalence of ASD as high as 96.2% was identified, compared to 18.0% in the OCD-without-onychophagia group. Discussion: Onychophagia is a relatively common problem in patients with OCD, with almost one individual out of ten experiencing this issue. OCD and onychophagia, when both present, might define a peculiar clinical phenotype with specific characteristics. The extremely high frequency of ASD in patients with OCD and onychophagia (96.2%) might be very useful information for clinicians, who should pay particular attention to screening for autism in this cohort of individuals.