Gianluca Rosso

Objective: Adult ADHD assessments have increased sharply in recent years, yet the diagnostic yield and predictors of confirmed ADHD among assessment-seeking individuals remain insufficiently understood. This study aimed to examine the sociodemographic and clinical characteristics of adults self-referred or referred by clinicians for suspected ADHD, to determine confirmation rates, factors associated with confirmation, and alternative diagnoses. Methods: A cross-sectional study was conducted on 232 adults evaluated at a regional ADHD referral center. Assessments included semi-structured clinical interviews and standardized instruments (DIVA, SCID-5, ADHD-RS). Logistic regression was used to examine factors associated with the final clinical ADHD diagnosis. Results: Overall, 64.2% of individuals received an ADHD diagnosis. Compared with non-ADHD participants, those diagnosed with ADHD were more frequently referred by other healthcare professionals and displayed greater academic impairment. They also showed higher rates of mood swings and delayed sleep onset. Childhood inattention emerged as the only DIVA interview score significantly associated with an ADHD diagnosis. Among individuals without ADHD, the most frequent alternative diagnoses were anxiety disorders and depressive disorders, followed by personality disorders, substance use disorders, and bipolar disorders. Conclusions: Adult ADHD emerges as a multifactorial condition shaped by clinical and functional factors. The final clinical diagnosis was most strongly associated with structured clinical tools, functional impairments (in the academic domain), emotional-regulation difficulties, and childhood inattention, whereas self-reported and more general factors were less informative. These findings underscore the importance of a developmentally informed and comprehensive assessment approach, given the high prevalence of psychiatric conditions that may mimic ADHD.

Background: Obsessive–compulsive disorder (OCD) frequently co-occurs with autism spectrum disorder (ASD), but the prevalence and clinical correlates of this comorbidity remain incompletely understood. Methods: We examined a clinical sample of 603 patients with a primary diagnosis of OCD, of whom 149 (24.7%) presented with comorbid ASD. Sociodemographic variables, clinical characteristics, comorbidities, and obsessive–compulsive symptom dimensions were compared between patients with and without ASD. Results: Patients with OCD + ASD reported an earlier onset of both obsessive–compulsive symptoms and full-blown disorder. While overall symptom severity (Y-BOCS, HAM-D, and HAM-A) was comparable, OCD + ASD patients were characterized by a higher exposure to stressful and traumatic life events, including severe trauma (e.g., death of a close family member, sexual abuse, physical violence, serious illness, and bullying). Severe traumatic events, in particular, were independently associated with ASD comorbidity in our OCD cohort (exploratory model). Comorbidities were also distinct: onychophagia (66.4% vs. 0.4%) and trichotillomania (8.7% vs. 0%) were markedly more prevalent in the OCD + ASD group. Phenomenologically, OCD + ASD patients more often exhibited religious and somatic obsessions, as well as repetition compulsions. Specifically, somatic obsessions were independently associated with ASD in our regression analysis. Conclusions: OCD with comorbid ASD represents a clinically distinct subgroup, characterized by greater vulnerability to trauma, earlier onset, unique symptom profiles, and specific comorbidities. Recognition of these features, and in particular a history of severe traumatic experiences and the presence of somatic obsessions, may support earlier consideration of ASD comorbidity during OCD assessment and may inform personalized treatment planning.

Background: Obsessive–compulsive disorder (OCD) frequently co-occurs with autism spectrum disorder (ASD), but the prevalence and clinical correlates of this comorbidity remain incompletely understood. Methods: We examined a clinical sample of 603 patients with a primary diagnosis of OCD, of whom 149 (24.7%) presented with comorbid ASD. Sociodemographic variables, clinical characteristics, comorbidities, and obsessive–compulsive symptom dimensions were compared between patients with and without ASD. Results: Patients with OCD+ASD were significantly younger at assessment and reported an earlier onset of both obsessive–compulsive symptoms and full-blown disorder. A family history of affective disorders was more frequent in this subgroup. While overall symptom severity (Y-BOCS, HAM-D, HAM-A) was comparable, OCD+ASD patients reported higher exposure to stressful and traumatic life events, including severe trauma. Severe traumatic events, in particular, were found to be a predictor of ASD in our OCD cohort. Comorbidities were also distinct: onychophagia (66.4% vs. 0.4%) and trichotillomania (8.7% vs. 0%) were markedly more prevalent in the OCD+ASD group, as were Cluster B personality disorders (18.1% vs. 11.4%). Phenomenologically, OCD+ASD patients more often exhibited religious and somatic obsessions, as well as checking and repetition compulsions. Conclusions: OCD with comorbid ASD represents a clinically distinct subgroup, characterized by greater vulnerability to trauma, earlier onset, unique symptom profiles, and specific comorbidities. Recognition of these features, and in particular severe traumatic experiences, is crucial for early detection of ASD in individuals with OCD, personalized treatment planning and improved outcomes.

Introduction: Treatment-resistant bipolar depression (TRBD) is a major challenge in psychiatric practice, leading to marked impairment in functioning and quality of life, and increased healthcare utilization. Despite its clinical relevance, consensus on diagnostic criteria and evidence-based therapeutic strategies remains limited. Within the framework of personalized medicine, identifying effective and well-tolerated options for this heterogeneous population is important. This study evaluates the short-term effectiveness and tolerability of lurasidone as an adjunctive treatment in TRBD, with attention to its potential role in tailoring interventions to individual clinical profiles. Methods: This four-week, retrospective, multicentre observational study included patients with TRBD receiving lurasidone in augmentation to ongoing pharmacological treatment. Dosages were adjusted according to clinical judgement. Symptom severity was assessed with the 17-item Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Hamilton Anxiety Rating Scale (HAM-A). Changes from baseline to endpoint were analyzed with repeated measures ANOVA; missing data were managed with the Last Observation Carried Forward (LOCF) method. Results: Sixty patients were enrolled. The mean final lurasidone dose was 51.2 mg/day. Significant improvements were observed across all scales, with consistent reductions in depressive and anxiety symptoms. Clinical response was achieved in 33.3% of participants, while remission occurred in 3.3%. Adverse events were reported by 68.3% of completers, all mild to moderate. Conclusions: Lurasidone appears to be an effective and generally well-tolerated adjunctive option for TRBD. However, remission rates remained low, underscoring the need for further research. In this perspective, lurasidone may contribute to more individualized treatment strategies for difficult-to-treat patients, although confirmatory studies are required to better define its role within precision psychiatry.

Background/Objectives: Obsessive–compulsive disorder (OCD) is a chronic psychiatric illness with intrusive obsessions and compulsive behaviors severely impacting daily functioning and quality of life. The purpose of this narrative review is to present an updated summary of available evidence on third-generation antipsychotics (TGAs) as augmentation strategies for SRI-refractory OCD. Methods: The literature was reviewed using the PubMed database to recognize studies on the use of TGAs in treatment-resistant OCD. Only articles in the English language and on human participants were included. Results: We included nine reports in our review. More numerous (five reports) and higher evidence-level reports were retrieved for aripiprazole, which consistently shows high response rates compared to placebo and other antipsychotics. Two cohort studies were included on brexpiprazole, with no active or placebo comparator. These showed varying but high response rates. One cohort study reported a response rate of 61.5% to cariprazine. Only one paper reported on the efficacy of lumateperone in OCD. This was a single-case report on an adolescent patient with refractory OCD responding to lumateperone monotherapy. Conclusions: The current state of evidence supports the clinical utility of TGAs, particularly aripiprazole, in augmenting SRI treatment in patients with refractory OCD. Evidence regarding cariprazine and lumateperone is scarce, but still contributes to the discussion on the use of TGAs in OCD.

Aim: This cross‐sectional observational study was designed to characterize global functioning in patients with unipolar depression (UD) and bipolar depression (BD), focusing on the relationship between functional impairment and objectively assessed and subjectively perceived cognitive deficits, as well as to potential domain‐specific cognitive–functional patterns across diagnostic groups. Methods: Individuals experiencing a major depressive episode (MDE) in the context of major depressive or bipolar disorder were recruited. Global functioning was assessed with the Functional Assessment Short Test (FAST), objective cognition with the Screen for Cognitive Impairment in Psychiatry (SCIP), and subjective cognition with the Perceived Deficits Questionnaire–Depression–5‐item (PDQ‐D‐5). Group differences were analyzed using χ ² tests and ANCOVA, adjusting for illness duration and age at onset. Associations between cognitive measures and global functioning were examined using Pearson’s correlations. Results: A total of 102 patients were recruited: 54 with UD, 48 with BD. Clinically relevant functional impairment was observed in 87% of UD patients and 93.7% of BD patients. BD individuals showed greater global functional impairment than UD patients, with higher FAST total scores (44.5 ± 23.1 vs. 33.5 ± 14.6, p = 0.006) and worse functioning across most domains. Global functioning was strongly associated with subjectively perceived cognitive difficulties in both UD ( ρ = 0.609, p < 0.001) and BD ( ρ = 0.475, p < 0.001), whereas no significant associations were found with objective cognitive performance. Domain‐specific analyses revealed different patterns of association, with attention and organization related to functioning in UD and retrospective memory in BD. Conclusion: MDEs in unipolar and bipolar disorders are associated with marked functional impairment. Perceived cognitive difficulties may impact daily functioning more than objectively assessed deficits, highlighting their clinical relevance. The distinct cognitive–functional profiles in UD and BD patients underscore the importance of domain‐specific assessments to guide interventions targeting both symptom remission and functional recovery.

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.

Introduction Onychophagia, commonly known as nail biting, is a chronic and repetitive behaviour disorder characterized by a compulsive/habitual nature. Obsessive-compulsive disorder (OCD) and onychophagia present an 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 program 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 9.4%. Intriguingly, individuals with OCD and onychophagia had some specific clinical features compared to patients with OCD only. 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 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 a very useful information for clinicians that should pay particular attention in screening for autism in this cohort of individuals.