Ester di Giacomo

The objective of this review is to examine the recent literature on Intimate Partner Violence (IPV) and Witnessing Domestic Violence (WDV) with a view to providing definitions, prevalence data for Italy and other countries, and for special populations (such as patients with severe mental illness), investigations into risk factors (alcohol, substances, child abuse) and the consequences for general and mental health. In addition to a free search with Google, Medline was interrogated, using PubMed and PsycInfo for both topics. A total of 757 publications were extracted from Pubmed and 338 from PsycInfo for IPV and mental disorders, while 334 publications were found in Pubmed and 205 in PsycInfo for WDV; updated epidemiological data was obtained from Italian websites (e.g. ISTAT, Office for National Statistics). We concluded that given the increasing incidence of domestic violence, health and academic institutions should frame the phenomenon in epidemiological and clinical terms, providing updated research data to the stakeholders in order to improve treatment and prevention practices.

Importance: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders, and it afflicts about 7% of young people. As a consequence, many young women might be pregnant while taking medication for ADHD, but data about safety have not yet been strictly examined.Objective: To examine adverse effects in offspring of mothers receiving treatment with atomoxetine and methylphenidate during pregnancy.Data Sources: Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through December 31, 2023, with the following search terms: (atomoxetine OR methylphenidate) AND (pregnancy).Study Selection: Observational studies (eg, cohort studies, case-control studies, case-crossover studies, cross-sectional studies, and registry-based studies) that reported offspring outcomes in pregnancy with atomoxetine and/or methylphenidate and in mothers with ADHD but unexposed to ADHD treatment during pregnancy or from the general population were included. Ten studies of 656 records satisfied criteria.Data Extraction and Synthesis: Two independent reviewers performed data extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted based on reported odds ratios (ORs) and corresponding 95% CIs using a linear random effects model. Each study was inversely weighted by the reported variance of the estimators. Risk of publication bias and analysis of heterogeneity through univariate and multivariate metaregressions were also rated. Data were analyzed from January to March 2024.Main Outcomes and Measures: Study outcomes included miscarriages and congenital anomalies.Results: Ten studies involving 16 621 481 pregnant women, 30 830 of them affected by ADHD, were included. Congenital anomalies or miscarriages were not more frequent in offspring of mothers receiving treatment with methylphenidate or atomoxetine during pregnancy compared with unexposed offspring (OR, 1.14; 95% CI, 0.83-1.55; P = .41; I² = 8% for congenital anomalies; OR, 1.15; 95% CI, 0.82-1.62, P = .67; I² = 0% for miscarriages) or compared with the general population (OR, 1.19; 95% CI, 0.93-1.53; P = .16; I² = 74% for congenital anomalies; OR, 0.98; 95% CI, 0.77-1.25; P = .40; I² = 0% for miscarriage).Conclusions and Relevance: Evidence from this meta-analysis, which involves a substantial sample of pregnant women with and without ADHD, suggests the maintenance of methylphenidate or atomoxetine during pregnancy is safe, given that congenital anomalies and miscarriages did not appear to significantly increase. Further studies are recommended to support and confirm these findings.

Background: Borderline personality disorder (BPD) is a complex mental health condition marked by instability in mood, relationships, self-image, and behavior. Individuals with BPD often struggle with intense emotions, impulsivity, and maintaining stable relationships. Oxytocin, known as the "love hormone" or "bonding hormone," plays a crucial role in social bonding, trust, empathy, and emotional regulation and its dysregulation may contribute to BPD difficulties. This systematic review aims to analyze existing literature, examining the intricate interplay and encouraging future research and treatment strategies.Methods: A systematic search of Literature in PubMed, Embase and Psychinfo, without any language or time restriction, was performed until March 2024 combining thesaurus and free-search indexing terms related to “borderline personality disorder” and “oxytocin”, producing 310 results (77 in PubMed, 166 in Embase and 67 in Psychinfo). Ninety-four full texts were analyzed, and 70 articles were included in qualitative analysis.Results: Oxytocin may influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributes to the complexity of BPD. Genetic variations in the oxytocin receptor gene may influence social and emotional abilities and contribute to the development of psychopathology. Additionally, early adverse experiences, such as childhood maltreatment, can alter oxytocin functioning, impacting social cognition and emotional regulation.However, oxytocin's role in BPD treatment remains uncertain, with some studies suggesting potential benefits for specific symptoms like social threat avoidance, while others indicate adverse effects on nonverbal behavior and mentalizing.Conclusion: Understanding oxytocin's role in BPD offers insights into potential therapeutic interventions. While oxytocin-based treatments may hold promise for addressing specific symptoms, further research is needed.

Therapeutic termination of pregnancy (TToP) is performed for maternal health risks or severe fetal malformations. Research focuses on women's psychopathological outcomes after TToP, noting that 10-22% of women experience psychiatric disorders, especially depressive symptoms and post-traumatic stress disorder (PTSD). However, little is known about paternal mental outcomes. This study analyzed biological fathers' mental health at a 1-year follow-up after TToP. Results indicate biological fathers show no alarming psychiatric outcomes one-year post-TToP, with no signs of PTSD. Resilience might be a protective factor, but further research is needed. Furthermore, the high percentage of paternal emotional neglect during childhood should interfere with the conclusions. Additional analysis is mandatory and it is essential to highlight that 30% of the original male sample refused to complete the questionnaires due to emotional distress in recalling. Still, their data are missing, and it is not possible to make inferences from them. However, mental health support should be offered on a regular basis to both men and women.

The aim of the “Diogene Project” is to recruit, evaluate, and treat homeless people affected by psychiatric disorders. Three multidisciplinary street units patrolled the streets in Milan, Italy, two/three evenings per week to recruit participants. A sociodemographic questionnaire, the HoNOS, and the GAF were administered at recruitment (T0), 1 year (T1), and 2 years (T2) after the first evaluation. Personalized treatment (none, social support, psychiatric treatment + social support) was tailored to each patient's needs. One hundred twelve homeless people participated. Forty-six users dropped out after the first assessment. The highest percentage of dropouts was registered among those who did not receive any kind of treatment (67.4%). Time spent on the street was not significantly correlated to adherence and outcome. Interestingly, the greatest improvement in psychopathological symptoms was recorded among patients under both treatments. This study confirms the validity of our model in approaching such vulnerable patients through specific interventions.

Narcissistic personality disorder is characterized by self-absorption, grandiosity, exploitation of others and lack of empathy. People with that disorder may switch from an overt form, mainly with grandiosity, to a covert presentation, with fears, hypersensitivity and dependence from others. Empathy represents a key point in detecting people affected by narcissistic personality disorder because, even if it is described as reduced, it plays a fundamental role in exploitation and manipulation. A systematic search of Literature without any language or time restriction, was performed combining thesaurus and free-search indexing terms related to Narcissistic personality disorder and empathy and produced 531 results. Fifty-two papers that analyzed possible issues in the empathic attitude of people with narcissistic personality disorder were included in this narrative review. Empathy is the capability of understating and feeling others emotions. It is not a unitary construct and can be distinguished in cognitive and affective. It might be channeled into prosocial and antisocial behaviors. A crucial trait identified in narcissistic empathy is affective dissonance that is closely related to rivalry as part of the dark tetrad (narcissism, machiavellianism, psychopathy, and sadism). Subjects affected by narcissistic personality disorder show greater impairment in affective aspects while their cognitive part of empathy appears preserved. Saving at least the cognitive aspects of empathy may contribute to therapeutic improvement of affective aspects.