Federica Marcolini

Background: Sex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care. Objective: To examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS–AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study. Methods: A cohort of 1004 adolescents (aged 17–19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories. Findings: Males showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder). Conclusions: Sex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS–AMHS transition, with males generally more impaired and females showing better adaptive outcomes. Clinical implications: Identifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions—especially for under-recognised presentations such as ADHD/ASD in females and ED in males. Trial registration number: ISRCTN83240263 .

Introduction: Catatonia is a complex neuropsychiatric syndrome characterized by psychomotor and affective symptoms. While current neurobiological models have focused on cortical and cerebellar dysfunctions, the limbic system—crucial for emotional regulation and motivation—remains comparatively underexplored. Emerging evidence suggests that limbic abnormalities may contribute to the pathophysiology of catatonia, offering a more integrated understanding of its clinical manifestations. Aims: This systematic review aims to synthesize current evidence on neurobiological abnormalities within the limbic system in individuals with catatonia and to identify which structures may be implicated in symptom development. Methods: Following PRISMA guidelines, systematic searches were conducted across MEDLINE, Web of Science, PsycINFO, and Scopus without date restrictions. Eligible studies included patients with a codified catatonia diagnosis undergoing instrumental or biological investigations involving limbic structures. Data extraction covered study design, diagnostic criteria, limbic regions assessed, and neuroanatomical or functional findings. Results: A total of 1792 studies were identified through database searching, of which 54 full-text articles were assessed; 14 studies met the inclusion criteria and were included. Six additional studies were identified through reference screening, resulting in 20 included articles: 13 observational studies and seven case reports. Most investigations highlighted alterations in the anterior cingulate cortex, including abnormal gyrification, grey matter reduction, and perfusion changes associated with catatonic symptoms. Orbitofrontal cortex abnormalities—though not classically part of the limbic system—were also frequently reported. Evidence regarding other regions was heterogeneous and included volumetric abnormalities of the amygdala and hypothalamus, as well as genetic or acquired factors affecting limbic biochemical regulation. Conclusions: This systematic review highlights the available neuroanatomical findings in patients with catatonia, supporting the involvement of limbic structures in the development and maintenance of this syndrome. However, variability in catatonia assessment, small sample sizes and study designs limit definitive conclusions. Future studies are needed to better understand the neural underpinnings of catatonia and inform treatment strategies.

Introduction: Climate change poses a serious threat to fundamental human needs, including access to water, air, food, and housing. It also contributes to a range of mental health risks. Among its psychological impacts, eco-anxiety, defined by the American Psychological Association as a chronic fear of environmental doom, is receiving increasing attention. Although awareness of eco-anxiety is growing, research on this phenomenon remains limited, especially in countries like Italy, which the Intergovernmental Panel on Climate Change identifies as especially vulnerable to the consequences of global warming. Methods: This study investigated the prevalence of eco-anxiety in a sample of healthy Italian adults recruited among voluntary blood donors, focusing on its distribution across generational cohorts. In May 2024, an online questionnaire was administered via QR code to members of AVIS (Associazione Volontari Italiani Sangue) in Bologna. A total of 1,795 participants (1,060 males, 727 females, 8 non-binary) took part, ranging in age from 18 to 70 years (M = 46.6). Eco-anxiety was assessed using the Hogg Eco-Anxiety Scale (HEAS). Results: The sample showed a median HEAS score of 4.0 (IQR = 8.0). Kruskal–Wallis tests revealed significant differences across generational cohorts ( p < .001; ε² = 0.0603), with Generation Z (18–28 years) reporting the highest levels of eco-anxiety. Nearly half of Generation Z participants (48.4%) exhibited high levels of eco-anxiety (χ² = 81.3; p < .001; V = 0.213). Spearman’s correlation and linear regression analyses confirmed a strong association between younger age and elevated eco-anxiety scores. After adjusting for general anxiety and depressive symptoms, Generation Z participants were more than four times as likely as Baby Boomers to report high eco-anxiety (OR = 4.21; 95% CI [2.755, 6.421]). Conclusions: These findings highlight a marked generational gap in climate-related distress, underscoring the need for targeted psychological interventions for younger populations and further research into the mechanisms underlying eco-anxiety.

Anorexia Nervosa (AN) is a complex psychiatric illness, characterized by a high risk of developing cardiovascular complications. Given the high risk of vascular diseases in patients with AN, we can assume that patients with severe AN have a high risk of developing ischemic stroke. However, to the best of our knowledge, no reports of patients with AN presenting with ischemic stroke have been published, other than a report of the development of IS during refeeding therapy in patients with severe AN. The present case report is aimed at describing the characteristics of an ischemic stroke occurring in a 19-year-old university student who had a 6-month history of AN. She was a non-smoker, had no relevant medical history and no family history of stroke. Upon hospital admission due to symptoms of stroke (aphasia and facial droop), she exhibited severe malnutrition with a BMI of 12.8 kg/m2. Computerized tomography imaging revealed occlusion of the left M2 branch and a congruous extensive area of hypoperfusion. Further investigations ruled out all common causes of stroke: she had no vascular stenosis, no heart diseases or arrhythmias, and no shunts, and gave negative results in autoimmune, toxicological and thrombophilia screenings. Clinicians should suspect development of severe complications, including ischemic stroke, in patients with severe AN. Further extensive group studies or group-based studies are needed to elucidate the etiology of ischemic stroke in patients with severe AN. This will enable us to develop more precise and effective interventions.

Introduction: For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. Objectives: This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. Methods: We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. Results: Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, “Psychotherapy”, mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves “Pharmacological Treatments”. Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, “Brain Stimulation Therapies,” such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. Conclusions: SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.

Purpose: Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients’ motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. Methods: We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach’s α and McDonald’s ω estimates, and Confirmatory Factor Analysis (CFA). Results: Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). Conclusion: The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. Level of evidence: Level V, descriptive studies.

Background: Anorexia Nervosa (AN) poses significant therapeutic challenges, especially in cases meeting the criteria for Severe and Enduring Anorexia Nervosa (SE-AN). This subset of AN is associated with severe medical complications, frequent use of services, and the highest mortality rate among psychiatric disorders. Case presentation: In the present case series, 14 patients were selected from those currently or previously taken care of at the Eating Disorders Outpatients Unit of the Maggiore Hospital in Bologna between January 2012 and May 2023. This case series focuses on the effects of the disease, the treatment compliance, and the description of those variables that could help understand the great complexity of the disorder. Conclusion: This case series highlights the relevant issue of resistance to treatment, as well as medical and psychological complications that mark the life course of SE-AN patients. The chronicity of these disorders is determined by the overlapping of the disorder's ego-syntonic nature, the health system's difficulty in recognizing the problem in its early stages, and the presence of occupational and social impairment.