Giuseppe Mandracchia

Background: Cannabis is the most widely used illicit substance, particularly among youth. Earlier onset is associated with poorer clinical trajectories in cannabis use disorder (CUD), but its relationship with hedonic–motivational components remains unclear. Methods: Outpatients with severe CUD (n = 121) were stratified by age at onset (n = 112) served as a reference group. Results: CUD groups were comparable in clinical characteristics and cannabis use patterns. TEPS-Anticipatory scores were lower in patients with onset before age 18 (p < 0.001) and remained associated with onset group after adjustment for gender, education, and CUD duration (p < 0.001). When healthy subjects were included, significant group effects were observed (p < 0.001). Post hoc comparisons confirmed reduced TEPS-Anticipatory scores in early-onset vs. both later-onset and control groups, and higher SHAPS scores in both CUD groups vs. controls. Conclusions: CUD onset before age 18 is associated with reduced anticipatory pleasure, suggesting a greater involvement of anticipatory than other dimensions of hedonic functioning. Age at onset may therefore help identify patients with greater motivational vulnerability and inform early, targeted prevention and intervention strategies.

Complex psychosis (CP) remains one of the most challenging conditions in mental health, characterized by persistent symptoms, cognitive impairment, functional disability, and reduced autonomy. Traditional rehabilitation approaches, although essential, are often insufficient to address the multidimensional needs of these individuals. Over the past decade, rapid advances in digital health have opened new opportunities to enhance psychosocial rehabilitation, improve engagement, and personalize treatment pathways. This narrative review synthesizes current evidence on the use of digital and immersive technologies in the rehabilitation of people with CP, including virtual reality (VR), augmented reality (AR), telerehabilitation platforms, mobile health (m-Health) applications, digital phenotyping, and AI-assisted cognitive remediation. We examine clinical trials, feasibility studies, and real-world implementations published between 2015 and 2025, highlighting the efficacy of VR-based social cognition training, remote cognitive remediation, ecological momentary interventions, and hybrid digital–in-person rehabilitation models. Mechanisms of action, transfer to real-world functioning, and predictors of engagement are described. Barriers such as digital literacy, access disparities, privacy concerns, and clinical integration are critically discussed. We also outline future directions, including adaptive algorithms, biosensor integration, and the development of multimodal digital ecosystems tailored to individual recovery trajectories. By integrating technological innovation with recovery-oriented care, digital rehabilitation tools have the potential to transform the treatment landscape for people with CP. This review offers a roadmap for clinicians, researchers, and policymakers seeking to incorporate evidence-based digital solutions into modern psychiatric rehabilitation.

Background: The advent of digital technology has significantly altered ways of writing. While typing has become the dominant mode of written communication, handwriting remains a fundamental human skill, and its profound impact on cognitive processes continues to be a topic of intense scientific scrutiny. Methods: This paper investigates the neural mechanisms underlying handwriting and typing, exploring the distinct cognitive and neurological benefits associated with each. By synthesizing findings from neuroimaging studies, we explore how handwriting and typing differentially activate brain regions associated with motor control, sensory perception, and higher-order cognitive functions. Results: Handwriting activates a broader network of brain regions involved in motor, sensory, and cognitive processing. Typing engages fewer neural circuits, resulting in more passive cognitive engagement. Despite the advantages of typing in terms of speed and convenience, handwriting remains an important tool for learning and memory retention, particularly in educational contexts. Conclusions: This review contributes to the ongoing debate about the role of technology in education and cognitive development. By understanding the neural differences between handwriting and typing, we can gain insights into optimal learning strategies and potential cognitive advantages, in order to optimize educational, cognitive, and psychological methodologies.

Background/Objectives: While positive symptoms of schizophrenia are often satisfactorily controlled, negative symptoms are difficult to treat, persisting despite treatment. Different strategies have been devised to deal with this problem. We aimed to review drug treatment for negative symptoms of schizophrenia in controlled trials of marketed drugs. Methods: We searched the PubMed database and the resulting records’ reference lists to identify eligible trials using schizophrenia[ti] AND “negative symptom*”[ti] as a search strategy. We determined eligibility through Delphi rounds among all authors. Results: On 11 February 2025, we identified 1485 records on PubMed and 3 more from reference lists. Eligible were 95 records. Most studies were double-blind, randomized controlled trials, carried-out in add-on in patients stabilized with antipsychotics. Other antipsychotics were the most frequent comparators, followed by antidepressants, and recently, antioxidants are gaining importance in trials. Many trials, especially those conducted in the Western world, found no significant effects compared to placebo, while most Iranian studies were positive, although not with a strong effect size. Conclusions: Current research has contributed little to progress in the treatment of the negative symptoms of schizophrenia. The reason might reside in the absence of knowledge of the mechanisms whereby these symptoms are generated, which prevents us from designing possibly effective treatment strategies, and/or to the chronicity of negative symptoms, as they are the first to be established even when they do not become fully apparent.

Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers’ underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.