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Autism spectrum is a psychopathological dimension which encompasses a wide range of clinical presentations: from subthreshold forms and autistic traits (AT), that can be found in the general population, to full-blown autism spectrum disorder (ASD). Many studies reported high rates of comorbidity between both ASD and AT and mood disorders, as well as a high prevalence of suicidal ideation among patients with ASD/AT. The aim of this study was to investigate the presence of mood symptoms and suicidal ideation and behaviors in patients with full-blown ASD and in subjects with AT, as well in a healthy control (HC) group, with a specific focus on which of the autistic features may be predictive of suicidal ideation and behaviors. We recruited 262 adult subjects: 34 with ASD without intellectual impairment or language disability (ASD group), 68 fulfilling only one symptom criterion for ASD according to DSM-5 but who do not meet criteria for a full-blown diagnosis of ASD (AT group), and 160 HC. All subjects were assessed with the Structured Clinical Interview for DSM-5 (SCID-5); in addition, they were asked to fill two questionnaires: The Mood Spectrum, Self-report (MOODS-SR) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum). ASD subjects reported significantly higher AdAS Spectrum and MOODS-SR total scores, as well as higher MOODS-SR depressive component total scores, when compared with AT and HC subjects. AT subjects scored significantly higher than the HC group. No significant differences were reported between ASD and AT subjects for the suicidality score according to MOODS-SR, despite both groups scored significantly higher than the HC group. The strongest predictor of suicidality score were MOODS-SR depressive component score and AdAS Spectrum Restricted interests and rumination domain score. Our results highlight a correlation between autism and mood spectrum, as well as between suicidality and both ASD and AT. Subthreshold forms of ASD should be accurately investigated due to their relationship with suicidal thoughts and behaviors. •Mood symptoms are associated with both subthreshold and over threshold autism spectrum.•Suicidal thoughts and behaviors are equally associated with full-blown autism and autistic traits.•Ruminative thinking is the autistic dimension more strongly associated with suicidality.

Increasing literature has shown the usefulness of a dimensional approach to autism. The present study aimed to determine the psychometric properties of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), a new questionnaire specifically tailored to assess subthreshold forms of autism spectrum disorder (ASD) in adulthood. 102 adults endorsing at least one DSM-5 symptom criterion for ASD (ASDc), 143 adults diagnosed with a feeding and eating disorder (FED), and 160 subjects with no mental disorders (CTL), were recruited from 7 Italian University Departments of Psychiatry and administered the following: SCID-5, Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale 14-item version (RAADS-14), and AdAS Spectrum. The AdAS Spectrum demonstrated excellent internal consistency for the total score (Kuder–Richardson's coefficient=.964) as well as for five out of seven domains (all coefficients>.80) and sound test–retest reliability (ICC=.976). The total and domain AdAS Spectrum scores showed a moderate to strong (>.50) positive correlation with one another and with the AQ and RAADS-14 total scores. ASDc subjects reported significantly higher AdAS Spectrum total scores than both FED (p<.001) and CTL (p<.001), and significantly higher scores on the Childhood/adolescence, Verbal communication, Empathy, Inflexibility and adherence to routine, and Restricted interests and rumination domains (all p<.001) than FED, while on all domains compared to CTL. CTL displayed significantly lower total and domain scores than FED (all p<.001). A significant effect of gender emerged for the Hyper– and hyporeactivity to sensory input domain, with women showing higher scores than men (p=.003). A Diagnosis* Gender interaction was also found for the Verbal communication (p=.019) and Empathy (p=.023) domains. When splitting the ASDc in subjects with one symptom criterion (ASD1) and those with a ASD, and the FED in subjects with no ASD symptom criteria (FED0) and those with one ASD symptom criterion (FED1), a gradient of severity in AdAS Spectrum scores from CTL subjects to ASD patients, across FED0, ASD1, FED1 was shown. The AdAS Spectrum showed excellent internal consistency and test–retest reliability and strong convergent validity with alternative dimensional measures of ASD. The questionnaire performed differently among the three diagnostic groups and enlightened some significant effects of gender in the expression of autistic traits.

This multicentric randomized controlled trial (RCT), carried out in six Italian University mental health sites, aims to test the efficacy of a six-month psychosocial intervention (LYFESTYLE) on Body Mass Index (BMI), body weight, waist circumference, fasting glucose, triglycerides, cholesterol, Framingham and HOmeostasis Model Assessment of insulin resistance (HOMA-IR) indexes in patients with schizophrenia, bipolar disorder, and major depression. Moreover, the efficacy of the intervention has also been tested on several other physical and mental health domains. Patients were randomly allocated to receive the six-month experimental intervention (LIFESTYLE) or a behavioural control intervention. All enrolled patients were assessed at baseline and after one year. We recruited 401 patients (206 in the experimental and 195 in the control group) with a diagnosis of schizophrenia or other psychotic disorder (29.9%), bipolar disorder (43.3%), or major depression (26.9%). At one year, patients receiving the experimental intervention reported an improvement in body mass index, body weight, waist circumference, HOMA-IR index, anxiety and depressive symptoms and in quality of life. Our findings confirm the efficacy of the LIFESTYLE intervention in improving physical and mental health-related outcomes in patients with severe mental illnesses after one year.

Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours. 138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R). participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs. Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged. •Feeding and eating disorder patients show higher autism traits than healthy controls.•Rigidity and restricted interests are more represented in restricrive patients.•Different clinical presentations of autism spectrum symptoms are highlighted.

IntroductionPatients with Post-traumatic stress disorder (PTSD) or mood disorders, as depression, often showed dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, resulting in increased levels of pro-inflammatory cytokines and heightened activity of the immune system that may cause alterations in the structure and function of brain regions through direct neurotoxic effects, oxidative stress, changes in levels of neurotransmitters and decreasing some neurotrophins. Among the most studied pro-inflammatory cytokines in this field there are Intereleukine-6 (IL-6) and Interleukine-1β (IL-1β); however, scant and conflicting data are currently available in the literature about their use as potential biomarkers, and even less on possible comparisons in PTSD and depression.ObjectivesThe aim of the present study was to evaluate circulating levels of IL-6 and IL-1β in patients with PTSD and to compare them with those of subjects with depression and healthy controls.MethodsA sample of 45 subjects, including 15 subjects diagnosed with PTSD (PTSD group), 15 with depression (DEP group), and 15 healthy controls (HC group) were recruited at the Psychiatric Clinic of the Department of Clinical and Experimental Medicine, University of Pisa. HC group included subjects recruited on a voluntary basis. The psychiatric diagnosis was assessed by the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5-CV), the Impact of Event Scale-Revised (IES-R) and the Trauma and Loss Spectrum-Self Report lifetime version (TALS-SR). A peripheral venous blood sample was collected to perform the biochemical assays. The analyses of IL-6 and IL-1β were performed with a dedicated enzyme-linked immunosorbent assay (ELISAs) achieved at the Laboratory of Biochemistry of the Department of Pharmacy, University of Pisa.ResultsNo statistically significant gender or age differences emerged in the three groups. There were no statistically significant differences in IL-1β levels among the three groups. Conversely, the PTSD group showed higher levels of IL-6 compared to the DEP and to the HC ones, with a statistically significant difference in the post-hoc analysis among the PTSD and DEP groups with respect to the HC one (p<0.05).ConclusionsOur results suggest the key role of a chronic low-grade inflammatory state in PTSD and in depression, probably related to a dysregulation in HPA axis and cortisol release, with an increase in proinflammatory cytokines including IL-6 that seemed to be more pronounced in PTSD.Disclosure of InterestNone Declared

In recent years, numerous studies have highlighted the overlap between autism spectrum disorder (ASD) and catatonia, both from a clinical and pathophysiological perspective. This study aimed to investigate the relationship between the autism spectrum (autistic traits and ASD signs, symptoms, and behavioral manifestation) and Catatonia Spectrum (CS). A total sample of 376 subjects was distributed in four diagnostic groups. Subjects were assessed with the Structured Clinical Interview for DSM-5, Research Version, the Adult Autism Subthreshold Spectrum (AdAS Spectrum), and CS. In the statistical analyses, the total sample was also divided into three groups according to the degree of autism severity, based on the AdAS Spectrum total score. A statistically significant positive correlation was found between AdAS Spectrum and CS total score within the total sample, the gender subgroups, and the diagnostic categories. The AdAS Spectrum domains found to be significantly and strongly correlated with the total CS score were hyper-hypo reactivity to sensory input, verbal communication, nonverbal communication, restricted interests and rumination, and inflexibility and adherence to routine. The three groups of different autistic severity were found to be distributed across all diagnostic groups and the CS score increased significantly from the group without autistic traits to the group with ASD. Our study reports a strong correlation between autism spectrum and CS.

IntroductionSleep disturbances are frequently reported in patients with Bipolar Disorder (BD), parallel, patients with BD report significantly higher rates of exposure to major lifetime traumatic events than the general population with a high risk of developing PTSD.ObjectivesThe aim of this study was to compare sleep parameters subjectively and objectively measured, in patients with BD with or without PTSD with respect to healthy control subjects.Methods73 patients with BD (26 BD+ PTSD and 46 BDw/oPTSD) and 88 HC were evaluated through actigraphic monitoring to explore sleep and circadian parameters, scales exploring sleep quality (Pittsburgh Sleep Quality Index -PSQI-) and chronotype (reduced Morningness-Eveningness Questionnaire –rMEQ-) and the Trauma and Loss Spectrum Self Report (TALS-SR), for lifetime trauma and loss spectrum symptoms.ResultsCompared to age-matched HC, patients with BD reported lower sleep quality, lower rMEQ scores suggestive of delayed chronotype, longer total sleep time, higher waking after sleep onset, lower interdaily stability and lower sleep health. Patients with BD+PTSD reported significantly higher PSQI scores than BDw/oPTSD; significant correlations between the PSQI total scores and TALS-SR symptomatic domains emerged in the BD+PTSD group only.ConclusionsOur results suggest a strong correlation between sleep disturbances, particularly evaluated by subjective measures, and PTSD symptoms in patients with BD.Disclosure of InterestNone Declared

IntroductionThere is evidence that anxiety and depressive symptoms may lead individuals to under-estimate their own sleep quality, particularly among younger subjects (aged <45 yrs).ObjectivesThe aim of this study was to investigate the discrepancy between objective and subjective measurements of sleep quality in a sample of healthy control subjects (HCs) with no Axis I mental disorders, and the possible impact of panic-agoraphobic spectrum symptoms.MethodsA total of 117 HCs (65 males and 97 females; Age: 35.3±14yrs) were evaluated by the: Panic Agoraphobic Spectrum-Self Report (PAS-SR), to investigate panic spectrum; the Pittsburgh Sleep Quality Index (PSQI) and actigraphy, respectively for the subjective and the objective sleep efficiency (SE) measures. Groups were divided according to the congruence between SE-actigraphic vs SE-PSQI (“Accurate”, “Underestimate”, “Overestimate”), establishing as a threshold an SE>85% as a measure of good SE. Regression analyses were conducted to assess the association between PAS-SR domains and the discrepancy between objective and subjective measurements, controlling confounding factors such as age, gender and BMIResultsSince our data showed that a low sleep quality was associated with a greater age and that higher PAS-SR scores were associated with younger age, we used a sub-sample of 117 participants with age <45 years and comparing the 3 groups of subjects created on the basis of the discrepancy: Accurate, N = 74 (63.2 %), “Overestimate group”, N= 23 (19.7 %), “Underestimate group”: N=20 (17.1 %), we found a statistically significant difference among groups in the PAS.SR separation anxiety domain (p value=0.032), with a multinomial regression model confirming this domain contributed significantly to the differentiation between the three groups with higher symptoms being associated with a higher probability of belonging to the “underestimate” group.ConclusionsOur results suggest that the discrepancy between objective and subjective sleep efficiency measurements in HCs could be affected by panic spectrum symptoms, particularly separation anxiety.Disclosure of InterestNone Declared

Aims Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy. Methods Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents’ educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student’s unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score. Results more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender. Conclusions Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.

IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social interaction and communication, whose etiology is heterogeneous, including genetic, epigenetic, and environmental factors. It is associated with restricted interests and stereotyped behaviors with high prevalence rates in general population, neurobiological bases and high heritability.ObjectivesThe aim of our study is to identify the possible phenotype-genotype relationships regarding neurodevelopmental disorders and to evaluate a correlation between genomic alterations and the manifestations of the overt and subthreshold ASD in a family administered psychiatric clinical evaluations at our hospital.MethodsThe family M underwent a psychiatric evaluation through the MINI interview according to the SCID-5 criteria, the AQ, ADAS, PAS-SR, SHI-SHY,SHY-OBS to assess respectively the subthreshold traits of ASD in adulthood, the panic-agoraphobic, social-phobic and obsessive-compulsive spectrum and CAT-Q Italian version, to evaluate social camouflage behaviors typical of ASD individuals. Array Comparative Genomic Hybridization was used for studying DNA imbalances in this family.ResultsWe found that Mrs.A, her father, her brothers and her older sister had a microduplication, very likely pathogenic, since it has been never reported in healthy subjects and harbors several genes. It could be related with overt and subthreshold traits of ASD. From the questionnaires administered and from the clinical interview, it emerged that Mrs.A is affected by ASD and Bipolar Disorder. Her twin brothers have been evaluated at early ages by child neuropsychiatric clinic and they were diagnosed with ASD and mental and psychomotor impairment. Her father was reported a significant trend in ADAS, AQ, PAS-SR, SHI-SHY and SHY-OBS scores. Finally, about her older sister, even if our results were not significant for an ASD diagnosis, we speculated that she performed a high score in some ADAS items and in the CAT-Q but not in the AQ. Females generally tend to attract fewer attention than males thanks to their better coping and camouflaging mechanisms as well as their ability to “disappear” in large groups.ConclusionsGenetic knowledge can have a relevant clinical impact; a genetic etiology can be identified in individuals with ASD, leading to the identification of treatable psychiatric comorbidities. Furthermore, knowing the causative genetic variants of ASD could provide crucial information for genetic counseling as well as to understand the neurobiology of these disorders and to contribute to an early diagnosis.Disclosure of InterestNone Declared