Gabriele Mandarelli | Università degli Studi "La Sapienza" di Roma (original) (raw)

Papers by Gabriele Mandarelli

Research paper thumbnail of Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study

International Journal of Social Psychiatry

Background: Immigrants in Europe appear to be at higher risk of psychiatric coercive intervention... more Background: Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. Methods: In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the ...

Research paper thumbnail of Schizophrenia: the issue of psychopathological dimensions

Official Journal of the Italian Society of Psychopathology, 2008

Research paper thumbnail of Relationship between the core features of Tellenbach's Typus Melancholicus and unipolar depressive disorders: a cross-sectional study

Rivista di psichiatria, 2020

PURPOSE One of the most consistent models investigating the relationship between premorbid person... more PURPOSE One of the most consistent models investigating the relationship between premorbid personality and depression was described by Tellenbach. According to this model, concern with orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity are the core features of Typus Melancholicus (TM). Previous studies showed a relationship between unipolar depression and TM. The primary hypothesis of this study was that patients affected by unipolar depressive disorders bare more of TM-related features of concern with orderliness and conscientiousness than healthy subjects. METHODS In this single center cross-sectional study we recruited 74 patients affected by unipolar depressive disorders according to DSM-5 criteria and 60 healthy controls. In order to assess the presence of TM's orderliness and conscientiousness we adopted the factors of Kasahara's Inventory for the Melancholic Type Personality (KIMTP) named "harmony in personal relationships" and &...

Research paper thumbnail of Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis

International Psychogeriatrics

Objectives: To perform a meta-analysis of clinical studies on the differences in treatment or res... more Objectives: To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD), and healthy comparisons (HCs). Design: A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases. Setting: The United States, France, Japan, and China. Participants: Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included. Measurements: The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC). Results: We identified 109 potentially eligible studies fro...

Research paper thumbnail of Patricide and overkill: a review of the literature and case report of a murder with Capgras delusion

Forensic Science, Medicine and Pathology

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spect... more Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature.

Research paper thumbnail of Women and Men who Committed Murder: Male/Female Psychopathic Homicides

Journal of Forensic Sciences

The present study was designed to compare gender differences in psychiatric diagnosis with the di... more The present study was designed to compare gender differences in psychiatric diagnosis with the dimension of psychopathy in women and men who had attempted or committed homicide. The study samples consisted of 39 homicidal females and 48 homicidal males who were confined in one of Italy’s REMS or prison facilities in two southern provinces of Italy (Puglia and Basilicata). Assessment instruments included the SCID‐5, the PID‐5 IRF, and the PCL‐R. Each gender group was stratified according to the level of criminal responsibility for the homicidal offense (full, partial, absent), and after assessments, according to the degree of the psychopathic dimension. There were clear gender differences in homicidal individuals. Female offenders were less likely to have had a record of criminal charges/convictions or imprisonment, and their homicides were more often intrafamilial, victimizing especially of their children, whereas males targeted intimate partners and extrafamilial victims. In the entire group, there was an inverse relationship between the level of psychopathy and the personality disorder on one side, and the psychotic disturbance on the other. Factor 2 (lifestyle/antisocial dimension) of the PCL‐R was higher among the homicidal males, whereas females tended to score higher on Factor 1 (the interpersonal/affective dimension). Finally, if the psychopathic dimension is a qualifier for antisocial personality disorder, as indicated in DSM‐5, this appears to be less true for females who tend to have other personality disorders.

Research paper thumbnail of Parachuting fatality: A case report video-recorded

Forensic Science International: Reports

Abstract Parachuting accidents are very uncommon and mostly related to landing and incorrect proc... more Abstract Parachuting accidents are very uncommon and mostly related to landing and incorrect procedures. In these cases, the cause of death is usually easily identified but the events leading up to death are usually a matter for investigation. We describe the case of a former military parachutist who died after civilian skydiving. A total body computed tomography scan, an external examination, and a complete medico-legal autopsy were performed. Furthermore, the fatality was filmed from two different observation points so the specific dynamic of the events and the injuries observed could be explained. This unusual case highlights the importance of a multidisciplinary forensic investigation.

Research paper thumbnail of Ethical Challenges in Health Care Policy during COVID-19 Pandemic in Italy

Medicina

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be on... more Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethi...

Research paper thumbnail of Admission Experience Survey--Italian Version

Research paper thumbnail of Psychopathy in Italian female murderers

Behavioral Sciences & the Law

Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming... more Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming one of the lowest rates in Europe (357 = 0.7 per 100,000 inhabitants in 2017, according to ISTAT). The number of homicides committed by women was about 9% of the total number of homicides during our study period. The percentage has increased in recent years because the total number of homicides has decreased without a proportionate decrease in the number of female homicides. Indeed, murder is an unusual type of crime for a woman and is often associated with a mental disorder, so when a woman committed a homicide, a psychiatric assessment was often performed. A forensic psychiatry expert was assigned to investigate the offender's psychopathology and mental state at the time of the offense. The root causes of the crime remained unexplained, however, due to the lack of a psychiatric precedent to justify this kind of assessment. The role of psychopathy in homicide has seldom been studied in female offenders, even though psychopathy has an important role in violent crimes. The investigators examined, clinically and historically, a sample of women who committed murder with different levels of criminal responsibility (female homicide offenders found not guilty by reason of insanity, having partial criminal responsibility, and convicted as criminally responsible and sentenced to prison) to identify the prevalence of the psychopathic dimension and its possible role in this sample. Prevalence and degree of psychopathic traits were examined in these female offenders using the Psychopathy Checklist-Revised. This study showed that females who had committed homicide were likely to suffer from mental illness; most of the homicidal acts were committed impulsively; and most female homicides occurred within the family, especially among women who were psychotic, but less so if they were psychopathic. Psychopathy tended to co-occur more with personality disorders than with psychotic psychopathology. Psychopathy was more evident among female homicide offenders who had been abused or traumatized. Psychopathic women who killed had high factor F1 scores and low antisocial component of factor F2.

Research paper thumbnail of Translating clinical findings to the legal norm: the Defendant’s Insanity Assessment Support Scale (DIASS)

Translational Psychiatry

Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on... more Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on the jurisdictions. Yet, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at crime time. Despite some efforts having been made to guide and structure criminal responsibility evaluations, a valid instrument that could be useful to guide forensic psychiatrists’ criminal responsibility assessments in different jurisdictions is lacking. This is a gap that needs to be addressed, considering the significant forensic and procedural implications of psychiatric evaluations. In addition, differences in methodology used in insanity assessments may also have consequences for the principle of equal rights for all citizens before the law, which should be guaranteed in the European Union. We developed an instrument, the Defendant’s Insanity Assessment Support Scale (DIASS), which can be useful to support, struct...

Research paper thumbnail of Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Epidemiology and Psychiatric Sciences, 2017

Aims. To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in... more Aims. To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients. Methods. 131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed. Results. Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p &lt...

Research paper thumbnail of P02-72-Clinical assessment of competence to consent to sexual activity in bipolar disorder and schizophrenic spectrum disorders. A preliminary study

Objectives: To develop a clinician-oriented semi-structured interview for the assessment of sexua... more Objectives: To develop a clinician-oriented semi-structured interview for the assessment of sexual consent: the Sexual Consent Competency Assessment Scale (SCAS). To assess sexual consent competence in a sample of hospitalized patients, affected by bipolar disorder (BD) and schizophrenic spectrum disorders (SSD, schizophrenia or schizoaffective disorder). Methods: Patients were recruited at the Psychiatric ward of S. Spirito Hospital, Rome and diagnosed according to DSM-IV-TR criteria. The SCAS items were derived and adapted from Kennedy et al. (Am J Ment Retard 2001;106:503-510). The scale items were directly rated by 2 independent clinicians, on a 3point Likert Scale corresponding to 3 possible outcomes: capable, marginally capable or incapable. Internal consistency, test-retest and inter rater-reliability were good. Principal component factor analysis (PCA) with varimax rotation was applied. Results: Fifty-four BD patients (51.9% females) and 31 SSD patients (71.0% females) were recruited (mean age, years: 38.1±13.4; 38.4±9.7 respectively; p=0.91). BD patients had better sexual consent competence compared to SSD, there were no gender differences. Cognitive functioning as measured by the Raven Progressive Matrices appeared to moderate the relationship between diagnostic group and sexual consent decisional capacity, with better scores corresponding to higher competence. PCA revealed two interpretable factors 1) cognitive-emotional and 2) consequences-prevention. There were no significant group differences between BP and SSD in the second factor. Conclusion: The SCAS proved good psychometric validity and reliability. Patients with bipolar disorder showed better sexual consent competence compared to schizophrenic spectrum disorders.

Research paper thumbnail of The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization

Background. Mastering a first language at school is mediated by the regulatory abilities of pupil... more Background. Mastering a first language at school is mediated by the regulatory abilities of pupils. An open question is how the executive functions implementing conscious self-regulation are related to language competences. Objective. To study the relationship between basic executive functions (switching, inhibition, working memory updating, and error correction) and language competences. Design. A sample of 104 Russian middle school children (aged 13-15 years) performed three cognitive tasks assessing basic executive functions and two tasks assessing language competences in the areas of punctuation, spelling, morphology, syntax, semantics, vocabulary, and style. Results. Inhibition was mostly related to punctuation, spelling, and morphology competences and was most important in the first competences task, requiring the recognition of errors. Switching was mostly related to the competences in syntax, reflecting the importance of switching attention between alternative syntactic structures. Working memory updating was the most important executive function related to language competences, with a heavy focus on higher-level lexical, semantic, and stylistic competences. The role of updating was especially important in the second competences task, which required generation of well-formed sentences. Error correction was mostly relevant for the recognition of language errors. Conclusion. While inhibition and switching affect aspects of constructing the surface form of a sentence, working memory is preferentially related to the construction of semantically appropriate sentences. Error monitoring and correction are generally related to the recognition of language errors. Conscious self-regulation and its cognitive mechanisms are systematically related to the development of native language competences in middle school.

Research paper thumbnail of Informed Consent Decision-Making in Deep Brain Stimulation

Brain Sciences

Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson's diseas... more Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson's disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessivecompulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.

Research paper thumbnail of P02-71 - Competence to give informed consent in acute psychiatric hospitalization. Preliminary results from a case-control study

European Psychiatry, 2010

To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental ... more To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental disorder, as compared to matched acute voluntary hospitalized patients (VHP). To evaluate the effect of psychopathology severity and cognitive dysfunction on decisional capacity.

Research paper thumbnail of THE RELATIONSHP BETWEEN EXECUTIVE FUNCTIONS AND CAPACITY TO CONSENT TO TREATMENT I N ACUTE PSYCHIATRIC HOSPITALIZATION

Despite the acknowledged ingluence of cognition on patients' capacity to consent to treatment, th... more Despite the acknowledged ingluence of cognition on patients' capacity to consent to treatment, the specific neuropsychological domains involved remain elusive, as does the role of executive functions. We investigated possible associations between executive functions and decisional capacity in a sample of acute psychiatric inpatients. Patients were recruited and evaluated through the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini-Mental State Examination (MMSE), and the Wisconsin Card Sorting Test (WCST). Patients with poor executive functioning performed worse in MacCAT understanding, appreciation, and expression of a choice, compared with good performers. These findings point to the importance of cognition in decisional capacity processes. In addition, the strong association found between learning abilities and informed consent decision-making provide empirical evidence indicating possible cognitive enhancement strategies that may improve psychiatric patients' competency.

Research paper thumbnail of Decisional Capacity to Consent to Clinical Research Involving Placebo in Psychiatric Patients

Evidence from a few studies indicates the existence of several issues related to psychiatric pati... more Evidence from a few studies indicates the existence of several issues related to psychiatric patients’ decisional capacity to give
informed consent to clinical research. Clinicians often face difficulties in acquiring valid informed consent in clinical practice and even more so
in drug trials. Participants often fail to fully understand or retain information regarding the actual implications of research protocols. The Brief
Assessment for Consent to Clinical Research (BACO) was developed to investigate capacity to consent to clinical trials and further compare
patients with schizophrenia and healthy comparisons’ decisional capacity. A method to avoid possible confounding effects of choosing a treatment
regarding a current disease was applied. The study groups were administered the BACO and the MacArthur Competence Assessment Tool
for Clinical Research. Psychiatric patients performed poorer in comprehending, appreciating, and reasoning abilities, than their healthy counterparts.
Impaired cognitive functioning and psychiatric symptoms severity were associated with reduced capacity to consent.

Research paper thumbnail of Bradykinesia in patients with obsessive-compulsive disorder

European Psychiatry, 2010

Research paper thumbnail of The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review

Human Psychopharmacology: Clinical and Experimental, 2015

Objective The present study provides a comprehensive review of the existing literature on the saf... more Objective The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation. Methods Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE. Results Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding. Conclusions Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established.

Research paper thumbnail of Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study

International Journal of Social Psychiatry

Background: Immigrants in Europe appear to be at higher risk of psychiatric coercive intervention... more Background: Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. Methods: In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the ...

Research paper thumbnail of Schizophrenia: the issue of psychopathological dimensions

Official Journal of the Italian Society of Psychopathology, 2008

Research paper thumbnail of Relationship between the core features of Tellenbach's Typus Melancholicus and unipolar depressive disorders: a cross-sectional study

Rivista di psichiatria, 2020

PURPOSE One of the most consistent models investigating the relationship between premorbid person... more PURPOSE One of the most consistent models investigating the relationship between premorbid personality and depression was described by Tellenbach. According to this model, concern with orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity are the core features of Typus Melancholicus (TM). Previous studies showed a relationship between unipolar depression and TM. The primary hypothesis of this study was that patients affected by unipolar depressive disorders bare more of TM-related features of concern with orderliness and conscientiousness than healthy subjects. METHODS In this single center cross-sectional study we recruited 74 patients affected by unipolar depressive disorders according to DSM-5 criteria and 60 healthy controls. In order to assess the presence of TM's orderliness and conscientiousness we adopted the factors of Kasahara's Inventory for the Melancholic Type Personality (KIMTP) named "harmony in personal relationships" and &...

Research paper thumbnail of Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis

International Psychogeriatrics

Objectives: To perform a meta-analysis of clinical studies on the differences in treatment or res... more Objectives: To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD), and healthy comparisons (HCs). Design: A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases. Setting: The United States, France, Japan, and China. Participants: Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included. Measurements: The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC). Results: We identified 109 potentially eligible studies fro...

Research paper thumbnail of Patricide and overkill: a review of the literature and case report of a murder with Capgras delusion

Forensic Science, Medicine and Pathology

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spect... more Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature.

Research paper thumbnail of Women and Men who Committed Murder: Male/Female Psychopathic Homicides

Journal of Forensic Sciences

The present study was designed to compare gender differences in psychiatric diagnosis with the di... more The present study was designed to compare gender differences in psychiatric diagnosis with the dimension of psychopathy in women and men who had attempted or committed homicide. The study samples consisted of 39 homicidal females and 48 homicidal males who were confined in one of Italy’s REMS or prison facilities in two southern provinces of Italy (Puglia and Basilicata). Assessment instruments included the SCID‐5, the PID‐5 IRF, and the PCL‐R. Each gender group was stratified according to the level of criminal responsibility for the homicidal offense (full, partial, absent), and after assessments, according to the degree of the psychopathic dimension. There were clear gender differences in homicidal individuals. Female offenders were less likely to have had a record of criminal charges/convictions or imprisonment, and their homicides were more often intrafamilial, victimizing especially of their children, whereas males targeted intimate partners and extrafamilial victims. In the entire group, there was an inverse relationship between the level of psychopathy and the personality disorder on one side, and the psychotic disturbance on the other. Factor 2 (lifestyle/antisocial dimension) of the PCL‐R was higher among the homicidal males, whereas females tended to score higher on Factor 1 (the interpersonal/affective dimension). Finally, if the psychopathic dimension is a qualifier for antisocial personality disorder, as indicated in DSM‐5, this appears to be less true for females who tend to have other personality disorders.

Research paper thumbnail of Parachuting fatality: A case report video-recorded

Forensic Science International: Reports

Abstract Parachuting accidents are very uncommon and mostly related to landing and incorrect proc... more Abstract Parachuting accidents are very uncommon and mostly related to landing and incorrect procedures. In these cases, the cause of death is usually easily identified but the events leading up to death are usually a matter for investigation. We describe the case of a former military parachutist who died after civilian skydiving. A total body computed tomography scan, an external examination, and a complete medico-legal autopsy were performed. Furthermore, the fatality was filmed from two different observation points so the specific dynamic of the events and the injuries observed could be explained. This unusual case highlights the importance of a multidisciplinary forensic investigation.

Research paper thumbnail of Ethical Challenges in Health Care Policy during COVID-19 Pandemic in Italy

Medicina

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be on... more Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethi...

Research paper thumbnail of Admission Experience Survey--Italian Version

Research paper thumbnail of Psychopathy in Italian female murderers

Behavioral Sciences & the Law

Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming... more Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming one of the lowest rates in Europe (357 = 0.7 per 100,000 inhabitants in 2017, according to ISTAT). The number of homicides committed by women was about 9% of the total number of homicides during our study period. The percentage has increased in recent years because the total number of homicides has decreased without a proportionate decrease in the number of female homicides. Indeed, murder is an unusual type of crime for a woman and is often associated with a mental disorder, so when a woman committed a homicide, a psychiatric assessment was often performed. A forensic psychiatry expert was assigned to investigate the offender's psychopathology and mental state at the time of the offense. The root causes of the crime remained unexplained, however, due to the lack of a psychiatric precedent to justify this kind of assessment. The role of psychopathy in homicide has seldom been studied in female offenders, even though psychopathy has an important role in violent crimes. The investigators examined, clinically and historically, a sample of women who committed murder with different levels of criminal responsibility (female homicide offenders found not guilty by reason of insanity, having partial criminal responsibility, and convicted as criminally responsible and sentenced to prison) to identify the prevalence of the psychopathic dimension and its possible role in this sample. Prevalence and degree of psychopathic traits were examined in these female offenders using the Psychopathy Checklist-Revised. This study showed that females who had committed homicide were likely to suffer from mental illness; most of the homicidal acts were committed impulsively; and most female homicides occurred within the family, especially among women who were psychotic, but less so if they were psychopathic. Psychopathy tended to co-occur more with personality disorders than with psychotic psychopathology. Psychopathy was more evident among female homicide offenders who had been abused or traumatized. Psychopathic women who killed had high factor F1 scores and low antisocial component of factor F2.

Research paper thumbnail of Translating clinical findings to the legal norm: the Defendant’s Insanity Assessment Support Scale (DIASS)

Translational Psychiatry

Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on... more Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on the jurisdictions. Yet, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at crime time. Despite some efforts having been made to guide and structure criminal responsibility evaluations, a valid instrument that could be useful to guide forensic psychiatrists’ criminal responsibility assessments in different jurisdictions is lacking. This is a gap that needs to be addressed, considering the significant forensic and procedural implications of psychiatric evaluations. In addition, differences in methodology used in insanity assessments may also have consequences for the principle of equal rights for all citizens before the law, which should be guaranteed in the European Union. We developed an instrument, the Defendant’s Insanity Assessment Support Scale (DIASS), which can be useful to support, struct...

Research paper thumbnail of Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Epidemiology and Psychiatric Sciences, 2017

Aims. To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in... more Aims. To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients. Methods. 131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed. Results. Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p &lt...

Research paper thumbnail of P02-72-Clinical assessment of competence to consent to sexual activity in bipolar disorder and schizophrenic spectrum disorders. A preliminary study

Objectives: To develop a clinician-oriented semi-structured interview for the assessment of sexua... more Objectives: To develop a clinician-oriented semi-structured interview for the assessment of sexual consent: the Sexual Consent Competency Assessment Scale (SCAS). To assess sexual consent competence in a sample of hospitalized patients, affected by bipolar disorder (BD) and schizophrenic spectrum disorders (SSD, schizophrenia or schizoaffective disorder). Methods: Patients were recruited at the Psychiatric ward of S. Spirito Hospital, Rome and diagnosed according to DSM-IV-TR criteria. The SCAS items were derived and adapted from Kennedy et al. (Am J Ment Retard 2001;106:503-510). The scale items were directly rated by 2 independent clinicians, on a 3point Likert Scale corresponding to 3 possible outcomes: capable, marginally capable or incapable. Internal consistency, test-retest and inter rater-reliability were good. Principal component factor analysis (PCA) with varimax rotation was applied. Results: Fifty-four BD patients (51.9% females) and 31 SSD patients (71.0% females) were recruited (mean age, years: 38.1±13.4; 38.4±9.7 respectively; p=0.91). BD patients had better sexual consent competence compared to SSD, there were no gender differences. Cognitive functioning as measured by the Raven Progressive Matrices appeared to moderate the relationship between diagnostic group and sexual consent decisional capacity, with better scores corresponding to higher competence. PCA revealed two interpretable factors 1) cognitive-emotional and 2) consequences-prevention. There were no significant group differences between BP and SSD in the second factor. Conclusion: The SCAS proved good psychometric validity and reliability. Patients with bipolar disorder showed better sexual consent competence compared to schizophrenic spectrum disorders.

Research paper thumbnail of The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization

Background. Mastering a first language at school is mediated by the regulatory abilities of pupil... more Background. Mastering a first language at school is mediated by the regulatory abilities of pupils. An open question is how the executive functions implementing conscious self-regulation are related to language competences. Objective. To study the relationship between basic executive functions (switching, inhibition, working memory updating, and error correction) and language competences. Design. A sample of 104 Russian middle school children (aged 13-15 years) performed three cognitive tasks assessing basic executive functions and two tasks assessing language competences in the areas of punctuation, spelling, morphology, syntax, semantics, vocabulary, and style. Results. Inhibition was mostly related to punctuation, spelling, and morphology competences and was most important in the first competences task, requiring the recognition of errors. Switching was mostly related to the competences in syntax, reflecting the importance of switching attention between alternative syntactic structures. Working memory updating was the most important executive function related to language competences, with a heavy focus on higher-level lexical, semantic, and stylistic competences. The role of updating was especially important in the second competences task, which required generation of well-formed sentences. Error correction was mostly relevant for the recognition of language errors. Conclusion. While inhibition and switching affect aspects of constructing the surface form of a sentence, working memory is preferentially related to the construction of semantically appropriate sentences. Error monitoring and correction are generally related to the recognition of language errors. Conscious self-regulation and its cognitive mechanisms are systematically related to the development of native language competences in middle school.

Research paper thumbnail of Informed Consent Decision-Making in Deep Brain Stimulation

Brain Sciences

Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson's diseas... more Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson's disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessivecompulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.

Research paper thumbnail of P02-71 - Competence to give informed consent in acute psychiatric hospitalization. Preliminary results from a case-control study

European Psychiatry, 2010

To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental ... more To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental disorder, as compared to matched acute voluntary hospitalized patients (VHP). To evaluate the effect of psychopathology severity and cognitive dysfunction on decisional capacity.

Research paper thumbnail of THE RELATIONSHP BETWEEN EXECUTIVE FUNCTIONS AND CAPACITY TO CONSENT TO TREATMENT I N ACUTE PSYCHIATRIC HOSPITALIZATION

Despite the acknowledged ingluence of cognition on patients' capacity to consent to treatment, th... more Despite the acknowledged ingluence of cognition on patients' capacity to consent to treatment, the specific neuropsychological domains involved remain elusive, as does the role of executive functions. We investigated possible associations between executive functions and decisional capacity in a sample of acute psychiatric inpatients. Patients were recruited and evaluated through the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini-Mental State Examination (MMSE), and the Wisconsin Card Sorting Test (WCST). Patients with poor executive functioning performed worse in MacCAT understanding, appreciation, and expression of a choice, compared with good performers. These findings point to the importance of cognition in decisional capacity processes. In addition, the strong association found between learning abilities and informed consent decision-making provide empirical evidence indicating possible cognitive enhancement strategies that may improve psychiatric patients' competency.

Research paper thumbnail of Decisional Capacity to Consent to Clinical Research Involving Placebo in Psychiatric Patients

Evidence from a few studies indicates the existence of several issues related to psychiatric pati... more Evidence from a few studies indicates the existence of several issues related to psychiatric patients’ decisional capacity to give
informed consent to clinical research. Clinicians often face difficulties in acquiring valid informed consent in clinical practice and even more so
in drug trials. Participants often fail to fully understand or retain information regarding the actual implications of research protocols. The Brief
Assessment for Consent to Clinical Research (BACO) was developed to investigate capacity to consent to clinical trials and further compare
patients with schizophrenia and healthy comparisons’ decisional capacity. A method to avoid possible confounding effects of choosing a treatment
regarding a current disease was applied. The study groups were administered the BACO and the MacArthur Competence Assessment Tool
for Clinical Research. Psychiatric patients performed poorer in comprehending, appreciating, and reasoning abilities, than their healthy counterparts.
Impaired cognitive functioning and psychiatric symptoms severity were associated with reduced capacity to consent.

Research paper thumbnail of Bradykinesia in patients with obsessive-compulsive disorder

European Psychiatry, 2010

Research paper thumbnail of The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review

Human Psychopharmacology: Clinical and Experimental, 2015

Objective The present study provides a comprehensive review of the existing literature on the saf... more Objective The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation. Methods Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE. Results Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding. Conclusions Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established.