Nowadays, it is well-known that burnout is a syndrome that mainly affects the helping professions. The nursing profession is obviously among those categories of workers that can develop burnout and, precisely because of its proximity to people who suffer associated with high workloads characterized by high emotional impacts.

According to UNHCR, at the end of June 2024 there were 8 million asylum seekers and 43.7 million refugees worldwide, a 16% increase versus year end 2023 for both categories; these rapidly growing numbers are posing significant political, humanitarian, and healthcare challenges. These are persons who have been displaced due to wars, persecution, political and economic instability, climate change, and other disasters. Trauma, an inevitable consequence of forced displacement, is a crucial factor in the development of psychiatric diseases, causing short and long-term synaptic alterations. Post-traumatic stress disorder (PTSD), anxiety, depression, and impulse control disorders are prevalent in this sub-population; providing efficient mental health services is a global challenge that requires developing early mental health screening and treatment programs.

In contemporary bio-juridical debate, the expression 'Ulysses contract' is used to define a set of self-binding instruments through which a person who suffers from a mental disorder with a remitting-relapsing or cyclical pattern can make explicit their advance directives regarding psychiatric treatment (PAD), in anticipation of a crisis in which the subject's preferences may conflict with those previously expressed. Unlike other countries, Italy does not have a specific regulation regarding PAD; however, we believe that important hints may come from law 219/2017 regulating informed consent, advance directives and shared care planning. The aim of this paper is to provide an interpretation of shared care planning (SCP) in psychiatry and thus contribute to the discussion on the implementation of law 219/2017 for people with mental disorders. The article presents a description of PAD in the international context, highlights their value for the subject's self-determination, and considers obstacles and facilitators to advance directives in psychiatry resulting from the literature. Building on these elements and considering the SCP specificity, SCP is suggested as a tool for making advance decisions on treatment in the context of mental disorders, specifically of those with a remitting-relapsing or cyclical pattern. The study also points to the need for an interdisciplinary dialogue between the bioethical, legal and clinical field in order to confirm the validity of SCP in psychiatry, including with regards to Ulysses contracts, and to provide practical guidance to ensure its applicability.

Although bipolar disorder (BD) and cognitive impairment are straightly connected, limited tools exist to capture the patient's perspective on cognitive decline and its impact on this disorder. The aims of the study are: 1) to assess the reliability and validity of the Italian version of a brief self-report scale (COgnitive Complaints in Bipolar disorder Rating Assessment - COBRA) among euthymic bipolar patients; 2) to investigate the relationship between the self-report scale, COBRA, the objective neurocognitive measure Screen for Cognitive Impairment in Psychiatry (SCIP), and the course of illness in BD.

The increasing prevalence of Novel Psychoactive Substances (NPS) presents a significant challenge for both diagnosis and treatment, particularly due to the complex psychotic states they can induce. This paper explores the concept of lysergic psychoma, rooted in Bonhoeffer's exogenous psychosis model, and its relevance to modern substance-induced psychoses. Lysergic psychoma, characterized by vivid hallucinations, delusional thinking, and somatoesthetic disturbances, represents a critical stage where temporary psychotic episodes risk evolving into chronic psychosis. This condition is closely linked with mental automatism, a phenomenon initially described by De Clérambault, where patients experience uncontrollable, parasitic thoughts and sensations that disrupt normal cognitive functions. The study underscores the importance of recognizing mental automatism in the progression of substance-induced psychosis, particularly as NPS use continues to rise. It challenges traditional distinctions between endogenous and exogenous psychosis, suggesting a more nuanced understanding of the interaction between genetic predisposition, environmental stressors, and the neurobiological impacts of psychoactive substances. This work calls for refined diagnostic criteria and targeted interventions to address the growing mental health crisis associated with NPS use. Emphasizing early intervention and prevention, particularly among adolescents, is critical in mitigating the risks of these emerging psychotic disorders. Integrating historical perspectives with contemporary research, this study offers new insights into the psychopathological processes underlying substance-induced psychoses, providing valuable frameworks for clinical practice and future research.

This paper explores the concept of causality in Massimo Fagioli's works, in the context of his 'Human Birth Theory', especially with respect to propositions in Western philosophical thought and to the psychiatric debate. In the history of philosophy, the nature of cause-and-effect relationship has taken on three basic meanings: regular succession, rational deductibility and productive power. We propose how these are rethought in Fagioli's theorisation as follows: as psychic activity (reaction), as dynamic phenomenon in the context of an unconscious relationship, and as human creativity. In particular, Fagioli analyzed how, within sadomasochistic relationships, the subject unconsciously conceives a concept of cause as constant repetition, and how this dynamic is resolved pathologically with the annulment pulsion, through the psychic elimination of the external object. This makes it possible to regard interhuman relationships as irrational, unconscious dynamics. Finally, the concept of cause is reconsidered based on the internal emergence of new psychic contents for the disappearance fantasy - psychic human creativity - originating at birth. Implications for psychopathology, psychodynamics and psychotherapy are then discussed.

Catatonia, a complex neuropsychiatric condition, is frequently linked to psychiatric illnesses, especially schizophrenia. While its motor and behavioral signs are well-recognized, cognitive deficits in catatonia are insufficiently studied. This systematic review investigates whether catatonia involves impairments in attention, executive functioning, and other cognitive areas, particularly in psychiatric conditions like schizophrenia.

The Psychiatric Fast Track pathway at the Bolzano Hospital was established in 2023 to improve the management of psychiatric emergencies in the Emergency Department context. This brief document analyzes the current structuring of the pathway and its implementation in the practical reality of Bolzano and its surrounding area. The benefits of the pathway, the challenges encountered, and potential areas for improvement are discussed.

The intellectual capital of medicine is the creativity linking clinical practice and research. Intellectual freedom, that allows the emergence of new paradigms, is the basic component of scientific progress in medicine. There have been major threats to intellectual freedom in the past decades: financial conflicts of interest that allowed the drug industry to gain control of scientific societies, clinical practice guidelines and reporting investigations in meetings and journals; special interest groups suppressing the pluralism of viewpoints; financial thresholds for investigators reporting their data and views (open access journals); the totalitarian derive of Evidence-Based Medicine. Further, there have been growing attacks of publishers to the independence of editors and editorial boards, with the ensuing resignations of editors and members of the editorial boards. Such events recently occurred in a journal, Psychotherapy and Psychosomatics, that was a symbol of independent thinking, pluralism and innovations.

The aim of the study was to define compliance and clinical efficacy on sleep disorders of a niaprazine-based galenic product; the active molecule marketed by an Italian pharmaceutical company since long time is no longer available as medical prescriptions are mostly oriented towards benzodiazepines and derivatives whose side effects in the medium-long term suggest however moderating and modulating their use. Niaprazine might therefore be prescribed in the interval drop out of benzodiazepines, or even as a primary therapeutic indication without significant side effects as widely confirmed by its previous historical use very frequent in children. Our research evaluated some aspects of prescribing pertinence and the clinical outcome results obtained with the use of galenic niaprazine in a cohort of patients with an indication for hypnoinducing treatment.

Many women with perinatal depression (PND) do not respond adequately to treatment, and perinatal insomnia remains particularly challenging to manage. The aim of this study was to evaluate the efficacy of light therapy (LT) as an adjunctive treatment to standard care in reducing symptoms of PND and sleep disturbances.

To compare magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) in adolescent major depressive disorder (MDD) regarding cognitive protection (assessed via the Montreal Cognitive Assessment, MoCA) and suicidality improvement (assessed via the Columbia-Suicide Severity Rating Scale, C-SSRS), with a focus on cognitive subdomains and the mediating role of cognitive changes.

Inflammation plays a role in the etiology and pathophysiology of schizophrenia symptoms, through the effects of proinflammatory cytokines such as IL-1β. Ajwa dates are one of the non-pharmacological modalities that have anti-inflammatory and antioxidant properties. However, clinical trials are still limited in exploring the role of Ajwa dates as an adjuvant in the management of schizophrenia.

The debate on assisted suicide for patients suffering from severe depression raises complex issues spanning clinical, ethical, scientific, medico-legal, and cultural domains. This position paper asserts that such an option is unacceptable in the context of depressive illness, even in its most severe and treatment-resistant forms. Depression is not an irreversible or terminal condition: there are multiple therapeutic options available, including spontaneous and late remissions, and suicidal ideation must be seen as a core symptom of the disorder, not as a rational choice. Scientifically, there are no reliable biomarkers to define the "incurability" of depression, and prognosis is often uncertain. Ethically, the principle of non-maleficence prohibits physicians from contributing to a patient's death, while the vulnerability of individuals with severe depression impairs their decision-making capacity. From a medico-legal standpoint, it is extremely difficult to assess competence in such contexts with any degree of certainty. Culturally and symbolically, psychiatry must reaffirm its healing mandate and resist dangerous shifts that could legitimize stigma or suicidal contagion. In conclusion, psychiatrists cannot and must not adopt the role of facilitators of death. Instead, they are called to provide care, instil hope, and protect patients, even in the most challenging clinical scenarios.

Depression is a highly prevalent and debilitating condition that frequently coexists with various physical illnesses, including cardiovascular, metabolic, neurological, oncological, pulmonary, and gastrointestinal diseases. This bidirectional relationship complicates diagnosis, exacerbates disease burden, and negatively impacts clinical outcomes, quality of life, and treatment adherence. The underlying mechanisms involve neuroinflammation, autonomic dysfunction, metabolic dysregulation, and behavioral factors. The pharmacological management of depression in patients with comorbid physical conditions requires careful selection of antidepressants to minimize adverse effects and drug interactions. Special considerations are necessary for patients with hepatic and renal impairment, as altered drug metabolism and clearance may increase the risk of toxicity or therapeutic inefficacy. Similarly, in pregnant and breastfeeding women, antidepressant selection must balance maternal benefits with fetal and neonatal safety. While SSRIs such as sertraline are generally preferred due to their relatively favorable safety profiles, medications like paroxetine and fluoxetine require caution due to potential teratogenic risks and higher infant exposure through breast milk. A comprehensive, multidisciplinary approach integrating psychiatric and medical care is essential to improve outcomes and ensure the safe and effective treatment of depression in individuals with chronic physical diseases and special populations.

A study was conducted on the acceptability of a music therapy intervention in a group context, in a psychiatric ward where people with acute psychopathological conditions are hospitalized. The objectives of the intervention are both therapeutic (stress reduction) and informative-descriptive, on topics ranging from stress management, to the first signs of crisis and drugs. For this purpose, musical stimuli provided by the presentation, listening and analysis of author's pieces were used, through the diffusion of pleasant sounds at moderate rhythm and volume among patients and operators. Acceptability was assessed through a satisfaction questionnaire. The responses to the questionnaire were very positive, confirming the narrative observations of the operators who found favorable ways of interacting with the patients with whom they shared the activity in all its contents. Participation in the music therapy intervention in a group context led users to an improvement in their stress management skills and to a more positive adaptation to the condition of hospitalization.

Artificial intelligence (AI) is the simulation of human intelligence by machines, especially computer systems. It includes learning, reasoning, and problem-solving. Chatbots are AI-powered programs that simulates human conversation. This paper explores the growing role of AI, particularly chatbots, in the field of mental health.

To assess the utilization rate of a university psychological counselling center in Southern Italy, a retrospective analysis of data collected from September 2018 to December 2023 was conducted.

The consequences of war extend beyond the directly exposed generation, affecting the mental and physical health of descendants. Recent studies show that trauma can be transmitted intergenerationally through epigenetic mechanisms, altering gene expression without changes to the DNA sequence. This editorial explores the psychological impact of war, highlighting epigenetic effects in the offspring of survivors.

Tardive dyskinesia (TD) is a chronic, often disabling hyperkinetic movement disorder associated with prolonged use of dopamine receptor blocking agents (DRBAs), particularly antipsychotics (APs) for psychiatric disorders such as schizophrenia and bipolar disorder. It manifests as abnormal, involuntary movements, often involving the orofacial region, extremities, or trunk, and is associated with significant physical and psychosocial impairment. TD is primarily linked to dopamine receptor hypersensitivity, oxidative stress, and genetic susceptibility, with a higher prevalence in patients treated with first-generation APs. However, second-generation APs (SGAs) have not eliminated the risk entirely, particularly in older adults and those with prolonged exposure. Diagnosis relies on clinical assessments such as the Abnormal Involuntary Movement Scale (AIMS) and comprehensive neurological evaluations. Treatment guidelines emphasize early detection, prevention through minimal effective doses of APs, and the use of VMAT2 inhibitors (vesicular monoamine transporter 2 inhibitors) as a first-line therapy in moderate-to-severe cases. VMAT2 inhibitors reduce dopamine signaling dysregulation without directly blocking D2 receptors, effectively managing symptoms in many patients. For treatment-resistant cases, deep brain stimulation and other non-pharmacological interventions offer promising alternatives. Current research underscores the complexity of TD's pathophysiology and the need for personalized approaches. Future directions include developing biomarkers for risk stratification, refining therapeutic strategies, and optimizing long-term outcomes through multidisciplinary care.

The liquidity of postmodernity would appear to have been displaced, within the mainstream, by a process of re-solidification under the aegis of strong values seeking cultural hegemony. The Author designates this shift as a form of "neo-Victorian puritanism", antithetical to the past in terms of ideological content yet equally prescriptive and homogenizing. At the level of clinical practice, its most salient effect manifests itself in the eclipse of sexuality as a theme, insofar as the clinician often refrains from engaging with it, not least out of concern for being perceived as deviating from the prevailing "neo-Victorian" cultural norm.