Article Highlights

In the “Article Highlights” of the first issue of 2022 of Clinical Neuropsychiatry, I had made an attempt to provide to summarize my impressions and my feelings about the “evolution” of Psychiatry during the last decade and, as a matter of facts, the variables that favored this evolution were many and not mutually exclusive. However, if there is something that all of us neuropsychiatry specialists and scholars will have to face in this new decade, it is the "crisis" of the so-called "biological" hypothesis. This issue of Clinical Neuropsychiatry that “closes” the year 2022 begins with an editorial of prof. Alfonso Troisi that manages to synthesize in an extraordinary way the results of over twenty years of scientific research dedicated to the so-called biological hypothesis.

Indeed, according to prof. Troisi (pp. 351-354), the main issue with biological psychiatry is that it relies on outdated ideas about how the human biology actually works. This is because this field has been tied to functional biology, which is a way of looking at the world that is based mostly on genetics, anatomy, and physiology. However, evolutionary biology may represent a different way of thinking that might eventually turn out to be more capable to take into account how people could be affected by their surroundings (i.e., development, relationships, and environment). If such new theoretical framework could be developed and aimed at incorporate both functional and evolutionary explanations, then, possibly, biological psychiatry may be able to get back on its feet.

Alongside the evolution of psychiatry, the interest in the consequences of the pandemic still remains a vivid hot-topic. On the other hand, even the vaccination campaign carried out has not been without controversy and numerous individuals have not hidden their hesitation in undergoing this type of treatment. Dr. Simone Cheli’s work (pp. 355364) aimed at investigating how externalizing traits might play a role in how people perceive the risk of cancer and whether they are more likely to hesitant about getting vaccinated for COVID-19. The study recruited 356 subjects who have either been treated for cancer or are in follow-up care for it and, indeed, highlighted that participants who were more concerned about the risks of vaccines were also more likely to be hesitant about getting vaccinated. However, this tendency resulted only partially associated with actual risk and hesitation was shown to be more likely in subjects who presented externalizing traits, even if they've followed all the other recommendations for getting vaccinated. As those results suggest, patients with externalizing traits may have difficulty coping with vaccination campaigns, which should possibly rethought and personalized to possibly prevent other health problems.

There is no doubt that correct adherence to treatments (even if publicized by promotional events or information) starts from a solid doctor-patient alliance. However, we must remain well aware of how difficult this can be to construct with patients with resistant psychotic spectrum disorders. In spite of this, there’s often an emphasis on the superiority of long-acting injectable antipsychotics (LAIs) over oral antipsychotics, even in terms of adherence and rehospitalization rates. So LAIs became particularly recommended during the COVID-19 pandemic. Dr. Mastelić and colleagues’ goal (pp. 365369) was to retrospectively identify if there was any significant difference in the number of rehospitalizations in patients treated for psychotic disorders with LAI antipsychotics versus oral antipsychotics. A total of 124 subjects were treated with oral antipsychotics, while 72 received LAIs along with oral antipsychotics. Interestingly, no significant difference in the number of rehospitalizations between the two groups emerged during the first year, nor during the second, nor after three years of follow-up while being, at the same time, remarked the crucial importance of an adequate adherence to treatments to avoid relapses and rehospitalizations.

The current issue of Clinical Neuropsychiatry proceeds in respectively presenting two papers focused the spectrum of post-traumatic disorders.

The study presented by Mazzoni and colleagues (pp. 379-389) investigated the effectiveness of the Eye Movement Desensitization Reprocessing (EMDR) Integrative Group Treatment Protocol (IGTP) for patients with a history of recurrent traumatic episodes of interpersonal nature. Seven women were recruited from a trauma centre, and offered 10 group sessions of the EMDR-IGTP. Before, at the end, and after 1 and 3 months since the conclusion of the treatment, they were assessed using a number of standardised measures. The results showed that the EMDR-IGTP was effective in reducing the number of traumatic memories and improving the patients' overall psychological well-being. After the EMDRIGTP treatment, all participants reported significant reductions in dissociative and traumatic symptoms. The patients also showed improved emotional regulation at 1- and 3-month follow-up assessments, suggesting that GITM-EMDR therapy may be helpful for people who have experienced traumatic episodes of interpersonal nature. Further research is needed in this area, but this suggests that GITM-EMDR may be a helpful treatment for people who have experienced these kinds of events.

Traumatic experiences may result into an extremely wide range of several, different, consequences. Scientists have been studying these consequences for a long time, and over the last few decades, there has been more focus on the negative effects. However, more recently, there has been discussion of the possible benefits of trauma, a condition that has been defined Post Traumatic Growth. Prof. Liliana Dell’Osso and her colleagues (pp. 390393) present a short but exhaustive editorial that aims at focusing on how traumatic experiences can have a positive effect on someone's development, even if they also are endowed of negative consequences.

In the current Clinical Neuropsychiatry issue, Carbone and colleagues (pp. 370-378) present an intriguing review of the scientific literature aimed at disentangle the possible connections intertwined amongst Type-2 Diabetes Mellitus, platelet activation and Alzheimer’s Disease. Indeed, subjects with type 2 diabetes often suffer of an abnormal platelet function, which, together with insulin resistance, hyperglycaemia and dyslipidaemia, may eventually turn into damage of the vascular system through a series of events (i.e. endothelial dysfunction, oxidative stress and low-grade inflammation). Activated platelets also contribute directly to cerebral amyloid angiopathy (CAA) by promoting the formation of beta-amyloid (Aβ) aggregates. In turn, Aβ activates platelets, creating a feedback loop that might suggest a role for platelets in the pathogenesis of Alzheimer's disease. Indeed, type 2 diabetes is associated with a 70% increased risk of developing dementia, including Alzheimer's disease and there is general agreement that insulin resistance might play a significant role in both conditions; therefore, "brain insulin resistance" has been suggested as a possible explanation for the growing body of evidence linking cognitive impairment and type 2 diabetes.