Giuseppe Nicolo

Introduction: Borderline personality disorder (BPD) is marked by emotional instability, interpersonal dysfunction, and high comorbidity, posing significant treatment challenges. Metacognitive Interpersonal Therapy (MIT) targets core features of BPD, including metacognitive impairments and emotional dysregulation. This study uses Latent Transition A...

Background Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional dysregulation, impulsive behaviors, and difficulties in interpersonal relationships. Despite the poor understanding of the underlying biological processes, the oxytocin (OXT) system may be involved in and mediate some of BPD’s symptomatic and beh...

Introduction: Cognitive Impairment (CIAS) is a core aspect of schizophrenia and one of the main obstacles to clinical and functional recovery in patients. People with CIAS have difficulties with learning and using information in real world. Despite its well-recognized role, it is not yet a diagnostic criterion in DSM-5 and ICD system. The effective...

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...

Bipolar disorder is a debilitating psychiatric condition characterized by recurrent episodes of mania and depression, affecting millions worldwide. While pharmacotherapy remains the cornerstone of treatment, a significant proportion of patients exhibit inadequate response or intolerable side effects to conventional medications. In recent years, neu...

People diagnosed with psychiatric disorders are more likely to be both victims and perpetrators of violent conducts (Sariaslan et al., JAMA Psychiatry 77:359–367, 2020). Several studies (Witt et al., PLoS One 8(2):e55942, 2013) have found the correlation between different risk factors and violent behavior: history of violent victimization, male gen...

Il presente lavoro delinea le indicazioni di buona pratica clinica per il trattamento del disturbo bipolare sulla base dell'ultimo aggiornamento delle linee guida del National Institute for Health and Care Excellence (NICE). Alla luce degli interventi presi in considerazione, gli studi suggeriscono che gli interventi psicologici strutturati produco...

Bipolar disorder is a debilitating psychiatric condition characterized by recurrent episodes of mania and depression, affecting millions worldwide. While pharmacotherapy remains the cornerstone of treatment, a significant proportion of patients exhibit inadequate response or intolerable side effects to conventional medications. In recent years, neu...

Background Goal-directed decision-making is a central component of the broader reward and motivation system, and requires the ability to dynamically integrate both positive and negative feedback from the environment in order to maximize rewards and minimize losses over time. Altered decision-making processes, in which individuals fail to consider t...

Background: There has been a substantial change in the law on the provision of secure health services for offender-patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender-patient admissions between European countries....

Negli ultimi anni la classificazione dimensionale dei disturbi di personalità e lo sviluppo di trattamenti manualizzati hanno concorso a una nuova concettualizzazione di tali disturbi. Pertanto, si rende necessaria la messa in atto di trattamenti clinici basati su evidenze e buone pratiche, tramite l'applicazione di linee guida internazionali per i...

Treatment-resistant depression (TRD) represents a severe clinical condition with high social and economic costs. Esketamine Nasal Spray (ESK-NS) has recently been approved for TRD by EMA and FDA, but data about predictors of response are still lacking. Thus, a tool that can predict the individual patients’ probability of response to ESK-NS is neede...

Different psychotherapeutic approaches demonstrated their efficacy but the possible neurobiological mechanism underlying the effect of psychotherapy in borderline personality disorder (BPD) patients is poorly investigated. We assessed the effects of metacognitive interpersonal therapy (MIT) on BPD features and other dimensions compared to structure...

Background: bipolar depression accounts for most of the disease duration in type I and type II bipolar disorder (BD), with few treatment options, often poorly tolerated. Many individuals do not respond to first-line therapeutic options, resulting in treatment-resistant bipolar depression (B-TRD). Esketamine, the S-enantiomer of ketamine, has recent...

Aim: The aim is to describe remote multifamily psychoeducational intervention led by REMS "Castore" team (an Italian health care facility for offenders who suffer from mental disorders and socially dangerous) in ASL Roma 5, a local health authority, during covid-19 emergency. Methods: The applied theoretical models have been the integrated psych...

Background: People with Severe Mental Illness (SMI) (schizophrenia, bipolar disorder, major depressive disorder, and personality disorders) experience a considerable risk of premature mortality because of cardiovascular disease, smoking, metabolic syndrome, etc. Recent research has demonstrated that this population spends almost 13 h per day being...

istance learning has proven to be crucial for the safeguarding of high-level educational programs around the globe during the COVID-19 pandemic, which has represented an accelerator of the digital revolution of education, offering new possibilities but also posing new challenges. In this chapter, the case of an Italian psychotherapy training school...

I Social Skills Training (SST) sono considerati interventi psicosociali indispensabili e con maggiore evidenza scientifica per il trattamento della compromissione sociale causata dai disturbi mentali gravi. Il manuale offre una serie di pacchetti specifici di trattamento delle abilità sociali attraverso l’adozione di un approccio integrato, basato...

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choi...

Background Treatment-resistant Depression (TRD) represents a widespread disorder with significant direct and indirect healthcare costs. esketamine, the S-enantiomer of ketamine, has been recently approved for TRD, but real-world studies are needed to prove its efficacy in naturalistic settings. Objectives Evaluate the effectiveness and safety of e...

Background Several studies have identified traumatic history among forensic patients and its association with criminal behaviors and psychiatric diagnoses. Post-traumatic stress disorder (PTSD) is highly prevalent in forensic settings causing a serious deterioration of the primary psychiatric disorder. Aims Our study aims to evaluate the prevalenc...

Psychotic-like experiences (PLEs) are a phenomenon that occurs in the general population experiencing delusional thoughts and hallucinations without being in a clinical condition. PLEs involve erroneous attributions of inner cognitive events to the external environment and the presence of intrusive thoughts influenced by dysfunctional beliefs; for...

Objectives: This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: 1) patients' symptoms and global functioning; 2) relatives' objective and subjective burden and coping strategies. Methods: This is a multicentre,...

Covid-19 is an infective respiratory illness caused by a novel virus, which might present different degrees of severity: from mild or even asymptomatic carriers to severe pneumonia, requiring intubation and intensive care unit (ICU) management. SARS-CoV-2 may cause also central nervous system involvement, including psychiatric manifestations. Some...

RIASSUNTO. La gestione del paziente con schizofrenia richiede un approccio multidimensionale e integrato tra interventi farmacologici, psicologici e psicosociali. Tra i farmaci antipsicotici, le formulazioni long-acting (long-acting injectable antipsychotics-LAI) si sono dimostrate particolarmente efficaci per la gestione dei pazienti con episodi r...

Questo articolo illustra un protocollo cognitivo-comportamentale (CBT) per la terapia di gruppo del disturbo da Attacchi di Panico (DAP) con Agorafobia, sperimentato all’interno di un Centro di Salute Mentale di Roma. Il progetto è nato dall’esigenza di dare una risposta in tempi brevi al maggior numero possibile di utenti, con un trattamento in gr...

A good assessment and good feedback to the patient are fundamental to creating the basis of a good therapeutic relationship. This chapter describes the pretreatment phase, whose purpose is the diagnostic assessment of the patient useful to setting up an integrated therapeutic pathway whose strategic goal is the improvement of metacognitive function...

In this chapter, we present the case of Enrico, which has all the characteristics of what we can call “complex cases.” The difficulties that the therapist faces in both diagnosis and treatment planning are illustrated. Enrico has a rather varied symptomatology that does not fit into a specific diagnostic framework, and giving multiple categorical d...

This chapter discusses the state of the art of pharmacological treatment of personality disorders from a clinical perspective. Although it is important always to remember that no drug has yet been officially approved for the treatment of personality disorders, the chapter proposes a model of reasoned management of psychopathological and behavioral...

Metacognitive therapy proposes to enhance skills for knowing one’s mind with an eye to a better regulation of problematic mental states. Promoting metacognition and mastery of mental states are, therefore, the main strategic goals of our treatment. The promotion of metacognition is carried out through a set of procedures that break down metacogniti...

In treating complex cases, it is useful to have a team composed of psychotherapists experienced in the use of different techniques, so as to encourage multidisciplinarity and integration of the different procedures and techniques that modern psychotherapy offers us, in order to face each specific aspect of psychopathology. This chapter illustrates...

Aims The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psy...

Background This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods A total of 155 patients with BED complete...

Objective: The study intends to include the evaluation of family styles while the patients are admitted at a hospital dedicated to the emergency (SPDC). Methods: The sample of the study involved patients of a SPDC and their families. The clinical assessment has been conducted through the use of ICD-IX, DSM-5 and BPRS. During the stabilization ph...

This book proposes an integrated model of treatment for Personality Disorders (PDs) that goes beyond outdated categorical diagnoses, aiming to treat the general factors underlying the pathology of personality. The authors emphasize the development of metacognitive functions and the integration of procedures and techniques of different psychotherapi...

Repetitive transcranial magnetic stimulation (rTMS) has gained growing interest for the treatment of major depression (MDD) and treatment-resistant depression (TRD). Most knowledge on rTMS comes from human studies as preclinical application has been problematic. However, recent optimization of rTMS in animal models has laid the foundations for impr...

Attention deficit/hyperactivity disorder (ADHD) often persists into adulthood. Although its persistence and relative high prevalence, ADHD in adults is often underdiagnosed and undertreated in Italy, leading to poor clinical and functional outcomes, and higher costs of illness. The aims of the study were to identify the Italian mental health servic...

Background: This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA), in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods: One hundred and fifty-five patients wit...

Background: This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA), in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods: One hundred and fifty-five patients wit...

Shared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be...

Aim: This paper aims to study, evaluate and compare the effectiveness of two group interventions within a Psychiatric Intensive Care Unit (PICU). The outcome indicators of the satisfaction of patients and their families with the ward were evaluated with a Satisfaction Questionnaire on the department, and their satisfaction with the groups were eva...

Mindreading is contingent upon interpersonal context. Little is known about how competitive contexts influence mindreading skills. The idea was that the capacity to think about mental states would decline when individuals experiencing failure in competition. This study aims to assess effects of a competitive experience (a computer competitive PC ga...

Background: Metacognitive functions play a key role in understanding which psychological variables underlying the personality might lead a person with a severe mental disorder to commit violent acts against others. The aims of this study were to: (a) investigate the differences between patients with poor metacognitive functioning (PM group) and pa...

Objective: This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dys-regulation in patients with binge eating disorder (BED). Method: Forty non-BED-obese and 46 BED-obese patients completed...

Background: Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands. Aim: We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric ev...

L’HCR-20V3 è tra gli strumenti più diffusi al mondo per la valutazione del rischio di recidiva in popolazioni carcerarie, forensi e cliniche adulte (dai 18 anni in poi). Lo strumento si basa su un modello di giudizio professionale strutturato (structured professional judgement). Il giudizio professionale strutturato è un metodo analitico che viene...

Background: Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The "gold standard" treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to asse...

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology an...

Background Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide‐related behaviours, and little is known about its effect with offender‐patients. Aims To evaluate DBT with...

Italy has a consolidated history of de-institutionalization, and it was the first country to completely dismantle psychiatric hospitals, in order to create small psychiatric inwards closer to the community (i.e. in general hospitals). Nevertheless, it took the nation nearly 40 years to end the process from the beginning of de-institutionalization,...

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a...

Background Grandiose narcissism has been associated with poor ability to understand one’s own mental states and the mental states of others. In particular, two manifestations of Narcissistic Personality Disorder (NPD) can be explained by poor mindreading abilities: absence of symptomatic subjective distress and lack of empathy. Methods We conducte...

Database file. All the variables described in the reported studies are included in the database. (SAV)

To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking firs...

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 obsessive-compulsive disorder, treatment-resistant major depressive disorder, and imp...

Objectives Schizophrenia is a chronic, debilitating psychiatric disease with highly variable treatment pathways and consequent economic impacts on resource utilisation. The aim of the study was to estimate the economic burden of schizophrenia in Italy for both the societal and Italian National Healthcare perspective. Methods A probabilistic cost of...

Our present work represents a review of the scientific literature currently available on effective psychotherapeutic treatments for mentally ill offenders. What has come out from the review of the scientific literature on effective treatments focused on this specific subpopulation is the necessity of highly integrated therapeutic interventions that...

Social sharing capacities have attracted attention from a number of fields of social cognition and have been variously defined and analyzed in numerous studies. Social sharing consists in the subjective awareness that aspects of the self’s experience are held in common with other individuals. The definition of social sharing must take a variety of...

Objective: Avoidant personality disorder (AvPD) is closely related to and partially overlaps with social phobia (SP). There is an ongoing debate as to whether AvPD and SP can be classified as separate and distinct disorders or whether these diagnoses rather reflect different degrees of severity of social anxiety. The hypothesis of this study is tha...

Background: Aggression is a behaviour with evolutionary origins, but in today’s society it is often both destructive and maladaptive. Increase of aggressive behaviour has been observed in a number of serious mental illnesses, and it represents a clinical challenge for mental healthcare provider. These phenomena can lead to harmful behaviours, incl...

Objective: Metacognition is a multi-component psychological construct, characterized by the ability to identify and describe one's own mental states and those of others. Evidence has been found for an association between impairments in metacognitive abilities and poor social functioning, low quality of life, severity of psychopathology in Personali...

The current field of forensic psychiatry and psychology requires that professionals have adequate skills to assess the potential risk that a criminal poses to the society. The aim of such assessments is to indicate a viable and effective path to follow in juridical, clinical and rehabilitative practices. The aim of this article is to propose a stru...

Turner syndrome (TS) is a neurogenetic disorder characterized by partial or complete monosomy-X, usually resulting of a sporadic chromosomal nondisjunction. It is one of the most common sex chromosome abnormalities, affecting approximately 1 in 2,000 live born females. There are sporadic few case reports of concomitant TS with schizophrenia worldwi...

The ability to reflect on one's own states of mind and those of others (metacognition or mindreading) is strongly implicated in personality disorders (PDs). Metacognition involves different abilities, and there is evidence that specific abilities can be selectively impaired in different PDs. The purposes of this study were to compare metacognitive...

Cerca segui quotidianosanita.it stampa Chiusura OPG. Benissimo ma gli psicopatici non possono stare nelle nuove REMS Questi pazienti hanno bisogno di un percorso differenziato che non è identificabile nelle attuale strutturazione delle Rems, ma presentano peculiarità che per sicurezza e coerenza trattamentale non sono allo stato realizzabili nelle...

This work aims to define the aggression in all its forms, with notes on management and rapid tranquilization. The pathological aggression is described as a non-homogeneous phenomenon, it is variable in according to social, psychological and biological agents. The distinction of violence between affective aggression and predatory aggression can be f...

Objective: Metacognition is a multi-component psychological construct, characterised by the ability to identify and describe one’s own mental states and those of others. Evidence has been found for an association between deficits in metacognitive abilities and poor social functioning, low quality of life, psychopathology, and symptoms in Personalit...

Background: Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder, their implementation on a large scale remains limited. The aim of the present study is to identify obstacles for the feasibility of PFIs in routine care. Methods: This was a mul...

The capacity of understanding mental states is a complex function which involves several components. Single components can be selectively impaired in specific clinical populations. It has been suggested that impairments in mindreading are central for borderline personality disorder (BPD). However, empirical findings are inconsistent, and it is deba...

To evaluate the cost-effectiveness of paliperidone palmitate (paliperidone long-acting injectable; PP) compared with long-acting injectable risperidone (RRP) in multi-episode patients (two or more relapses) with schizophrenia in Italy.

Objective To evaluate the cost-effectiveness of paliperidone palmitate (paliperidone long-acting injectable; PP) compared with long-acting injectable risperidone (RRP) in multi-episode patients (two or more relapses) with schizophrenia in Italy. Methods A pre-existing Markov model was utilized to simulate the history of a cohort of multi-episode pa...

Aim: Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed...

Metacognitive impairment is crucial to explaining difficulties in life tasks of patients with personality disorders (PDs). However, several issues remain open. There is a lack of evidence that metacognitive impairments are more severe in patients with PDs. The relationship between severity of PD pathology and the extent of metacognitive impairment...

Abstract Personality Disorders (PDs) can reasonably hope to gain benefit from psychotherapy. Nevertheless many patients do not fully respond. Research therefore has to be done into which variables need to be targeted in psychotherapy, in order to tailor treatment to the needs of the majority of PD patients. These have to date been understudied, in...

Background: Schizophrenia is preceded by basic symptoms which may persist after long time and include subjective cognitive impairment. Furthermore, it is characterised by cognitive deficits that may deteriorate with the progression of illness. To examine the relationship between neurocognition and basic symptoms along the course of schizophrenia,...

Personality disorders are better understood as entities that vary according to severity along specific domains rather than a phenomenon separate from and unrelated to Axis I disorders. This study explores whether patients who were rated as having greater numbers of personality disorder traits reported greater levels of interpersonal problems, psych...

Background: Metacognition is a multi-facet psychological construct; deficits in metacognitive abilities are associated to low social functioning, low quality of life, psychopathology, and symptoms. The aim of this study was to describe and develop a valid and reliable interview for assessing metacognition. Methods: The semi-structured interview,...