Background: The aim of the present study was to summarise the available data about the link between air pollution exposure and the new-onset and severity of psychiatric disorders in pregnant women during the perinatal period. Materials and methods: We selected articles published until June 2022 on PubMed and the Web of Science. Pollutants included were PM2.5 (particulate matter 2.5 micrometres and smaller), PM10 (particulate matter 10 micrometres and smaller), NO2 (nitrogen dioxide), O3 (ozone), SO2 (sulphur dioxide), CO (carbon monoxide), PBDEs (polybrominated diphenyl ethers), PFAS (per- and polyfluoroalkyl substances), lead, and cadmium. The perinatal period was considered as the time of pregnancy until one year after childbirth. Results: Nine studies were included; most of them evaluated the association between exposure to air pollutants and the onset of Postpartum Depression (PPD). Two studies showed an association between, respectively, only PM2.5 and both PM2.5 and NO2 exposure and PPD onset 12 months after childbirth, while another study found a significant association between NO2 exposure and PPD occurrence 6 months after childbirth. PBDE blood levels were associated with more severe depressive symptoms. Lastly, one study observed a link between stressful symptoms and exposure to PM2.5, PM10 during pregnancy. Conclusion: More comprehensive and uniform studies are required to make a roadmap for future interventions, given the growing relevance of issues such pollution and mental health, particularly during the perinatal period.
L'odierna Psichiatria Forense italiana non può dimenticare le sue origini legate alla Medicina Legale, quale modello fondativo e strutturale. La realtà odierna, però, è caratterizzata da un rilevante iato culturale ed organizzativo che separa norme, forse troppo radicali, e risorse, strutturalmente carenti. Tutto ciò si traduce spesso in percorsi articolati ma di grande difficoltà, se non impossibili, soprattutto qualora la formazione in ambito psichiatrico non preveda un percorso strutturato che renda idonei gli specialisti all'impiego degli strumenti dell'arte forense. Il panorama internazionale è di difficile confronto per una questione ontologica correlata sostanzialmente alle differenze legali e dell'iter giudiziario, ma sicuramente può essere da spunto per pensare all'opportunità di un riconoscimento di specifici requisiti in ambito forense. Stante la persistenza di modelli talvolta arcaici e di pratiche non di rado obsolete per quanto attiene alla realtà contemporanea in ambito forense, si rende necessario attualizzare i modelli didattici della disciplina, così da poter chiedere al legislatore anche una riforma dei parametri valutativi e del contesto di riferimento dove si opera. Ciò renderebbe il lavoro peritale maggiormente qualificato e degno di essere identificato e riconosciuto come parte integrante di una Psichiatria contemporanea, ovvero una rielaborazione culturale e didattica in grado di allargare gli orizzonti di una disciplina certamente nobile.giustificazione del minore, ma di responsabilizzazione dell'adulto e di inquadramento contestualizzante. In tale contesto la chiave di lettura della Criminologia, opportunamente corredata in specie in presenza di casi di disagio psichico dal contributo interpretativo della Psichiatria forense, può costituire uno strumento operativo di rilevanza centrale in prospettiva sia trattamentale che preventiva.
Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) share underlying neurobiological mechanisms and several clinical features which, with medical comorbidities, may increase misdiagnosis and delay proper treatment. The aim of the study was to evaluate the association between clinical/socio-demographic markers and GAD/PD diagnosis. Outpatients (N = 290) with PD or GAD were identified in mental health services in Monza and Milan (Italy). Descriptive analyses and a binary logistic regression model were performed. Post-onset psychiatric (p = 0.05) and medical (p = 0.02) multiple co-morbidities were associated with GAD; treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with PD, while GAD diagnosis was associated with treatment with atypical antipsychotics or GABAergic drugs (p = 0.03), as well as psychodynamic psychotherapy (p < 0.01). Discontinuation of the last pharmacological treatment was associated with GAD diagnosis rather than the PD one (p = 0.02). GAD patients may have a worse prognosis than PD patients because of more frequent multiple co-morbidities, relapses and poorer treatment compliance. The different treatment approaches were consistent with the available literature, while the association between GAD and psychodynamic psychotherapy is an original finding of our study. Further studies on larger samples are necessary to better characterize clinical factors associated with GAD or PD.
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