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Psychological Assessment can be defined as a complex procedure of information collection, analysis and processing. Formal Psychological Assessment (FPA) tries to improve this procedure by providing a formal framework to build assessment tools. In this paper, FPA is applied to depression. Seven questionnaires widely used for the self-evaluation of depression were selected. Diagnostic criteria for major depressive disorder were derived from the DSM-5, literature and Seligman’s and Beck’s theories. A Boolean matrix was built, including 266 items from the questionnaires in the rows and 20 selected attributes, obtained through diagnostic criteria decomposition, in the columns. In the matrix, a 1 in a cell meant that the corresponding item investigated the specific attribute. It was thus possible to analyze the relationships between items and attributes and among items. While none of the considered questionnaires could alone cover all the criteria for the evaluation of depressive symptoms, we observed that a set of 30 items contained the same information that was obtained redundantly with 266 items. Another result highlighted by the matrix regards the relations among items. FPA allows in-depth analysis of currently used questionnaires based on the presence/absence of clinical elements. FPA allows for going beyond the mere score by differentiating the patients according to symptomatology. Furthermore, it allows for computerized-adaptive assessment.

Aim: Major depressive episode (MDE) can manifest with different features. Discriminating between different types of MDEs is crucial for proper treatment. The aim of this study is to propose a new tool for MDE assessment in bipolar disorder (BD) or major depressive disorder (MDD) to overcome some limitations of current rating scales. The proposed tool investigates all of the clinical features of different MDEs and gives qualitative information, differentiating patients with the same score but different symptoms and psychopathology severity. To achieve this purpose authors used a new methodology called Formal Psychological Assessment (FPA). FPA allows creating relations between the items of an assessment tool, and the set of diagnostic criteria of a given clinical disorder. In the application at hand, given the capability to analyze all clinical features, FPA appears a useful way to highlight and differentiate between inhibited and agitated depressive symptoms.Method: The new tool contains 41 items constructed through 23 clinical criteria from the DSM-5 and literature symptoms. In line with FPA, starting from a set of items and a set of clinical criteria, a Boolean matrix was built assigning to each item its own set of clinical criteria. The participants include 265 in the control group and 38 patients with MDE (diagnosed with MDD or BD) who answered the QuEDS. After 1 month, 63 participants performed the test again and 113 took the Depression-Anxiety-Stress Scale to analyze convergent—divergent validity.Results: The scale showed adequate reliability and validity. A hierarchical confirmatory factor analysis highlighted the presence of three sub factors (affective, somatic, and cognitive) and one high-order factor (depression).Conclusions: The new tool is potentially able to inform clinicians about the patients' most likely diagnostic configuration. Indeed, the clinical state of a patient consists of the subset of items he/she answered affirmatively, along with his/her subset of specific symptoms. Qualitative information is fundamental from a clinical perspective, allowing for the analysis and treatment of each patient according to his/her symptoms in an effective way.

Measurement is a crucial issue in psychological assessment. In this paper a contribution to this task is provided by means of the implementation of an adaptive algorithm for the assessment of depression. More specifically, the Adaptive Testing System for Psychological Disorders (ATS-PD) version of the Qualitative-Quantitative Evaluation of Depressive Symptomatology questionnaire (QuEDS) is introduced. Such implementation refers to the theoretical background of Formal Psychological Assessment (FPA) with respect to both its deterministic and probabilistic issues. Three models (one for each sub-scale of the QuEDS) are fitted on a sample of 383 individuals. The obtained estimates are then used to calibrate the adaptive procedure whose performance is tested in terms of both efficiency and accuracy by means of a simulation study. Results indicate that the ATS-PD version of the QuEDS allows for both obtaining an accurate description of the patient in terms of symptomatology, and reducing the number of items asked by 40%. Further developments of the adaptive procedure are then discussed.

Objectives It has been suggested that agitated depression (AD) is a common, severe feature in bipolar disorder. We aimed to estimate the prevalence of AD and investigate whether presence of AD was associated with episodic and lifetime clinical features in a large well‐characterized bipolar disorder sample. Method The prevalence of agitation, based on semi‐structured interview and medical case‐notes, in the most severe depressive episode was estimated in 2925 individuals with DSM‐IV bipolar disorder recruited into the UK Bipolar Disorder Research Network. Predictors of agitation were ascertained using symptoms within the same episode and lifetime clinical features using multivariate models. Results 32.3% (n = 946) experienced agitation during the worst depressive episode. Within the same episode, significant predictors of presence of agitation were: insomnia (OR 2.119, P < 0.001), poor concentration (OR 1.966, P = 0.027), decreased libido (OR 1.960, P < 0.001), suicidal ideation (OR 1.861, P < 0.001), slowed activity (OR 1.504, P = 0.001), and poor appetite (OR 1.297, P = 0.029). Over the lifetime illness course, co‐morbid panic disorder (OR 2.000, P < 0.001), suicide attempt (OR 1.399, P = 0.007), and dysphoric mania (OR 1.354, P = 0.017) were significantly associated with AD. Conclusions Agitation accompanied bipolar depression in at least one‐third of cases in our sample and was associated with concurrent somatic depressive symptoms, which are also common features of mixed manic states. Furthermore, AD in our sample was associated with lifetime experience of mixed mania, in addition to severe lifetime illness course including comorbid panic disorder and suicidal behavior. Our results have implications for the diagnosis and treatment of agitated features in bipolar depression.

Background: Mania seems to be associated with an increased dopamine (DA) transmission. Antidepressant treatments can induce mania in humans and potentiated DA transmission in animals, by sensitizing DA D2 receptors in the mesolimbic system. We have suggested that the sensitization of D2 receptors may be responsible of antidepressant-induced mania. This review aims to report the experimental evidence that led to the hypothesis that antidepressant-induced DA receptors dysregulation can be considered an animal model of bipolar disorder.Methods: We reviewed papers reporting preclinical and clinical studies on the role of DA in the mechanism of action of antidepressant treatments and in the patho-physiology of mood disorders.Results: A number of preclinical and clinical evidence suggests that mania could be associated with an increased DA activity, while a reduced function of this neurotransmission might underlie depression. Chronic treatment with imipramine induces a sensitization of DA D2 receptors in the mesolimbic system, followed, after drug discontinuation, by a reduced sensitivity associated with an increased immobility time in forced swimming test of depression (FST). Blockade of glutamate NMDA receptors by memantine administration prevents the imipramine effect on DA receptors sensitivity and on the FST.Conclusion: We suggest that chronic treatment with antidepressants induces a behavioural syndrome that mimics mania (the sensitization of DA receptors), followed by depression (desensitization of DA receptors and increased immobility time in the FST), i.e. an animal model of bipolar disorder. Moreover the observation that memantine prevents the “bipolar-like” behavior, suggests that the drug may have an antimanic and mood stabilizing effect. Preliminary clinical observations support this hypothesis.

Obesity places a significant burden on people affected, increasing their risk of unintended health consequences and reducing their life expectancy. Rising obesity levels have also had an adverse effect on society and economic prosperity, causing a decrease in economic activity through loss of productive life years, and by placing increasing demands on healthcare systems. Despite the scientific community recognising obesity as a multifactorial chronic disease which requires long-term management, it is often considered to be the responsibility of the individual by governments, healthcare systems and even people with obesity. Obesity is not recognition as disease in Italy, but it has a relevant impact on heath policy, clinical, social and economic. On November 13th 2019, the Chamber of Deputies of the Italian Parliament voted unanimously to approve a motion that recognises obesity as a chronic disease and asks the Government to implement specific actions to promote and improve obesity prevention and management. Among the various commitments there is also a national plan that harmonises the activities in the field of prevention and the fight against obesity; full access to the diagnostic procedures for comorbidities, to dietary-food treatments in the most serious cases, access to second-level centres to evaluate psychological, pharmacological and surgical approaches; guidelines concerning the “first 1,000 days of life” of the child and programs for the prevention of childhood obesity. Obesity now recognised as a chronic disease in Italy. The collaborative, multi-stakeholder effort was long in the making and includes a Charter of Human Rights for People Living with Obesity. The document enumerates actions necessary for the protection of health for obesity prevention and treatment of people living with obesity. The process implemented as a typical policy domino game. Key messages Obesity now recognised as a chronic disease. Policy domino game.

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