Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body (“from the neck down”), whereas its effectiveness in treating core features of depression (“from the neck up”) is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression.

Introduction:Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.Objectives:We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.Methods:All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.Results:44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.Conclusion:These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.

Introduction'Body- Art” and dissociative episodes are associated with a higher risk for self harm and suicide attempts (SA) in adolescents. Evidence of these associations in adults are lacking.Objectiveswe investigate the association between body-art, SA and dissociative episodes in a sample of adult psychiatric in-patients. AIMS: to investigate and further describe the relationship between these issues.Methodsall subjects aged more than 18 hospitalized for a SA in the Psychiatric Clinic of Genova (February 2013- 2014) were recruited. For each of them an age- and sex- matched control hospitalized for reasons other than SA was enrolled. Each of them completed SCID I, II; ISS; DES. A semistructured interview about the body-art, the method used in the SA, the presence of family TS was conducted.Resultspositive association between body-art, more previous SA and dissociative episodes. 75% of patients with more than one body-art had a diagnosis in both axis and repeated SA. No association between axis II diagnosis and dissociative episodes. Positive association between violent methods in SA and dissociative episodes, but not with body art.Discussionour results support in adults evidence from previous literature concerning adolescents. The results can be understood in the light of recent epigenetic evidence and of the altered pain threshold in suicidal people.ConclusionThe altered perception of the body mind bond could be an important target for prevention and treatment strategies of suicidal patients. Further studies are needed to better investigate these associations in adult population.