To compare the characteristics of the typology and frequency of depressive disorders in elderly patients of nursing care department and hospice.

Two groups of the patients:- 1) 49 persons (19 male and 30 female, mean = 73,17±7,13 yrs) hospitalized due to incurable oncopathology for palliative care in the hospice and 2) 101 patients of the nurse care department (19 male and 82 female, mean = 75,21 ± 8,2 yrs) with complex combined somatic pathology, being in the hospital with necessity of assistance rendering or validation of medical documents into nursing home - were questioned according to Hospital Anxiety and Depression Scale (HADS) and Geriatric Depression Scale (GDS-15). The inclusion criterions were the ability to understand the text of the questionnaire and the wish to answer to one.

the depressive disorders have been detected to 65,3% patients of the first group and to 69,39% patients of second group. Comparative analysis of affective disorders prevalence has shown a statistically significant data on a more frequent occurrence of recurrent depressive disorder in patients with oncological diseases, whereas patients with other somatic pathology were more frequently determined by the organic affective disorder (p = 0,00593).

Performed investigation has shown a high incidence of disorders of depressive spectrum in elder patients of palliative care hospital. Screening revealing of depressive disorders reaches important aims such as objectification of clinical diagnosis of mental status and efficacy of psychopharmacotherapy, promotes more empathic response of secondary staff to emotional needs of incurable patient.

To explore effectiveness, quality of life outcomes, burden of disease in children and adolescents with ADHD transitioning from ER MPH or Atomoxetine onto PR OROS MPH.

Twelve week open label study including 224 patients (aged 6-18) with ADHD (ICD-10) transitioning from ER MPH (N=180), Atomoxetine (N=42) or both (N=2) onto flexibly dosed PR OROS MPH. Starting dose was based on clinical judgement. Assessments included Children's Global Assessment Scale, IOWA Conners' parent rating scale, quality of life (ILC), and open question related to late afternoon or evening activities.

224 patients (85.3% boys, median age 11 yrs) were documented. 81% completed the study. Median starting and final dose of PR OROS MPH was 36 mg/d. Mean C-GAS improved from 58 ± 15 (previous ER MPH group) and 54 ± 11 (previous ATX group) to 71±16 (12±15; p< 0,01) and 64±18 (9±16; p< 0.001), respectively.

Playing with other children, doing household chores, behavior towards visitors and doing homework were improved after switching from ATX to OROS MPH (all p < 0.05), but not for going to bed (p = 0.57). All items improved in the previous ER MPH group (p < 0.0001). Symptoms measured on IOWA Connor's rating scale as well as burden of disease (ILC) improved in children, adolescents as well as their care givers (p < 0.005).

Transition from ER MPH and ATX onto PR OROS MPH was associated with improved functionality, social interaction and decreased burden of disease in children and adolescents with ADHD.

Eighteen percent of Italian population and 37% of admissions to general hospital are represented by over-65 subjects. Psychiatric comorbility of hospitalized elderly patients is an epidemiologically and clinically significant phenomenon for Consultation-Liaison (CL) psychiatrists. The aim of the work is to describe the experience of a CL Psychiatry Service with patients aged 65 and more.

A search through the clinical database of the Modena CL Psychiatry Service was conducted, to collect data on psychiatric consultations for over-65 patients. Demographics, data on the reason for referral and on outcome of consultations were collected and analyzed critically, with special focus on clinically relevant situations.

Over-65 patients account for 43% of all consultations (males 44%, mean age 75±13). Sixty-seven percent of referrals come from Internal Medicine wards and the most common reasons for referral are depression (42%), agitation (10%) and confusion (8%), with the distribution of frequency of reasons for referral differing significantly from that of under-65 patients (p=.003). A medical-psychiatric comorbidity was assessed in 77% of cases, with adjustment reactions and mixed anxiety-depression as most common psychiatric diagnoses (67%). Prescription of psychothropic drugs was the outcome of the psychiatric assessment in 78% of cases.

CL Psychiatry activities for elderly patients in the general hospital are frequent and clinically challenging. Unmet needs for elderly inpatients might be the underestimated question concerning coping strategies and adjustment reactions toward the presence of a medical illness.

INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to describe the training process on the use of INTERMED and to assess its effectiveness.

A training group of 9 subjects had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen's kappa.

Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as satisfaction. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen's kappa mean value of 0.80) and slightly improved during the course.

The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice.

INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs/risks of patients. It consists of a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to assess preliminary the effectiveness of a training program on the clinical use of INTERMED.

After a group training on the use of INTERMED carried out between April and September 2009, the method was applied to 30 female patients aged between 20 and 65, subsequently referring to three clinical settings: a GP clinic; a psychiatry day-care clinic; a CLP out-patient clinic. Demographic and clinical data were collected, together with administration of HADS and WHOQoL-bref.

The mean INTERMED score was 20.8, borderline as to definition of complex cases. Patients from the GP clinic and in the CLP setting scored lower (respectively 16.5 and 18.2) than patients from the psychiatric day-clinic (27.8), suggesting that the presence of severe psychiatric disturbances might contribute to increasing the level of case-complexity. Concordance with results at HADS and WHOQoL was high.

A clinical practice in the use of INTERMED after the theoretical phase of the training process is necessary to reinforce effectiveness of the training. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena.

The process of migration has been described as a “trauma”, with psychic consequences conceptualized as post-traumatic stress disorder. As many clinical and extra-clinical variables are involved, there is a need for a better understanding.

A case report is described and discussed, under the joint perspective of three different approaches to human suffering, namely that of a neuro-rehabilitation physician, a psychiatrist and a social worker.

M. B. is a 36 year-old male, single and high school-educated, who migrated from Morocco to Italy in 2003. In 2006, he fell accidentally from a scaffolding at work, causing himself a traumatic brain injury with transient loss of consciousness, occipital fracture and bilateral frontal haematomas. He was taken in charge by Social Services. Over the following months, he developed multi-sensorial pseudohallucinations and hallucinosis, changes in character and behaviour, demoralisation, insomnia. M.B. was referred to psychiatry and to a neuro-rehabilitative outpatient service, where he was found to be suffering from severe dysexecutive syndrome, attention deficits and verbal working and long-term memory impairments. Integration of neuro-rehabilitative, psychiatric and social interventions was established to deal with M.B.’s complex needs.

In the experience of M.B., the biological head trauma pairs with the social trauma of migration and the psychological trauma of forced interruption in the migration parabola. The interrelated meanings of trauma - breaking up of a psycho-somatic balance with consequences on cognition, emotions, behaviour and social functioning - require a narrative and collaborative approach to care, addressing complex bio-psycho-social needs.

There are concerns regarding a general underutilisation of mental health services (MHS) by migrants, with a high use of emergency services. This is probably related to factors such as cultural differences and language barriers. Aim of this study is to analyze and to compare the characteristics of migrant population attended to MHS in Modena.

We studied migrant population attended to 3 Mental Health Centres (MHC), to Psychiatric Hospital (PH), to Psychiatric Consultation Service (PCS) and to Accident&Emergency (AE) during the month of September 2009, in Modena.

Socio-demographic and clinical data were collected by means of a structured culturally-oriented form.

63 patients referred to all MHS (74.6% MHC; 11.1% PH; 14.3% PCS). 46% of all diagnosis were Psychotic Disorders. PH sample presented opposite characteristics to MHC ones: 71.43% were young men (< 30 years-old) without a work, 85.71% were alone, 28.57% hadn’t the residence permit (p=0.01) and 42.86% reported psycho-social migration trauma. 57.14% had language difficulties with use of a cultural interpreter (p=0.01). Half of the sample was recently migrated (< 5 years).

Migrants had a higher rate of compulsory admission in PH than Italians (0.28 vs. 0.22) and a higher rate of AE admission (0.034 vs. 0.028).

We confirmed the frequent emergency services utilisation of migrants. People referred to MHC seem to be adjusted, well integrated and more “accultured” according the new country issues, while people admitted in the PH seem to be more weak, with socio-economic difficulties and shortly integrated.

To test the presence of significant correlations between psychopathological symptoms in patients with dementia and the stress perceived by the primary caregiver.

Primary caregivers of patients with a DSM-IV diagnosis of dementia admitted to the neuro-psycho-geriatric-rehabilitation ward of the private hospital “Villa Maria Luigia”, Parma - Italy, between May and November 2008 were asked to take part in the study. The NPI scale (UCLA Neuropsychiatric Inventory - Commings J.L. et al., 1994) and a socio-demographic data collection schedule were administered to the primary caregiver willing to be involved in the study.

Only 30 of the 40 eligible subjects agreed to take part to the study (75%). 35 significant correlations (according to Spearman's Correlation Index) were found. Those most highly significant (p< 0.001) were between stress perception and the following NPI symptom categories: delirium, hallucination, agitation, euphoria, apathy, disinhibition, aberrant physical activity and sleep disorders.

The psychopathological symptoms found to contribute mostly to distress of caregivers were those most showy and disruptive of behaviour; other symptoms, such as anxiety, depression, irritability and eating disorders are better tolerated as considered normal consequences of ageism. Interventions addressed to caregivers should provide them with detailed and structured coping instruments. Clear, therefore, the need for all health professionals, to structure an intervention aimed at caregivers characterized by two different phases:

1. 1. To provide more tools to recognize those disorders which don’t emotionally involve them;

2. 2. To give detailed, structured information useful to cope with these disorders in everyday life.

Some studies in the literature have reported voice hallucinations in prelingually deaf patients with psychosis. There has been scientific debate on whether those correspond to the real experience of deaf patients with psychosis or are simply a reflex of the limitations of psychiatric terminology or insufficient knowledge of the neurobiology of hallucinations.

The aim of this study is to review literature on hallucinations in deaf people based on a clinical vignette of a case of an adolescent with psychosis, congenital deafness and hallucinations.

Literature review of peer reviewed studies in PubMed and Medline using the terms deafness, auditory verbal hallucinations and psychosis.

There are only few studies addressing the characteristics of hallucinations in deaf patients with psychosis. The hallucinatory experience of deaf people is very diverse, and seems to be related with the individual experience with language, sensorial input and grade of residual hearing.

The perceptual characteristics of the hallucinations in persons with deafness seem to be related to the individual auditory experience and to the patient language modality. This group of patients consist of a minority within a minority and their unique psychopathology is a challenge to the current understanding of psychiatric symptoms and classifications. Further research on this area can bring new insights to the understanding of the neurobiology of hallucinations and contribute to improved diagnosis and management of these rare cases.

Individuals with severe mental illness display significantly higher rates of violence than general population. In previous reports, violent behavior was found associated with mean serum creatine kinase activity (MSCK) and with reduced levels of total blood cholesterol (LTBC). The aim of study was to assess an association between MSCK and LTBC in two groups of male violent forensic psychiatric offenders.

The study population was 256 offenders from the closed ward, of whom 214 were schizophrenia patients and 42 were patients with personality disorders. The prevalence of murderers was 21.7% in the schizophrenia group and 21.3% in the group with personality disorders.

Schizophrenia patients had significantly higher MSCK and LDH levels then subjects with personality disorders. There were no significant between-groups differences on other biological parameters. No significant differences on these parameters were found between murderers and nonmurderers in both groups. In the overall sample, significant negative correlation was found between MSCK activity and total cholesterol levels. Similar correlation pattern was found in the schizophrenia group, but not in subjects with personality disorders.

The results show for the first time identifiable MSCK/LTBC pattern in violent schizophrenia patients but not in subjects with personality disorders. It is possible that different character of association between MSCK and LTBC in two groups of violent forensic psychiatric offenders (schizophrenia patients vs. subjects with personality disorders) reflects different biological origins of violent behavior. Further investigation of described MSCK/LTBC pattern in larger population of forensic and non-forensic, psychiatric and non-psychiatric subjects, is warranted.

Common language is a mirror of culture and society. Death and mental illness are the human deepest and most ancient taboos, which both patients and professionals have to face in the medical world. Psychiatry has strong and circular connections with culture and society. The aim of this work was to collect and analyze expressions in colloquial language originally derived from psychiatric technical terminology.

A hundred and ten fifth-year medical students (M/F% = 42/58; mean age = 23.5 ± 3.1) attending their semester in psychiatry were asked to list as many expressions as possible of their everyday colloquial use which they thought referred to psychiatry. The terms were collected and analyzed critically.

A list of 150 espressions was drawn and then classified in the following categories: technical psychiatric terms; medical-neurological terms; psycoanalytic references; terms referring to abnormality and need for care; irrelevant terms. Though an overall good level of pertinence in the use of technical psychiatric terms was observed, these usually refer to common situations, both individual and happening to others. Often these locutions are used as jokes or offences.

Due to fears and prejudices evoked by psychiatric themes, an attempt on exorcising and taking distance leads to the use of psychiatric terms as potentially offensive and despising. This work suggests the need to work - especially in training settings - on filling the gap between common and medical languages and to analyze critically the contaminations as suggestive of very relevant cultural issues.

Increasing numbers of reports concerning lipid dysregulation, diabetes and hyperglycaemia in patients treated with atypical antipsychotics have raised concerns about a possible association between these metabolic effects and treatment with these medications.

The available literature notes that ziprasidone is a weight-neutral antipsychotic and that lipids anomalies improve when patient are switched from other atypical antipsychotics to ziprasidone.

The purpose of this study was to examine the association of treatment with ziprasidone and changes in serum levels of cholesterol, triglycerides, serum levels of glucose and BMI changes.

Prospective, cohort, multicenter, open design in 373 in- and outpatients treated with ziprasidone for broad spectrum of psychotic disorders in flexible dose manner. The analysis was done in group of patients with no previous antipsychotic treatment or discontinuation of antipsychotic treatment longer than 3 months compared to group of patients directly switched from another antipsychotic treatment to ziprasidone.

Changes in fasting serum levels of total cholesterol were significant from baseline at week 24 in subgroup of patients directly switched from another antipsychotic treatment to ziprasidone (5,12 vs 4,94 mmol/l, p< 0,05, ANOVA).

We have observed statistical significant difference in fasting serum levels of total cholesterol in patients directly switched from another antipsychotic treatment to ziprasidone.

The Social Skill Training is structured as a cognitive-behavioral therapy for rehabilitation plans whereby the patient can develop and recover social skills.

To verify the effects of a literary workshop for increase assertiveness in patients with eating disorders.

Thirty-two patients consequently admitted to the Ward for Eating Disorders at the Private Clinic “Villa Maria Luigia” in the North of Italy were recruited in the study, and all of them agreed to take part in it. Of the 32 patients, 8 were randomly assigned to treatment and 24 to care as usual, being the difference between treatment and care as usual only represented by the literary workshop. The Rathus Assertiveness Schedule and Verbal Fluency Test (phonemic and semantic) was administered to all patients in the first and last week of hospitalization. The literary workshop consists in 16 weekly 45-minute group sessions. Issues of expressiveness through the use of writing are addressed during the sessions.

A significant improvement of semantic skills (t=-5.60; p< 0.01 vs. t=1.43; p=0.17), phonetic skills (t=-3.66; p< 0.01 vs. t=1.35; p=0.19) and assertiveness (t=4.47; p< 0.01 vs. t=0.94; p=0.93) was registered in the literary workshop group.

Effectiveness of the literary workshop in a rehabilitation program for patients suffering from eating disorders is suggested: improved communication and language skills might have a positive and significant impact on patients’ levels of assertiveness.

Schizophrenia is complex and clinically heterogeneous psychiatric disorder that has an evidenced genetic basis. Several reports indicate a possible role of the activation of the immune system in the pathogenesis of schizophrenia. CD28 is a molecule expressed on T-cells that provides the major co-stimulatory signal required for activation of immune response. For many years now, it has been strongly advocated that biological underpinnings of schizophrenia should be investigated with respect to subpopulations of subjects defined by homogenous symptomatology.

To investigate the association of polymorphism of the CD28 gene (T17int3C) with respect to schizophrenia symptomatology.

105 patients diagnosed with schizophrenia according to ICD-10 criteria and 380 controls were included in the study. The patients were diagnosed using the Operational Criteria for Psychotic Illness checklist (OPCRIT). Based on confirmatory factor analysis on OPCRIT items performed by Serretti et al. (2004), in our study we considered five factors of symptomatology (mania, positive symptoms, disorganization, depression and negative symptoms).

There was significant difference in distribution of genotypes between patients with schizophrenia with co-occurring manic symptoms and without co-occurring manic symptoms (respectively CC and/or TC: 23% vs. 47%, TT: 77% vs. 53%, p=0,040). There was also difference in distribution of genotypes between patients with schizophrenia with co-occurring depressive symptoms and without cooccurring depressive symptoms (respectively CC and/or TC: 24% vs. 47%, TT: 76% vs. 53%, p=0,043).

We have shown that CD28 gene polymorphism might increase risk for affective (depressive and/or manic) symptom dimension in schizophrenic patients.

Age of onset has been related to the severity of cognitive decline in learning, memory, attention and motor speed.

44 patients at their onset diagnosed with schizophrenia and schizophrenia form disorders performed neuropsychological testing based on Luria‘s methodology during 5-years follow-up. Assessment was done twice in acute state and twice in remission on the first and second years of observation and then annually in remission. The patients were assigned to subgroups within the onset: adult onset (n=33, 1st group mean age- 25, 33±5,64) and early onset (n=11, 2nd group, mean age-15, 61±2, 92).

At the onset patients of the 1st group presented deficit of the main cognitive functions (verbal and visual memory, gnosis, spatial motor skills, verbal and non-verbal thinking, attention, neurodynamics and executive functioning) during the first 2 years which corresponded to the worsening of clinical state over time. Later on these variables remained stable with further decline of visual memory and visual gnosis by the end of the follow-up.

Neurocognitive parameters of the 2nd group such as praxis, gnosis, visual-spatial recognition, verbal thinking and non-verbal thinking, verbal and visual memory, neurodynamics and executive functioning were considerably poor at the onset in comparison to the 1st group. Moreover, no dynamics has been revealed during follow- up period except overpatching of non-verbal thinking, the parameter which has significantly improved in five years outcome (p< 0, 05).

The following results indicate different courses of cognitive deterioration in the follow-up period in patients with various age of onset.

Teamwork in psychiatry is a very specific property of care organization, especially in the Italian tradition and daily practice. The purpose of the study was to define and describe the main variables that might influence and determine it.

A 15-item ad hoc questionnaire was specially designed and administered to health professionals of Modena Department of Mental Health. This questionnaire contained socio-demographic data (age, sex, longevity of service), professional characteristics, personal level of satisfaction and identification, and opinions on “ideality” and “reality” of teamwork. Statistical analysis was conducted to explore significant correlations.

Satisfaction rate was 46.2%, identification rate 59.1%. Teamwork seems to function well as far as “information circulation” and “making practical decisions”, but lacks in “reciprocal understanding” and “reciprocal emotional support”. The level of correspondence between ideal and real teamwork is strongly correlated to satisfaction (p = 0), identification (p = 0), but not to age, sex or duration of service. The priority of teamwork was “discussion of clinical cases”.

This study attempts to suggest difficulties and limits of contemporary care organization in Italian psychiatry, but also offers several ideas for organizational, administrative, clinical, and human improvements. It represents a first step to analyze and identify the qualitative determinants of psychiatric teamwork.

Disulfiram is an aversive medication that works by making the drinking of alcohol an unpleasant experience (FDA approved since 1951) and most study of understanding alcohol abuse and dependence are based on it. Also, the combined Cognitive Behavioral Therapy (CBT) and disulfiram assurance treatment was substantially effective in patients with alcohol disorders.

We conducted 150 male patients range of age 20-60 and treated in Special Hospital on Addictions for 3 months period of time (inpatient setting).The recommended dose of disulfiram was 250 mg. All patients were diagnosis of alcohol dependence according the ICD-X, excluded psychosis and no one was unable to take disulfiram for medical reason. We used medical history of illness, psychiatric interview and semi structured CBT protocol for alcohol disorder and CBT sessions (2 sessions per week). Control group were 80 patients on disulfiram assurance therapy (alone).

CBT plus disulfiram assurance (N=150): 93(62%) maintaining sobriety and absence of drinking for 3 months; 44 (29,33%) maintaining sobriety for 2 months and 13 (8,66%) absence of drinking only 1 - 1,5 month.Disulfiram assurance therapy alone (control group) (N=80): 41 (51,25%) maintaining sobriety of drinking for 3 months; 22 (27,5%) less than 3 months; 10 (12,5%) for 1,5 - 2 months and 7 patients (8,75%) drop-out after a week without no relevant or medical reasons.

In this paper was shown the high level of effectiveness for the CBT combined with disulfiram assurance therapy according the maintaining sobriety and absence of drinking.