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Earthquakes are one of the most frequently occurring natural disasters and lot of studies have been conducted on exposed populations, particularly to evaluate post-traumatic stress disorder (PTSD). On April 6th 2009, the town of L’Aquila, central Italy, was struck by an earthquake, with a strength of 5.9 on the Richter scale, and 309 people have died, 1600 were injuried and more than 65000 were displaced.
To investigate the impact of PTSD in a sample of L’Aquila's people.
To evaluate the prevalence rates of PTSD, either full-blown or partial, among 512 students attending the last year of high school in L’Aquila, 10 months after the earthquake.
Assessments included the trauma and loss spectrum-self report (TALS-SR) and the Impact of Event Scale (IES). Gender differences in the symptoms reported were investigated. Partial PTSD is defined as the presence of symptoms in the DSM-IV Criterion B and C or D for PTSD diagnosis.
Our results showed the presence of PTSD in 192 (37.5%) of the students examined, with significantly (p = .000) higher rates in women than men (N = 120, 51.7% and N = 72, 25.7%, respectively). Moreover, 153 (29.9%) students reported partial PTSD (75, 32.3% women and 78, 27.9% men respectively). Significantly higher PTSD symptoms were reported by women with respect to men.
Our results show high rates of full or partial PTSD in adolescents survived to L’Aquila's earthquake. Women resulted more affected than men. These results highlight the need to carefully explore these conditions.
To evaluate the clinical and functional effects of cannabis abuse in patients at First Episode Psychosis (FEP) referring to Community Mental Health Centre (CMHC) “Bologna Ovest” and in patients admitted with a diagnosis of psychosis at the Modena Emergency Psychiatry Ward (EPW).
All FEP patients, aged 18-35, referring to CMCH “Bologna Ovest” in a 6-years period were evaluated and followed-up at 3 and 12 months. Of the 1559 psychiatric admissions at the Modena EPW in a 3-year period, those with a positive history for substance abuse were selected.
Among the 88 Bologna Ovest FEPs, 32% were cannabis abusers (FEP-c). In Bologna, FEP-c were more frequently natives (23.39% vs 31.13%; c sq=5.1; p=0.02) single (26.38% vs 0,0% c sq=7.3, p=0.007) and unemployed (13.50% vs 18.32%, c sq=2.4, p=0.1). Non FEP-c did not use any other drug (0.0% vs 26.1%, c sq=77.5; p< 0.001). A trend towards higher prevalence of hospital admission at follow-up was found for FEP-c (4.20% vs 2.4%, c sq=3.8, p=0.07). 22.0% of patients admitted at the Modena EPW had a positive history for substance abuse: of these, 7% were diagnosed with paranoid schizophrenia, which significantly correlated with the use of cannabinoids (alone or in association).
Our results enlighten that cannabis use is frequent among psychotic patients admitted to hospital and worsens clinical course of FEP patients, consistently with previous evidence (Hambrecht & Hafner, 1996; Hafner et al., 2004).
The concept of Deficit Schizophrenia (DS) is considered one of the most promising attempts to reduce heterogeneity within schizophrenia. Few prospective studies tested its longitudinal stability and ability to predict clinical features and outcome at five years follow-up.
In the present study 51 patients with DS and 43 with Nondeficit Schizophrenia (NDS), previously included in an Italian Multicenter Study on Deficit Schizophrenia, were reassessed after 5 years from the initial evaluation. The diagnosis of DS and NDS was made by raters blind to initial categorization using the Schedule for the Deficit Syndrome. Clinical, neurocognitive and social outcome indices were also evaluated.
The follow-up diagnosis confirmed the baseline one in forty-two out of 51 patients with DS (82.4%) and in 35 out of 54 with NDS (79.6%). Clinical, neuropsychological and social functioning characterization of patients with DS also revealed high reproducibility with respect to baseline assessment: anergia and negative dimension, social isolation and neurocognitive impairment (in particular general cognitive abilities and attention impairment) were more severe in patients with DS than in those with NDS. In neither group a significant deterioration of clinical, neurocognitive and social functioning indices was found, in line with previous studies in patients with chronic schizophrenia.
Study findings provide evidence for the long-term stability of Deficit Schizophrenia.
The stigmatisation of the psychiatric patient is still a strong barrier to the integration process of these subjects in our society. Therefore, it is necessary to identify what types of prejudices exist and the types of variables with which they are linked, in order to plan strategies to reduce them. In this exploratory study we administered a semi-structured interview to 303 subjects in order to examine the relationships between social attitudes towards mental disorders and some social demographic variables, the information about mental disorders and the previous ‘contacts’ with psychiatric patients.
The data analysis shows that there is a relationship between knowledge of psychiatric patients and a more positive attitude towards them (i.e., less fear, more integration and work opportunities). This study is to be considered preliminary as far as people’s attitudes towards psychiatric patients are concerned. This result encourages the planning and implementation of sensitisation and information programs concerning mental disorders, in the sense that increasing the knowledge of mental disorders could lead to significant achievements in the important fight against the stigma surrounding psychiatric patients.
Enkephalin is an opioidergic neuromodulator that has been implicated in long-term behavioural sensitization after administration of drugs of abuse. Enkephalin is also a molecular marker of GABAergic neurons in the striato-pallidal pathway that is involved in sensory-motor gating and has been considered dysfunctional in the pathophysiology of psychosis.
In this study we investigated in male Sprague Dawley rats putative changes in Enkephalin transcripts by in situ hybridization after acute or subchronic administration of ketamine in either high or low subanaesthetic doses (50 mg/kg and 12 mg/kg respectively). Ketamine is a non-competitive NMDA-R antagonist that perturbs glutamate neurotransmission and provides a preclinical model of psychosis-like behaviour in rats.
In the acute paradigm the expression of Enkephalin was reduced in the motor, premotor, somatosensory cortices as well as in anterior cingulate. In the subchronic paradigm Enkephalin expression was reduced in the premotor cortex, in the ventromedial caudate-putamen and in the shell of nucleus accumbens. Comparative analysis showed that the relative decrement in gene expression was not significantly different between the acute and subchronic paradigm for each region of interest.
Changes in distribution of Enkephalin expression and correlation analysis of functionally related brain regions suggest that Enkephalin transcripts reduction may be implicated in the motivational aspects of drug addiction and may help explaining some aspects of the pathophysiology in ketamine-induced psychosis.
Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD).
Materials and methods:
This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment.
Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r = –0.72, P < 0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r = 0.38, P < 0.001).
Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.
Borderline personality disorder (BPD) is a chronic condition with a strong impact on patients’ affective, cognitive and social functioning. Neuroimaging techniques offer invaluable tools to understand the biological substrate of the disease. We aimed to investigate gray matter alterations over the whole cortex in a group of Borderline Personality Disorder (BPD) patients compared to healthy controls (HC).
Magnetic resonance-based cortical pattern matching was used to assess cortical gray matter density (GMD) in 26 BPD patients and in their age- and sex-matched HC (age: 38 ± 11; females: 16, 61%).
BPD patients showed widespread lower cortical GMD compared to HC (4% difference) with peaks of lower density located in the dorsal frontal cortex, in the orbitofrontal cortex, the anterior and posterior cingulate, the right parietal lobe, the temporal lobe (medial temporal cortex and fusiform gyrus) and in the visual cortex (P < 0.005). Our BPD subjects displayed a symmetric distribution of anomalies in the dorsal aspect of the cortical mantle, but a wider involvement of the left hemisphere in the mesial aspect in terms of lower density. A few restricted regions of higher density were detected in the right hemisphere. All regions remained significant after correction for multiple comparisons via permutation testing.
BPD patients feature specific morphology of the cerebral structures involved in cognitive and emotional processing and social cognition/mentalization, consistent with clinical and functional data.
Many patients with schizophrenia show major difficulties in performing basic social roles. Occupational and social functioning (and independent living) are considered domains of functioning. Improvement in functioning is recognized as an important aim in treatment guidelines and as an outcome by regulatory agencies.
The Europe, Middle East and Africa (EMEA) functioning survey canvassed opinions of psychiatrists (and neurologists with psychiatric backgrounds in Germany) across the region.
To ascertain psychiatrists' perceptions of the clinical importance, assessment and management of functioning amongst their patients with schizophrenia.
The survey comprised 17 questions and was conducted from March-April 2011, in 39 EMEA countries. Respondents' demographics and their opinions regarding personal and social functioning in patients with schizophrenia were collected.
Results were obtained from 3610 clinicians. Psychiatrists reported that they perceived more than two in three of their patients show impaired/very poor levels of functioning. 91% believed that personal and social functioning was an important treatment goal for patients with schizophrenia and 90% believed it was an important goal for patients' families. The majority of psychiatrists assess the personal and social functioning of their patient at each visit but 81% determine the level of functioning through clinical interview. To manage personal and social functioning in their patients, 26% of psychiatrists prefer pharmacological interventions while 47% prefer psychosocial interventions.
Although psychiatrists recognize that functioning is impaired/very poor in patients with schizophrenia, there is still a need to address it as a main treatment goal for patients with schizophrenia.
Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy.
A sample of 450 survivors of the L’Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, was reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).
Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in almost half of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about onefourth in females.
This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD.
The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes.
To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal.
Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA.
675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = −.26; p = .05) and heart rate (r = .33; p = .01).
Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.
PERDOVE study is a prospective observational cohort study, which providing follow-up at one year, aims to investigate the socio-demographic and clinical characteristics of patients in in the 23 medium-long term RFs of the St John of God Order.
(1) To describe the sociodemographic, clinical, and treatment-related characteristics of RF-patients during an index period in 2010;
(2) to identify predictors and characteristics associated with discharge at 1-year follow-up;
(3) to evaluate clinicians’ predictions about each patient's likelihood of Home Discharge (HD).
All patients staying in September 2010 with a primary psychiatric diagnosis received a set of standardized assessment instruments, including a “Patient Schedule”, BPRS, HONOS, PSP, PHI, and SLOF. Detailed socio-demographic and clinical data were also collected. Logistic regression analyses were run to identify independent discharge predictors.
The study involved 403 patients. 66,7% is male, mean age is 49 (±10). 70.7% is unmarried. The average duration of illness of these patients is 23 years. Primary diagnosis is represented by schizophrenic spectrum disorders (67.5%). At 1 year follow-up, 104 patients (25.8%) were discharged: 13.6% to home, 8.2% to other RFs, 2.2% to supported housing, and 1.5% to prison.
The main variables associated with a higher likelihood of being discharge to home were: to have an illness duration of less than 15 years and to have an available and effective social support in the last year. Lower severity of psychopathology, and higher working skills were also associated with a significantly higher likelihood to be discharged to home.
Many cross-sectional studies have explored the relationship between subjective QOL of people with schizophrenia and different socio-demographic characteristics, clinical and psychosocial factors. Only few studies tried to identify factors that influence the QOL of these patients using a longitudinal design.
Aim of the present study was to determine influence of clinical factors, socio-demographic variables, spirituality and satisfaction with services on QOL, to identify clinical predictors associated with quality of life at one year follow-up.
Material and methods
Measures at baseline included: demographics, BPRS, PHI, RBANS, FPS, HoNOS, SWBS, VSSS, and the Italian version of the WHOQoL-Brief. Measures at follow up included: HONOS, BPRS, FPS, WHOQoL-Brief. Logistic regression models were adopted to evaluate the association between WHOQoL-Brief scores and patient's sociodemographics, clinical characteristics, spirituality and services’ satisfaction.
The study included 171 patients: 64% males; mean age 48.7 (sd=8.9) with primary diagnosis of schizophrenia. Different domains of QOL were predicted by different indicators at baseline. Younger age, more time spending doing nothing, lower BPRS, lower satisfaction with services were explanatory variables for low quality of life in psychological facet. Spirituality and religiousness were associated with Environmental domain and VSSS was associated to all QOL domains.
Rehabilitation plans for people with schizophrenia living in RFs should pay attention to mediators of change in subjective QOL such as level of activities, social support, spirituality and satisfaction with mental health services. In particular, anxiety and depressive symptoms remain as long-term outcomes of QOL at one year follow up.
Interferon-related depressive disorders are well known in literature. Despite this, few study have been able to identify reliable predictors of depression
Our aim was to examine the predictive value of several bio-psycho-social factors for the development of persistent clinically significant depression in patients affected by HCV treated with IFN. We also aimed at describing the clinical course, treatment and impact on quality of life of depression.
We conducted a cohort prospective study with assessments at baseline and at 4, 8, and 24 weeks with clinical interview and self-administered psychometric tests. We evaluated depressive symptoms with the Hamilton Depression Rating Scale, manic symptoms, anxiety, suicidal ideation, temperament, alexithymia and quality of life with other reliable instruments.
Preliminary results are available for 61 patients. Depressive symptoms increased significantly during IFN therapy to peak after 4 weeks. A third of patients still suffered clinically significant symptoms after six months. In a multivariate model, the onset of irritability (aOR= 6.5; p=0.03) and living alone (aOR= 7.4; p=0,06) predicted the persistence of depression after 6 months. The preliminary model displayed good levels of specificity and sensitivity.
Both psychological traits (irritability) and social factors (living alone) predicted the persistence of depression. These findings might prove useful to improve early detection of vulnerable patients and their mental health care in the real clinical world. Larger samples are however needed to confirm these findings.
Psychosocial factors are often underestimated in psychotic patients, although they may profoundly influence (and be influenced by) clinical presentation and effectiveness of therapeutic interventions in these people.
To investigate relevance, relationship with clinical presentation and overall quality of life of multiple psychosocial factors in psychotic patients.
To evaluate whether knowledge about the illness and utilization of health services are defective in psychotic vs. non-psychotic patients and whether these correlates with the type of psychotic symptoms, cognitive performances, global social functioning, quality of life, and acceptance of pharmacotherapy.
Approximately 110 patients were enrolled after written informed consent. Patients were administered the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance scale (PSP), the Drug Attitude Inventory (DAI), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). All patients were also screened for cognitive performances. Patients and relatives completed a questionnaire on knowledge about the illness and on the level of utilization of mental health services. Patients were subdivided in psychotic (cases) and non-psychotic (controls) based on their score on the PANSS.
Psychotic patients and their relatives showed lower levels of knowledge about the illness. These features were associated with the other variables assessed in a very complex and multidimensional model of reciprocal influences.
Lack of response to pharmacological treatments and to overall therapeutic interventions in psychotic patients may also depend on multiple psychosocial factors, which may be carefully investigated and become the target of adjunctive, effectiveness-focused interventions.
According to the NMDA-R hypofunction hypothesis of psychosis, the administration of certain antagonists at NMDA-R, such as ketamine, may exacerbate psychotic symptoms in humans and provide a preclinical model of psychosis. Both ketamine and antipsychotic drugs induce molecular changes in genes of the post-synaptic density (PSD), involved in glutamate signaling and dopamine-glutamate interplay.
Memantine, an antagonist/partial agonist at NMDA-Rs with procognitive properties, has been proposed as an adjunctive treatment for schizophrenia.
We tested the hypothesis that memantine and propsychotic NMDA-Rs antagonists (ketamine and MK-801) may elicit divergent molecular changes at glutamatergic synapses.
Sprague-Dawley rats were treated by:
2) MK-801 0.8 mg/kg;
3) memantine 5 mg/kg;
4) ketamine 25 mg/kg;
5) ketamine 50 mg/kg.
We compared, by in situ hybridization histochemistry, the expression of PSD genes in cortical and striatal brain regions.
Homer1a expression was significantly induced by ketamine 25 mg/kg and reduced by MK-801 in striatum and cortex. Arc expression was significantly induced by ketamine and memantine in the cortex and by MK-801 in nucleus accumbens. Homer1b/c expression was significantly decreased by ketamine compared to vehicle in motor cortex and dorsolateral striatum. PSD-95 expression was significantly decreased by MK-801 compared to vehicle in all striatal regions and by ketamine in dorsomedial striatum.
These results demonstrate that NMDA-Rs antagonists with different pharmacological properties trigger different molecular changes at glutamatergic synapses. These results are consistent with the different clinical profiles of these compounds and with the observation that NMDA-R blockade is not necessarily associated to psychosis exacerbation.
PTSD and post-traumatic spectrum symptoms represent the most frequently reported psychiatric sequelae of earthquakes and several studies have investigated the role of risk factors1,2. Aim of the present study was to explore PTSD and post-traumatic spectrum symptoms in L’Aquila (Italy) 2009 earthquake survivors and their correlations with age, gender and degree of exposure.
1488 subjects were investigated by means of the TALS-SR5. The total sample was divided, by random extraction, in 8 homogenous subgroups comparable for gender, age (≤40 vs >40 years) and direct/indirect exposure to the earthquake.
41.3% of exposed subjects presented PTSD vs 16.6% of not exposed. Women reported significantly higher PTSD prevalence rates and post-traumatic spectrum symptoms than men. Exposed subjects reported higher PTSD rates both in the whole sample and in all subgroups, with the only exception of younger men.
Our results confirm different vulnerability to PTSD after earthquake on the basis of gender, age and degree of exposure.
To date, the proposition of recurrence as a subclinical bipolar disorder feature has not received adequate testing.
We used the Italian version of the bipolar spectrum diagnostic scale (BSDS), a self-rated questionnaire of bipolar risk, in a sample of patients with mood disorders to test its specificity and sensitivity in identifying cases and discriminating between high risk for bipolar disorder major depressive patients (HRU) and low risk (LRU) adopting as a high recurrence cut-off five or more lifetime major depressive episodes.
We included 115 patients with DSM-5 bipolar disorder (69 type I, 41 type II, and 5 NOS) and 58 with major depressive disorder (29 HRU and 29 LRU, based on the recurrence criterion). Patients filled-out the Italian version of the BSDS, which is currently undergoing a validation process.
The BSDS, adopting a threshold of 14, had 84% sensitivity and 76% specificity. HRU, as predicted, scored on the BSDS intermediate between LRU and bipolar disorder. Clinical characteristics of HRU were more similar to bipolar disorder than to LRU; HRU, like bipolar disorder patients, had more lifetime hospitalizations, higher suicidal ideation and attempt numbers, and higher rates of family history of suicide.
The BSDS showed satisfactory sensitivity and sensitivity. Splitting the unipolar sample into HRU and LRU, on the basis of the at least 5 lifetime major depressive episodes criterion, yielded distinct unipolar subpopulations that differ on outcome measures and BSDS scores.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The screen for cognitive impairment in psychiatry (SCIP) is a brief, accessible scale designed for detecting cognitive deficits in psychiatric disorders.
The objective of this study is to test the SCIP's validity as a cognitive test by comparison with standard neuropsychological scale using the Pearson's correlation.
Aims Test the convergent and discriminant validity of the SCIP within the Italian SCIP validation project.
Patients between 18 and 65 years who are in a stable phase of the disease, diagnosed with schizophrenia, schizoaffective disorder or bipolar I disorder were enrolled in this study, from the community mental health department of Ferrara.
The tests were administered to 110 patients (mean age: 45 ± 11,4) and to 86 controls (mean age: 35 ± 12,6) of both sex. SCIP presents high correlation with the R-BANS total score (P < 0.01) and the subscales (verbal learning test-immediate, working memory, verbal fluency test, verbal learning test-delayed, processing speed test, P < 0.01). There are significant differences (P < 0.01) in all SCIP dimensions between patient and control group (Table 1).
Our analysis confirm the results of the English, French and Spanish version of the SCIP regarding convergent and discriminant validity. The SCIP represents a valid, simple and brief screening tool for the cognitive evaluation of patients with schizophrenia-spectrum disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.