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Major Depressive (MDD) and Bipolar Disorder (BD) are chronic relapsing condition in which mood episodes are interspersed with periods of euthymia. Impairments in Executive Attention (EA) are a trait characteristic of mood disorder that persists also during remission. Similarly prefrontal dysfunctions are crucial in the genesis and maintenance of Obsessive-Compulsive Symptoms (OCS), which are highly comorbid in both MDD and BD.
The aim of this study is to test a model in which deficits in EA mediate the relationship between the OCS and the relapse in a cohort of patients with MDD and BD.
Sixty-four euthymic subjects with BD and MDD performed the Attentional Network Task Revised (ANT-R), that gauges EA in a standard conflict task. Here we adopted a drift diffusion model to measure the task efficiency as the drift rate in incongruent trials. Patients also completed at baseline the YBOCS, a questionnaire that evaluate the severity of OCS. All the participants have been followed-up for up to 5 years and relapses have been recorded.
The association between OCS and time in euthymia was fully mediated by the EA so that greater OCS were associated with poorer executive functions (beta=-0.341; p=0.006) that in turn predicted a sooner relapse (beta=0.349; p=0.005). This held true even when controlling for classic predictors of recurrence such as previous episode distance, the duration of illness and medications.
Treatment targeting executive functions could hence be crucial in preventing relapses in subjects with mood disorders experiencing obsessive compulsive-symptoms.
Bipolar disorder (BD) is a psychiatric disorder characterized by alternating episodes of high mood and low mood similar to depression. To differentiate BD patients from unipolar (UN) depressed patients remains a challenge and the clinical scales available failed to distinguish these 2 populations. ALCEDIAG developed EDIT-B, the first blood test able to make a differential diagnosis of BD. Based on RNA editing modifications measurement and AI, the test requires a simple blood draw and equipment available in most central laboratories. A first study on 160 UN and 95 BD patients allowed a differential diagnosis with an AUC of 0.935 and high specificity (Sp=84.6%) and sensitivity (Se=90.9%). A multicentric clinical study has been set up to validate these performances.
The objective of this project is to run a multicentric clinical study in Europe and assess the performances of the test.
The EDIT-B project, led by Alcediag, is supported by EIT-Health grant (European institute of Innovation and Technology) and gathers 4 clinical centers in 3 countries (France, Spain, Danemark), a CRO for the clinical study management (Aixial), a CRO for the development of a diagnostic kit (Veracyte), a diagnostic lab for molecular biology analyses (Synlab), and a regulatory company (PLG).
At the end of the study, the EDIT-B performance will be confirmed and the test will be CE-marked.
This test will address the needs of millions of patients suffering from misdiagnosis and therefore allow them to receive the correct treatment.
To evaluate the cognitive status in an elderly population including both community-dwellers and institutionalised subjects.
462 subjects (mean age 85.1±6.9 years, 53.2% females) living in the Faenza district (Ravenna, Northern Italy) were interviewed and clinically evaluated. The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was administered to all participants to collect socio-demographic and clinical information. The cognitive status was evaluated using the cognitive assessment included in the CAMDEX (CAMCOG) and the Mini-Mental State Examination (MMSE) (adjusted by sex and age). Cut-offs were as follow: CAMCOG scores < 80; MMSE scores < 24.
The CAMCOG identified 245 subjects (53.0%) as cognitively impaired; 132 persons (28.6%) had a MMSE score < 24 and were impaired in the activities of daily living. Prevalence of dementia (DSM-IV criteria) was 19.1% (N=88), including 11 cases of ‘questionable’ dementia. Demented subjects were more likely to be women (65.9%), were less educated (p< 0.05) and older than non-demented (p< 0.001). Demented subjects scored significantly lower than non-demented subjects in any cognitive domain at CAMCOG (p< 0.001).
Cognitive domains: mean score and standard deviation (p< 0.001).
Non-demented vs Demented
All subjects: 78.4(±15.9) vs 28.7(±21.7)
Males: 81.1(±13.0) vs 35.0(±19.9)
≤85: 83.3(±12.3) vs 38.0(±20.5)
>85: 75.7(±13.2) vs 34.0(±20.2)
Females all: 75.7(±18.0) vs 24.3(±21.9)
≤85: 82.5(±12.4) vs 58.5(±10.8)
>85: 67.0(±20.2) vs 18.4(±17.5)
Among demented subjects, only 4.5% were treated with acetylcholinesterase inhibitors (p=0.046); 10.2% used other anti-dementia medications (p=0.067).
Despite of the high prevalence of dementia, only few subjects affected by dementia were properly treated.
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.
The diagnostic boundaries of social anxiety disorder (SAD) are still controversial and recent evidence suggests that the condition could be better understood as a continuum of severity, rather than a strictly circumscribed entity. Current neuroanatomical theories on SAD support the involvement of limbic structures in its pathophysiology, with an emphasis on the amygdala. Thus, the objective of this study was to investigate the hypothesis of volumetric alterations in the amygdala of subjects in different points of the social anxiety spectrum.
The sample consisted of patients with generalized SAD (n=17), subthreshold SAD (increased social anxiety without avoidance; n=13), and healthy controls (n=15). Participants underwent structural magnetic resonance scans and the volume of the bilateral amygdala was manually determined.
Significantly greater volumes of bilateral amygdala were found in socially anxious individuals. Amygdala volumes of subthreshold SAD participants fell between the values found for generalized SAD and healthy controls.
Individuals suffering from SAD have greater amygdala volumes compared to controls and this difference seems to be in agreement with the theoretical conception of SAD as a severity continuum and not as a circumscribed nosological entity.
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 evaluate the relationship between depression, somatic symptoms, cognitive impairment and disability in an elderly population.
216 subjects (65-84 years) were clinically examined for somatic symptoms, and underwent a mental health examination. Depression was defined by Geriatric Depression Scale scores >11/30; cognitive impairment by Mini-Mental State Examination scores < 24/30; functional status by Instrumental Activities of Daily Living Scale. Associations between depression, cognitive impairment or somatic symptoms and disability were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI) adjusted by sex, age, education.
Disability was common among depressed individuals (OR(95%CI)=3.60(1.63-7.96)) and among cognitively impaired subjects (OR(95%CI)=7.35(3.07-17.60)). An increasing number of somatic complaints increased the probability of functional impairment: compared with presence of 1-2 somatic symptoms, complaint of 3-6 and 7-12 symptoms were related to disability with OR(95%CI)=3.30(1.11-9.80) and OR (95%CI)=4.20 (1.17-15.09) respectively. Distinguishing pain, gastrointestinal, pseudo-neurological and general symptoms, only general somatic symptoms (palpitations, fatigue, sleep disturbances) were associated with disability (OR(95%CI)=1.81(1.25-2.62), independently by medical conditions (OR(95%CI)=1.57(0.98-2.52)). An additive effect toward disability was observed when general somatic complaints and cognitive impairment were co-existing (OR(95%CI)=23.68(5.50-101.86)). Including simultaneously cognitive impairment, somatic complaints and depression in the model, only cognitive impairment was still significantly related (OR(95%CI)=5.87(2.66-12.96)).
Among many possible causes of disability in the elderly, an important role could be attributed to cognitive deficits.
INTERMED is a method to assess biopsychosocial case complexity and a screening instrument to identify patients with multiple care needs. It is based on an interview, brief and easy to use, that can be conducted also by a nurse. Various studies in the last 10 years have confirmed its face-validity and reliability as a clinimetric tool. Its self-assessment version (IM-SA) was developed for further implementation in clinical settings.
To evaluate language, structure and fluency of the IM-SA questionnaire.
IM-SA, Italian version 1.0, was administered to 25 patients admitted to an internal medicine ward and to other 25 in the waiting room of a Primary Care outpatient clinic. At the end of the questionnaire, nine extra-questions were specifically added to evaluate comprehension and difficulties encountered by patients while filling in the questionnaire.
Patients admitted to the hospital scored higher and were found to be “more complex” (p < .01). 90% of respondents found the questionnaire easy to answer and 96% answered that the structure of the sentences was not too complex. The majority of patients found IM-SA useful and/or interesting. Contradictions in results also were found, suggesting need for improvement of structural and linguistic properties of the tool.
IM-SA seems to be a feasible and reliable self-assessment method to evaluate biopsychosocial complexity. Further similar studies in different languages are being organized to reach a final version of IM-SA, which will be afterwards compared to the IM professional interview.
The risk of psychotic spectrum disorders in Western countries seems to be higher among immigrants than natives. The higher vulnerability may be related to biological, psychological and social factors while cultural and diagnostic difficulties seem to delay an effective therapeutic intervention, with longer DUP (duration of untreated psychosis).
Aim of the study is to analyze the characteristics of psychotic patients of foreign origin with a particular attention to their use of mental health services.
We studied all migrant patients attended to 3 Community Mental Health Centres (CMHC) and to the Psychiatric Hospital (PH) of Modena over a period of a month.
The socio-demographic and clinical data were collected by means of a structured culturally-oriented form.
63 patients of foreign origin attended to the Services. 46% of all diagnoses is a psychotic disorder (most frequent diagnosis being that of brief psychotic episode: 19.15% in CMHC, 22% in PH).
Psychotic disorders are prevalently present among Asian, South American and Eastern European populations.
Use of second generation antipsychotics is frequent in the CMHC (23.4% of all psychopharmacological treatments, p = 0.003) while combined therapies dominate in PH (42.86%). The DUP is on average 12 weeks in PH, 8 in CMHC.
We would confirm a high incidence of psychosis among migrant subjects, with a tendency to use emergency health services. Often there are difficulties in establishing a continuous and territorial therapeutic relationship, or to intervene in the early stage of onset.
Clozapine was administered to 28 resistant schizophrenics at psychiatric services in Bologna. At 26 weeks 62% responded. Positive and negative symptoms improved, but decrease of negative symptoms partially depended upon improvement of positive and EPS. No cases of agranulocytosis were seen. Some drop-outs were related to difficulties with psychopathological improvement.
There has been an increased interest on the role of urban security and fear of crime on mental health of the general population, but there are not studies about this among patients with minor psychiatric disorders.
Assess patients’ fear of crime and perceived urban insecurity.
1) evaluate the association between perceived urban insecurity and crime, and minor psychiatric disorders;
2) identify subgroups of patients with high levels of perceived urban insecurity and fear of crime.
A sample of 24 patients with depressive or anxiety disorders attending outpatient services was collected. Patients consenting to the study underwent a battery of psychometric instruments. This study is part of a national multicentric study that enrolled 426 subjects.
The sample was mainly composed by females (83%), cohabiting (58%), employed (54%). Patients were more frequently diagnosed with dysthymia (54%) had an average GAF score of 73 (SD=8,44), an average GHQ-12 of 17.33 (SD =3,95). 41% reported high level of insecurity or fear and 58% stated that their worries were increased compared to 10 years earlier. Reported reasons for this were mostly ‘decrease of social security’ and ‘loss of values’. 12.5% of the sample reported of having been victim of a theft or vandalism.
The results of this study are not only useful to understand the role of fear of crime in the onset and relapses of minor psychiatric disorders, but they can also help to plan psychiatrists’ and Public Health's interventions in order to prevent them.
Studying the pathways followed by psychiatric patients is important to plan both mental health services organization and training programmes for doctors and psychiatrists.
Detecting the main pathways-to-care followed by patients.
Finding the reasons why patients look for psychiatric help and the main responses given to patients’ problems by psychiatric services. Evaluating the delays occurring along the pathways.
The study has been done on 420 Italian patients. In one month, patients with a new episode of disease have been included. Each of them has been administered a questionnaire collecting socio-demographical, medical infos and data concerning health workers, timing and delays along the pathways. Diagnosis done using ICD-10 and an Intervention Detection Schedule filled for each patient.
The Carpi’s sample consists of 43 patients. The 58% has seen the General Practitioner (GP) in the first place, the 19% the hospital doctor (HD), the 16% the psychiatric worker. Nation-widely, most patients have firstly referred to the psychiatrist (34%). In Carpi, the 44% has received a diagnosis of “Neurotic, stress-related and somatoform disorders”. The 93% has been treated with psychotropic medications. The longest pathway has occurred for behavioural syndromes associated with physiological disturbances and physical factors, the shortest for affective disorders.
GP, HD and direct access are the 3 main pathways followed by patients. The importance of the GP is confirmed, so as the necessity for training of sanitary workers within the psychiatric field. A greater cooperation between general practice and mental health services should be pursued
A group of intercompany job is constituted from the DSMs of the ASLs of Biella (BI), Novara (NO), VCO, Vercelli (VC) and of the Psychiatric Clinic of the AOU of Novara (NO) finalized to the definition of relief runs for the patients with Eating Disorders (ED). Currently they result active 2 ambulatory devoted to the ED near NO and VCO. In the AOU NO a collaboration is active with the dietology and a daily DH with activity of group for patient with different diagnoses. To Borgosesia (VC) a project of promotion and prevention it is active in the secondary (course of formation for teachers, job with the students) schools. In the DSM NO it is active a program of food education in the schools. Patients affections from ED currently in load: AOU NO 47 (2 AN Purging, 5 AN Restrictive, 2 BED, 20 Bulimia, 18 EDNOS); DSM NO 15 (7 AN, 5 Bulimia, 3 EDNOS); DSM VCO 27 (10 AN, 5 Bulimia, 12 EDNOS); DSM VC 21 (5 AN Purging, 1 AN Restrictive, 6 Bulimia, 9 EDNOS); DSM Arona (NO) 13 (4 AN, 9 Bulimia); DSM BI 20 (8 AN, 8 Bulimia, 4 EDNOS). In the last two years the followings have been effected refuges in Therapeutics Community specific (CT) for ED: 3 near the CT to Moncrivello (VC) and 1 near the CT to Cuasso al Monte (VA). Besides the structures of the DSM they are present associations of relatives and volunteers (informative counter).
In Italy, 6 months of abstinence from alcohol/substances are required before OLT, evidence for this recommendation remaining controversial. No standard approach linking abstinence duration at the index psychiatric pre-OLT evaluation to referral to Community Services is followed.
To report data of the Modena Consultation-Liaison Psychiatric Service (MCLPS) for pre-OLT patients with Substance Use Disorders (SUDs), and to evaluate patients' concordance with referrals.
Case-control study. Data source: database of MCLPS. Psychiatric evaluations pre-OLT from 01/01/2008 to 31/12/2013 were extracted. Patients were controls if they had a SUD and abstinent for more than 6 months; cases if they had a SUD with less than 6 months of abstinence. Chi-squared analysis was performed with STATA 13.0.
515 consultations were requested for 309 pre-OLT patients, 36.3% (N=112) of patients had a current or past SUD. Controls were 80 (71.3%), while cases – who had stopped use less than 6 months before the consultation, or were still using- were 20 (17.9%). 52.5% of controls (N=42) and 85.0% of cases (N=17) were referred to community services (Chi 5.71; p=0.02). 70.0% of cases (N=14) and 33.6% of controls (N=27) were seen at least twice (Chi 7.22; p=0.01). 16.7% (N=2) of cases and 23.5 % (N=4) of controls referred to community services reported concordance with Consultant's recommendation at re-assessment, a non-significant difference with cases (Chi 0.00; p=1.00).
Consistently with previously research in this field, no difference of concordance with recommendations emerged between patients with SUD with different duration of abstinence.
Recent reviews of evidence-based guidelines for the clinical management of Bipolar Disorders (BD) have recommended that “all patients with BD should be offered group or individual psychoeducation” to prevent relapse, improve treatment adherence, quality of life and functioning.
The present study aimed at evaluating the psychoeducation in routine mental health.
One hundred and two outpatients were recruited from two Italian DMHs. Inclusion criteria were a lifetime diagnosis of BD type I or II assessed by SCID-I, being euthymic for at least 3 months. Exclusion criteria were a DSM-IV Axis I comorbidity, mental retardation (IQ < 70), organic brain damage. All subjects received standard psychiatric care, with standard pharmacological treatment; one group received additional 21 weekly sessions of psychoeducation group, according to Colom and Vieta model.
Data show that the number of patients hospitalized during the 1-year follow-up, the mean number of hospitalizations per patient and the mean number of days in hospital were significantly lower for psychoeducated patients.
Our study supports the view that group psychoeducation is an efficacious intervention to prevent patients’ hospitalization and decrease hospital days in pharmacologically treated patients with bipolar disorder, also in routine clinical settings. The results seem to confirm that the psychoeducation promotes an improvement in the course of illness, avoiding acute phases, and producing a greater stabilization of the disease and consequently an improvement in quality of life in people with BD.
In a demographic survey in 2005, 13.6% of Italians admitted to have taken CAMs during the 3 years before. A study on hospitalized patients for psychiatric reasons highlighted that 63% of them used CAM in the previous year and 79% did not mention this to their psychiatrists.
To collect the opinions about the use of CAMs in psychiatry among a group of psychiatrists and nurses working in a Mental Health Centre.
To investigate knowledge, opinions and experiences on CAMs.
A mixed qualitative-quantitative method was used: 2 focus groups were conducted in June 2011, involving 12 professionals of one Mental Health Community Centre in Modena, Italy. The audio-recordings of the focus groups were analyzed by 2 researchers, who identified the main themes with an inductive method. The participants were finally asked to fill in a respondent validation questionnaire.
Four main themes were developed:
1) advantages, and
2) disadvantages in the use of CAMs,
3) patients’ and own experiences,
4) variety of therapies under the CAM acronym.
Among the pros, 75% of respondents agreed that CAMs allow a better global approach to the patient, 58% that CAMs may improve quality of life, 66% that conventional psychiatric therapies do not solve every situation. As to disadvantages, some professionals (medical doctors) expressed skepticism on CAMs.
Being realistic, open-minded and ready to listen and cooperate: this could be the best attitude towards patients who take CAMs.
Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU + MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.
Training in Psychiatry is especially debated since the biological, psychological and social perspectives need to be integrated in the education of Early-Career Psychiatrists (ECP).
To describe the opinion of ECP about the training received and to evaluate their self-confidence in therapeutic interventions.
A training event for ECP from all over Italy takes place in Rome yearly. A 30-item ad hoc questionnaire with both yes/no and rating scale answers has been administered to all the participants in the event.
Over the past three years 224 questionnaires were collected from 216 last-year trainees and 8 recently qualified psychiatrists (68.5% women, mean age 30.5 ± 3.5). Only 13% of participants was globally satisfied with his/her training program in psychiatry, the most of them were only partially or a little satisfied (51.4% and 32.0% respectively). the most critical training areas were Forensic Psychiatry and Psychotherapy followed by Psychiatric Rehabilitation. Conversely, Clinical Psychiatry and Psychopharmacology were the most satisfying areas of training. Likewise, ECP felt themselves most confident in Clinical Psychiatry (87.9%) and Psychopharmacology (48.7%); whereas the most uncomfortable areas were Forensic Psychiatry (62.5%), Child and Adolescent Psychiatry (37.2%), and Dual Diagnosis/Substance-Abuse Related Disorders (33.9%).
The 45% of ECP complained that Psychotherapy is a critical issue. Despite the 46.4% of participants had supervision within the training program (less than two hours per week), the 87.4% seek help from external psychotherapeutic training programs.
To achieve a satisfactory educational standard and an adequate self confidence, network programs (within Italy and/or Europe) might be helpful.