To assess the prevalence of neuropsychiatric symptoms 2 years after the COVID-19 acute phase and to identify biobehavioral risk factors.

This 2-year prospective study assessed adult individuals with COVID-19 via face-to-face interview and laboratory testing at onset, and via telephone interview at 2-year follow-up. Data collected included COVID-19 severity and management at onset, as well as depression, anxiety, insomnia, cognitive failure, and fatigue at follow-up using standardized assessment tools.

Out of 1,067 screened COVID-19 patients, 230 completed the 2-year follow-up (female, 53.5%; aged>40, 80.9%; native Italian, 94.9%; medical comorbidity, 53.5%; chronic medication, 46.3%; moderate to severe COVID-19, 24.9%; hospital admission, 28.7%; ICU, 5.2%). At follow-up, 9.1% had anxiety, 11.3% depression, 9.1% insomnia, 18.3% cognitive failure, and 39.1% fatigue, of clinical relevance. Headache (OR = 2.49, 95% CI = 1.01–6.16, p = 0.048), dyspnea (OR = 2.55, 95% CI = 1.03–6.31, p = 0.043), and number of symptoms (OR = 1.23, 95% CI = 1.01–1.51, p = 0.047) at onset were associated with anxiety at follow-up; dyspnea at onset was associated with depression at follow-up (OR = 2.80, 95% CI = 1.22–6.41, p = 0.015); number of comorbidities at onset was associated with insomnia at follow-up (OR = 1.48, 95% CI = 1.06–2.08, p = 0.022); female gender (OR = 2.39, 95% CI = 1.14–5.00, p = 0.020) and number of symptoms (OR = 1.20, 95% CI = 1.02–1.42, p = 0.026) at onset was associated with cognitive failure at follow-up; number of comorbidities (OR = 1.33, 95% CI = 1.03–1.73, p = 0.029) and symptoms (OR = 1.19, 95% CI = 1.04-1.37, p = 0.013) and raised interleukin 6 levels (OR = 4.02, 95% CI = 1.42–11.36, p = 0.009) at onset was associated with fatigue at follow-up.

COVID-19 survivors, especially if female, with preexisting health problems, and with a more severe acute phase, may present with long-lasting neuropsychiatric sequalae, urging interventions to sustain recovery particularly in these higher risk individuals.

Satisfaction with the medical interview has been rarely explored in primary care outside the UK, despite evidence suggesting that a trustful doctor–patient relationship is a key ingredient to facilitate treatment adherence and relief from illness-related distress.

The aims of this study are to analyse the construct validity of the Italian version of the Medical Interview Satisfaction Scale (MISS-21) and its correlations with two outcome measures, the Inventory of Depressive Symptomatology – Self-Report and World Health Organization Quality Of Life Brief Version, in patients with mild-to-moderate depression, recruited in primary care practices.

The factor structure underlying the MISS-21 was investigated with principal component analysis, and the internal consistency of the factors was evaluated with Cronbach's alpha. Network analysis was used to investigate the interrelationships among items. The importance of individual items in the network structure was determined with centrality analyses. Correlations of MISS-21 scores with changes in depression and quality of life were analysed with Spearman's correlation coefficient.

The MISS-21 proved to have a robust four-dimensional factor structure. Cronbach's alpha for the factors ranged from 0.77 to 0.93, suggesting good to excellent internal consistency. The four factors identified were positively correlated with improvement in depressive symptoms and three quality-of-life domains.

The MISS-21 has sound psychometric properties, and comprises four factors related to clinical outcomes, which makes it suitable for clinical and research applications. The central items in the network should be considered as possible targets for quality improvement interventions in primary care.

Although the study of the neuroanatomical correlates of generalized anxiety disorder (GAD) is gaining increasing interest, up to now the cortical anatomy of GAD patients has been poorly investigated and still no data on cortical gyrification are available. The aim of the present study is to quantitatively examine the cortical morphology in patients with GAD compared with healthy controls (HC) using magnetic resonance imaging (MRI). To the best of our knowledge, this is the first study analyzing the gyrification patterns in GAD.

A total of 31 GAD patients and 31 HC underwent 3 T structural MRI. For each subject, cortical surface area (CSA), cortical thickness (CT), gray matter volume (GMV), and local gyrification index (LGI) were estimated in 19 regions of interest using the Freesurfer software. These parameters were then compared between the two groups using General Linear Model designs.

Compared with HC, GAD patients showed: (1) reduced CT in right caudal middle frontal gyrus (p < 0.05, Bonferroni corrected), (2) hyper-gyrification in right fusiform, inferior temporal, superior parietal and supramarginal gyri and in left supramarginal and superior frontal gyri (p < 0.05, Bonferroni corrected). No significant alterations in CSA and GMV were observed.

Our findings support the hypothesis of a neuroanatomical basis for GAD, highlighting a possible key role of the right hemisphere. The alterations of CT and gyrification in GAD suggest a neurodevelopmental origin of the disorder. Further studies on GAD are needed to understand the evolution of the cerebral morphology with age and during the clinical course of the illness.

Sono descritte con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Verona-Sud. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1010/100000 residenti adulti), prevalenza un giorno (306/100000 residenti adulti) e di incidenza (219/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Verona-Sud monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 2,5 a 1. II tasso di lungoassistiti e di 130/100000 adulti. La spesa globale del Dipartimento è aumentata di circa il 25%, con un incremento da parte di tutte le componenti dell'assistenza.

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

The principles, structure, Psychiatric Case Register (PcR) and catchment-area of the Community Psychiatric service of South-Verona are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1010/100000 adult inhabitants), one-day prevalence rates (306/100000 adult inhabitants) and incidence rates (219/100000 adult inhabitants) lower than those of other European PCRs. South-Verona PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 2.5 to 1. The rate of long-term patients is 130/100000 adult inhabitants. All the components of the treatment contributed to the 25% increment of the costs of the South-Verona Psychiatric Service.

Dopo una breve rassegna sui dati di confronto tra Registri Psichiatrici dei Casi (RPC) disponibili nella letteratura internazionale, vengono analizzati gli indici sociodemografici e i tassi standardizzati (per età e sesso) relativi alle attività assistenziali (anni 1987–90) svolte in cinque aree italiane di RPC. Gli indici socio-anagrafici sono risultati correlati con le caratteristiche urbano-rurali del territorio. In ognuna delle cinque aree di registro esisteva, alia fine del 1990, una rete di servizi considerata adeguata rispetto alle esigenze della popolazione. I tassi totali di prevalenza un giorno sono in lieve aumento in tutte le aree di RPC, mentre quelli di prevalenza un anno e incidenza hanno avuto un andamento piuttosto differenziato nelle varie aree. II ricorso al day-hospital è diventato mediamente piu frequente e l'attività territoriale è aumentata dappertutto. Sono diminuiti parallelamente i ricoveri. II fenomeno della lungodegenza è tuttora presente, anche se in forma ridotta, in alcune aree di RPC. I soggetti lungoospitati in comunità sono aumentati in un'area (Arezzo), diminuiti in un'altra (Caltagirone), mentre sono stabili nelle altre aree. I lungoassistiti sono aumentati in quattro aree e in lieve flessione nella quinta (Arezzo). Non e emersa una relazione tra livelli di assistenza psichiatrica erogata e caratteristiche della popolazione di riferimento. Secondo un punteggio assistenziale ponderato di costo lo sviluppo dell'attività assistenziale ha determinato un aumento dei costi a Verona-Sud e ad Arezzo, una diminuzione a Caltagirone e a Legnano e nessuna variazione a Portogruaro.

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

After a brief review of the literatur on comparison between Psychiatric Case Registers (PCR), this paper analyzes sociodemografic data and 1987-1990 age/sex standardised rates of psychiatric treatment in five Italian areas with a PCR. There was a correlation between sociodemografic indices and urban-rural characteristics of the areas. At the end of 1990 the comprehensive community psychiatric service of each area was considered able to meet the needs of the population. During the four years of our survey, one-day prevalence rates were consistently slighty increasing, while one-year prevalence and incidence rates showed different trend in the five areas. Overall, there was a development of the community services and a decrease of psychiatric admissions. There were still few hospital long-stay patients in some areas, but what is more evident was the increase of the number of long-term patients (hostel long-stay patients and communiy long-term patients). No correlations were evident between levels of psychiatric treatment and characteristics of the populations in the five areas. The development of a comprehensive network of community services required an increase of the costs in Verona-Sud and Arezzo, a decrease in Caltagirone and Legnano, while there was no variation of costs in Portogruaro.

Psychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.

A longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.

The duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.

The community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.