Predictors of Length of Stay in an Inpatient Psychiatric Unit of a General Hospital in Perugia, Italy.

The aim of this study was to understand which of a number of factors are most associated with psychiatric inpatient length of stay (LoS). We hypothesized that a longer LoS would be predicted by: older age, male gender, unmarried marital status, foreign nationality, more than one hospitalization, being hospitalized involuntarily, psychotic symptoms and behavioral dyscontrol at admission, discharge diagnosis of psychotic and personality disorders, not having a substance use disorder, treatment with more than one class of medications, and being discharged to a community residential facility. All admissions to the Psychiatric Inpatient Unit of Santa Maria della Misericordia, Perugia Hospital, Umbria, Italy, from June 2011 to June 2014, were included in a medical record review. Bivariate analyses were performed and a multiple linear regression model was built using variables that were associated (p < .05) with LoS in bivariate tests. The study sample included 1236 patients. In the final, most parsimonious regression model, five variables independently explained 18 % of variance in LoS: being admitted involuntarily, being admitted for thought disorders, not having a substance-related disorder, having had more than one hospitalization, and being discharged to a community residential facility. LoS on this inpatient psychiatric unit in Umbria was associated with a number of sociodemographic and clinical characteristics. Knowledge of these and other predictors of LoS will be increasingly important to, when possible, reduce the length of restrictive, costly hospitalizations and embrace community-based services.

Personality disorders features in a sample of women with perinatal depression in Perugia, Italy.

BACKGROUND: Antepartum depression (APD) and postpartum depression (PPD) are a significant public health problem. Aim of the study was to determine which personality disorders features could be found in women with APD and PPD compared to women without perinatal depression. SUBJECTS AND METHODS: The Edinburgh Postnatal Depression Scale and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were administered during peripartum to a sample of 54 women recruited at the Obstetrics and Gynaecology Unit, Perugia (Italy). RESULTS: Results were grouped according to the EPDS ranges 0-8 and ≥9, and to the MMPI-2 scores on each clinical scale. Women with APD had high scores on the MMPI-2 Hypomania, Cynicism, and Antisocial Practices scales; women with early onset PPD (detected in the first week after childbirth) had high scores on the Paranoia and Low Self-Esteem scales; women with late onset PPD (detected up to three months after childbirth), had high scores on the Fears, Obsessiveness, and Depression scales. CONCLUSIONS: Based on the high scores of specific MMPI-2 scales, our study would suggest that: cluster B personality features may represent a vulnerability factor for APD; passive-aggressive personality features may be a vulnerability factor for early onset PPD; cluster C personality features may act as a vulnerability factor for late onset PPD.

Schizo-Obsessive Disorder: A Brief Report of Neuroimaging Findings.

BACKGROUND: The term 'schizo-obsessive disorder' was coined to describe schizophrenia (SCZ) patients who are also affected by obsessive-compulsive symptoms (OCS) or also meet the criteria for obsessive-compulsive disorder (OCD). Several studies have investigated the clinical and epidemiological features of OCS/OCD in SCZ, but the neuroimaging literature is sparse. The aim of this brief report is to describe some of the most important neuroimaging findings regarding schizo-obsessive disorder. METHODS: A literature search of the PubMed electronic database was conducted up to July 25, 2015. Search terms included 'schizo-obsessive' combined with the names of specific neuroimaging techniques. RESULTS: Neuroimaging studies suggest that there may be a specific pattern of neuroanatomic dysfunction in schizo-obsessive patients, but the number of studies is limited and conclusions are preliminary because reports are of an exploratory nature. CONCLUSIONS: Further neurobiological research is needed to definitely determine whether schizo-obsessive disorder might have unique neuroanatomical and functional alterations.

The State of the Art of the DSM-5 "with Mixed Features" Specifier.

The new DSM-5 "with mixed features" specifier (MFS) has renewed the interest of the scientific community in mixed states, leading not only to new clinical studies but also to new criticisms of the current nosology. Consequently, in our paper we have reviewed the latest literature, trying to understand the reactions of psychiatrists to the new nosology and its epidemiological, prognostic, and clinical consequences. It seems that the most widespread major criticism is the exclusion from the DSM-5 MFS of overlapping symptoms (such as psychomotor agitation, irritability, and distractibility), with a consequent reduction in diagnostic power. On the other hand, undoubtedly the new DSM-5 classification has helped to identify more patients suffering from a mixed state by broadening the narrow DSM-IV-TR criteria. As for the clinical presentation, the epidemiological data, and the therapeutic outcomes, the latest literature does not point out a univocal point of view and further research is needed to fully assess the implications of the new DSM-5 MFS. It is our view that a diagnostic category should be preferred to a specifier and mixed states should be better considered as a spectrum of states, according to what was stated many years ago by Kraepelin.

Bipolar and Borderline Personality Disorders: a descriptive comparison of psychopathological aspects in patients discharged from an Italian Inpatient Unit using PANSS and BPRS.

BACKGROUND: There is current scientific debate in consideration of the possibility to consider the Borderline Personality Disorder (BPD) as a mood disorder within the bipolar spectrum furthermore, authors reported about the challenging differential diagnosis of BPD and Bipolar Disorder (BD). SUBJECTS AND METHODS: 32 patients hospitalized in the Inpatient Psychiatric Unit in Perugia, discharged with a diagnosis of BD or BPD, were included. Factor analyses of BPRS and PANSS items were performed. Association between socio-demographic, clinical and psychopathological variables was tested using bivariate analyses. RESULTS: Factor analysis identified 6 Factors, explaining 67.6% of the variance, interpreted as follow: 1) Euphoric Mania, 2) Psychosis, 3) Inhibited Depression, 4) Disorganization, 5) Psychosomatic features, and 6) Mixed features. Bivariate analyses identified statistically significant differences between BPD and BD according to: PANSS positive symptoms domain, BPRS total score, Euphoric Mania and Disorganization. No statistically significant differences came up on socio-demographic and clinical aspects. CONCLUSION: Even though the sample is small, interesting findings came out from our investigation. Our findings are in line with the current literature. Euphoric mood, is one of the aspects which best differentiated BD from BPD. Higher scores in Disorganization, BPRS and PANSS positive symptoms in BD may be related to the fact that our sample is a group of patients from an acute inpatient unit, so the impact of the symptoms severity for BD may be remarkable.

Comparison of assessment and management of suicidal risk for acute psychiatric assessment between two state sponsored hospitals in England and Italy.

The risk of suicide is one of the most important risk factors looked into for acute psychiatric assessments that influences the management plan. The prevalence of suicide is on a rise across European countries; as a consequence, the different countries have created specific guidelines and policies in order to prevent suicides in the acute settings. These guidelines are based on both different cultural aspects as well as the different organization of the mental health system in the different countries. This paper wants to present the comparison between the guidelines of two European countries, England and Italy, in order to evaluate the systems, understand differences and common contact points. The different European countries could learn one from the other and a European shared point of view may be a way forward to create better understanding and preventing the risk of suicide across the population.

Traumatic events in childhood and their association with psychiatric illness in the adult.

INTRODUCTION: Child maltreatment is a well-known condition that is currently considered to be associated with the development of severe psychiatric conditions. Consequently, the authors decided to review the current literature in order to give a complete scenario of the situation in the world and to give recommendations about prevention and treatment as well as research goals. METHODS: An electronic search was conducted through the means of MEDLINE database in order to find the most up to date peer-reviewed papers, including only those papers published in 2015. RESULTS: 15 papers were included and analyzed the current situation in different countries: US (n.3), Australia (n.2), Ireland (n.2), Israel (n.2), China (n.2), Indonesia (n.1), Pakistan (n.1) and Norway (n.1). DISCUSSION: Even though sexual abuse has been studied extensively, both physical and emotional abuse and neglect appear to be more represented within the population of patients that had suffered from abuse. Psychiatric disorders (mainly personality disorders, depression and anxiety), interpersonal, social and legal outcomes are important consequences of child maltreatment. CONCLUSIONS: Interventions and strategies are needed at different levels, from prevention to treatment and further research is important in order to better understand the phenomenon.

The psychosomatic spectrum: a clinical-analytic survey of the relationship between eating disorders and migraine.

OBJECTIVE: To evaluate if somatic symptoms of Eating Disorders and Migraine reflect similar aspects of personality and temperament. METHODS: The clinical notes of 27 migraineurs and of 26 ED outpatients were reviewed; 40 medical students of the University of Perugia were recruited as healthy controls. TCI, DMI, SCID-II and TAS-20 were used. STATISTICAL ANALYSIS: performed by logistic regression, a cluster analysis that gave the weight for the three groups, and a logistic regression of the cluster analysis. RESULTS: Patients showed medium scores in almost all the scales of the different tests. High scores in HA and low scores in NS characterized both migraine and ED patients. Logistic regression of the cluster analysis underscored that ED patients, migraineurs, and controls differed for HA (435.424, p≤0.0001), TAS-20 F2 (difficulty in describing feelings to others; 7.087, p=0.029), and the defense mechanism turning against object (6.702, p=0.035). DISCUSSION: The temperamental aspects of low NS and high HA represent the core symptoms of a spectrum composed of somatizing patients who use affective and behavioral strategies that are not functional enough in affective regulation.

Personality and psychotic symptoms as predictors of self-harm and attempted suicide.

BACKGROUND: Nonfatal suicidal behaviours (NSB), including suicide ideation, suicide plan and suicide attempt, constitute a serious problem for public healthcare services. Suicide gesture (SG) which refers to self-injurious behaviour with no intent to die, differs from NSB in a variety of important ways. The aim of this study was to investigate demographic and clinical characteristics of NSB and SG to examine whether self-injurers with intent to die differ significantly from self injurers without such intent. METHODS: All admissions for NSB and SG to the Psychiatric Inpatient Unit of University / General Hospital Santa Maria della Misericordia, Perugia, Umbria, Italy, from January 2015 to June 2015 were included in a medical record review. Basic descriptive statistics and distributional properties of all variables were first examined. Bivariate analyses were performed using Chi-square tests for group comparisons and t-test for independent samples used when appropriated. RESULTS: The study sample included 38 patients. Of these 23 had committed NSB (13.1%), 15 had commetted SG (8.5%). Number of married NSB was significantly higher than the number of married SG (p=0.08). We found a significant difference between NSB and SG related to the item of impulse control that was poorer in SG than NSB (p=0.010). BPRS items of hostility (p=0.082), suspiciousness (p=0.042) and excitement (p=0.02) were found to be significantly higher in SG than NSB. Borderline personality disorder (p=0.032) and Passive-Aggressive personality disorder (p=0,082) diagnosed by the means of the SCID-II, were more represented in SG than NSB (p=0.044). Schizoid personality disorder was significantly related to NSB (p=0.042). No others significant differences were found. CONCLUSIONS: NSB and SG are different for many psychopathological characteristics. These results confirm the importance of classifying individuals on the basis of the intent to die. Additional research is needed to understand and elucidate psychopatological and clinical characteristics of the different categories of self-injurers to find risk factors specific to suicide attempts.

Psychiatry in the emergency room: one year period of clinical experience.

OBJECTIVE: We examined the psychiatric consultations carried out over one year at the Emergency Room (ER) of the hospital of Perugia, with the aim of describing the epidemiologic characteristics of patients with any psychiatric illness and their management. We also assessed the distribution of psychiatric emergencies over this year of observation. METHOD: We recruited patients admitted to the ER, between July 2011 and June 2012, for which a psychiatric consultation was required. We used the t-test for continuous variables. Categorical variables were analyzed with the chi-squared test and the Fisher exact test. We considered significant test results with p<0.05. The post-hoc analyses were carried out with Bonferroni or Sidak correction. Statistical analyses were performed using STATA 12.0. RESULTS: Neurotic, stress-related and somatoform disorders were the most represented. The most frequent approach to patients with psychiatric complaints did not imply the use of psychopharmacological treatments or coercive interventions. No particular seasonality of psychopathology was observed. CONCLUSIONS: One of the fundamental aspects of the psychiatric intervention is empathy along with the attempt to enter into a relationship with the patient, in order to share, where possible, the therapeutic project, particularly in the case the of patients with acute and severe psychiatric illnesses.

Psychiatry in the emergency room: clinical experience in Perugia.

BACKGROUND: We examined all psychiatric consultations carried out over 3 years at the Emergency Room (ER) of the hospital of Perugia, with the aim of describing the epidemiologic characteristics of patients with any psychiatric illness and their management. We also assessed the distribution of psychiatric emergencies over this period of observation. SUBJECTS AND METHODS: We recruited patients consecutively admitted to the ER, between June the 20th 2011 and June the 20th 2014, for which a psychiatric consultation was required. We analysed socio-demographic and clinical data as well as the type of long-range plan after discharge. Continuous variables were presented as means and standard deviations. Categorical variables were presented as number and percentages. For comparing the means we used the Student's t-test. For analyzing the association between categorical variables we performed Pearson's chi-squared test or the Fisher's exact test where appropriate. We considered significant test results with p<0.05. The post-hoc analyses were carried out by means of standardized Pearson residuals, in order to assess the significance of the cell-wise divergences from homogeneity. Spearman's correlations were computed for reasons for a psychiatric consultation request across months. Multinomial logistics regression model was used for analyzing the variability of the reasons for the admission to the ER for the 12 months. Statistical analyses were performed using the R software v 3.1. RESULTS: Neurotic, stress-related and somatoform disorders were the most represented. The most frequent approach to patients with psychiatric complaints did not imply the use of psychopharmacological treatments or coercive interventions. No particular seasonality of psychopathology was observed. CONCLUSIONS: ERs may represent the place where the first psychiatric visit occurs and a point of reference for the chronic patients. It can also represent an opportunity for further examination of organic comorbidity.

Mixed States: a "new" nosographic entity.

OBJECTIVE: Mixed states represent a controversial topic in the current psychiatry. The definitions and the diagnostic criteria have changed over the past years. The new DSM-5 classification will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations. METHODS: We reviewed the latest literature by using the key words "mixed states" and "agitated depression" on the PubMed. RESULTS: Although there is a great expectation about the validity of the new DSM-5 mixed states diagnosis, little is known about its application on large population study but the formulation of less restrictive and more specific criteria for the diagnosis of mixed states represent a starting point for future researches, mainly in consideration of the fact that previous classifications consider the MS a superposition of manic and depressive symptoms, underestimating the clinical complexity and the wider phenomenologic variability of these conditions. CONCLUSIONS: Clinical trials need to address treatment effects according to the presence or absence of mixed features in consideration of the fact that replacing in the bipolar spectrum patients that traditionally are considered to be affected by unipolar depression, represent a topical research hypothesis and has a practical remarkable importance in the appropriate therapeutic choice.

Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 1: An analysis of potential prognostic factors.

BACKGROUND: Prognostic factors of bipolar disorder must be identified to assist in staging and treatment, and this may be done primarily during the initial psychiatric assessment. In fact, most of the prognostic factors, which determine disease outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic visit. METHODS: We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome. RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; a psychiatric comorbidity was noted in 26 patients (37.1%). 60.9% (42 patients) reported anxiety features and 12 patients (17.6%) were noted to have obsessive-compulsive characteristics. Percentages reported in our results are of the sample for which the data was available. Anhedonia is a depressive feature that was present in most of the population where this data was available (92.2%, 59 patients) and 81.8% (54 patients) reported suicidal thoughts during a depressive episode. 74.6% (47 patients) had a family history of bipolar disorder, depression, suicide or psychosis. 27 patients (39.7%) reported current alcohol use and 14 patients (22.6%) current illicit drug use. A comparison between 10 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use (χ(2)=11.471, P<0.001), current alcohol use/previous alcohol use (χ(2)=31.510, P<0.001) and current illicit drug use/anxiety (χ(2)=5.094, P=0.022) were statistically significant; the correlation between previous illicit drug use/previous alcohol use (χ(2)=5.071, P=0.023) and previous alcohol use/family history (χ(2)=4.309, P=0.037) were almost statistically significant. 17 patients (24.3%) of the 70 bipolar patients were assigned to a care coordinator; we have evaluated the possible differences between the patients with or without a care coordinator on the basis of the presence of 10 possible prognostic factors and found no statistically significant differences between these two groups of patients. CONCLUSIONS: We have identified several trends in our patients with bipolar disorder that agree with previous research. Our sample suggested that the assignation of a care coordinator is not done on a clinical basis. In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. In particular, specific features of the disease, like family history, age at onset, and features of depressive episodes may be highlighted as our sample suggests that these are often unrecorded when not known or negative.

Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 2: Mixed state features and rapid cycling.

BACKGROUND: Rapid cycling in bipolar disorder complicates the clinical picture and worsens the long-term outcomes of bipolar disorder. Mixed states features do similarly and are known to present an increased risk to patients. Early recognition of these patterns can lead to better treatment strategies and improvement of the long-term course of the disease. METHOD: We collected data from the clinical notes of 70 bipolar outpatients seen at an ASPA (initial assessment) clinic about socio-demographic and clinical characteristics. RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; percentages reported in our results are of the sample for which the data was available. 71.7% (33 patients) of the sample reported mixed states features and 32 patients (72.7%) are recorded to have more than 4 changes in mood in a year. There were no statistically significant correlations between mixed state features or rapid cycling and anhedonia, suicidal ideation, borderline symptoms, OCD symptoms, anxiety, positive psychiatric family history, current alcohol use, previous alcohol use, current illicit drug use, or previous illicit drug use. An almost significant correlation was found between mixed state features and anxiety. Assignation of a care coordinator did not seem to be associated with these prognostic factors. CONCLUSIONS: The two subgroups of mixed state features and rapid cycling patients share very common clinical characteristics: high incidence of suicidal thoughts, high levels of anxiety, and high previous substance use - but low levels of current alcohol and drug use and high levels of features of atypical depression. These features of mixed state bipolar disorder and rapid cycling bipolar disorder should be identified during psychiatric assessment to identify useful information for prognosis.

Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 3: A comparison between Italian and English mental health services and a survey of bipolar disorder.

BACKGROUND: Most of the prognostic factors of bipolar disorder, which determine disease course and outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic assessments. In previous parts of this research, we analysed various prognostic factors and focused on mixed states and rapid cycling subsets. We now compare our sample in England with a small sample from Italy to demonstrate the utility of focused prognostic questioning and of international comparison. METHODS: We collected data from the clinical notes of 70 English bipolar and 8 Italian bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome. RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) English outpatients and 7 bipolar I (87.5%) and 1 bipolar II (12.5%) Italian outpatients. Differences between the groups are seen mainly in terms of age of onset, duration of both depressive and hypomanic episodes, presence of psychiatric family history, incidence of mixed state features and rapid cycling, presence of elated mood in response to past antidepressant treatment, and misuse of illicit drugs and alcohol. CONCLUSIONS: In order to promote improved mental health primary care, mental health systems in all countries should develop standardized epidemiological tools that are shared between countries. We recommend the use of a questionnaire that reminds clinicians of potentially prognostic information and suggest that this might identify important components of a potential standardized diagnostic and prognostic tool.

Mood disorders in general hospital inpatients: one year data from a psychiatric consultation-liaison service.

BACKGROUND: Mood disorders (MD) show higher prevalence among psychiatric disorders. As a matter of fact 10% of inpatients in non psychiatric health care structures are affected by MD. A consultation-liaison service bridges the gap between psychiatric and other medical disciplines and increases the cooperation in the context of care, improving the diagnostic process for all inpatients in medical wards. SUBJECTS AND METHODS: Our sample is composed of 1702 patients assessed from 1 January 2012 to 31 December 2012 referred from the wards for psychiatric specialist evaluation in Santa Maria della Misericordia, Perugia, Italy. Each patient was assessed by a consultant psychiatrist performing a psychiatric interview leading to a diagnosis according to DSM-IV-TR criteria. Clinical and sociodemographic data were collected and registrered in the clinical records. SPSS software (ver. 18) was used for data analysis. Chi-square test and T-student tests were performed as appropriate. A p-value<0.05 was considered statistically significant. RESULTS: 17% of our sample shows a diagnosis within the mood disorder spectrum. As for the source of referrals we find that 51.4% came from the Emergency room, 39% from medical wards and 9.4% from surgical wards. On the basis of the consultation referral urgent status we found that 84% of requests needed to be seen within 24 h, most of them come from Emergency room. Statistically significant correlations can be found between the source of referrals, the reasons for the referrals, psychiatric care prior to the evaluation and the psychiatric disorder which was diagnosed during the assessment. CONCLUSIONS: Consultation-liaison service for MD in an italian general hospital is generally based on emergency/urgency referrals from the Emergency room for patients already assessed to mental care facilities by private or national health service psychiatrists.

Comparing a Community Mental Health team in Bedford (UK) with Community Mental Health Services in Perugia (Italy): description of teams and caseloads.

INTRODUCTION: The aim of our work is to evaluate and compare some of the key indicators that characterize one English Community Health team (Bedford), two Italian Mental Health Services, in Bastia and Magione, and one University Hospital Mental Health Service, in Perugia. Our work was conducted on the basis of a collaboration between Cambridge University (UK) and the University of Perugia (Italy). SUBJECTS AND METHODS: We analyzed and described the teams supplying information about the number of psychiatrists, types of staff and populations in the catchment areas. Furthermore, we analyzed their caseloads, referring to the epidemiologic features and the diagnostic aspects. We considered the population that were referred to the services in February 2013. RESULTS: There are some differences between the organization of the teams and the caseloads of the Community Mental Health Services in Italy and in England and between the community health services and the hospital service. As for the diagnostic aspects, Mood Disorders seem to be the most frequent diagnosis in each service (Bedford 53.8%, Perugia 48%, Magione 45%, Bastia 38%). CONCLUSIONS: The World Health Organisation identifies strong links between mental health status and development for individuals, communities and countries. In order to improve the mental health of the population, countries need effective and accessible treatment, prevention, and promotion programs. Achieving adequate support for mental health in any country requires a unified and shared approach. Little research has been done to describe the Mental Health Services in the different countries of the world, consequently more studies are needed to assess the improvements in the mental health system in relation to the services available for the population. In our study, according to the literature, we detected that mood disorders are the most frequent cause of referral to mental health services in all the populations studied.

Anniversary reactions in medical patients.

The aim of this study was to explore the prevalence and characteristics of anniversary reactions (somatic symptoms occurring at the anniversary of specific events) in a large sample of 1498 medical patients from different medical settings who underwent the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), which provide definition of anniversary reactions. In 54 (3.6%) of the 1498 patients for whom anniversary reaction was identified, 61.1% had a concurrent DSM-IV diagnosis. Other syndromes related to somatization, abnormal illness behavior, irritable mood, demoralization, and alexithymia were present in 9 of 10 cases. Symptoms of the conversion syndrome were found in 6 (0.4%) patients with the SCID and in 67 (4.5%) patients with the DCPR, 20% of whom also had anniversary reaction. The results should alert physicians to enquire about the timing of symptoms in relation to meaningful personal events.

Schizophrenia and obsessive-compulsive disorder: from comorbidity to schizo-obsessive disorder.

Current genetic, neurobiological, clinical-descriptive and pharmacological data about obsessive-compulsive symptoms (OCS) and/or obsessive-compulsive disorder (OCD) in schizophrenia hypothesize that schizophrenia combined with OCD is more than a mere comorbidity. To prove this hypothesis, "dimensional diagnosis", based on the identification of a dysfunctional area common to different clinical cases, should replace "categorical diagnosis", that focuses on discrete parameters that define specific disorders. It is our hope that the DSM-V will make reference to principles based on psychopathological "spectra" because these reflect the integration of pharmacotherapeutic, descriptive and etiopathogenetic aspects (genotypes common to various disorders, temperamental predispositions, neurobiological and chemical alteration). These three aspects explain how obsessive phenomena can develop into delusional phenomena.

Differences in the personality profile of medication-overuse headache sufferers and drug addict patients: a comparative study using MMPI-2.

BACKGROUND: Medication-overuse headache (MOH) refers to headache attributed to excessive use of acute medications. The role of personality needs studies to explain the shifting from drug use to drug abuse. The main aim of this study is to study personality, according to Minnesota Multiphasic Personality Inventory, comparing MOH, episodic headache, substance addicts (SA) vs healthy controls. METHODS: Eighty-two MOH patients (mean age 44.5; 20 M, 62 F) and 35 episodic headache (mean age 40.2; 8 M, 27 F), were compared to 37 SA (mean age 32.5; 29 M, 8 F) and 37 healthy controls (mean age: 32.49; 20 M, 17 F). International Classification of Headache Disorders 2nd Edition criteria were employed. Chi-square test, Kruskal-Wallis test, and post hoc comparisons were used for statistics. RESULTS: MOH patients scored higher on Hypochondriasis, Depression (only females), Hysteria (only females) (P < .000). MOH did not show higher scores than episodic headache or healthy controls in dependency scales, while SA did. CONCLUSION: The data obtained show that MOH and SA do not share common personality characteristics linked to dependence. Although further studies are needed to understand if such a difference is related to instrumental characteristics or to yet undiscovered psychobiological characteristics of MOH patients; however, we hypothesize that the detected difference may rely on the fact that drug dependence in the 2 groups is promoted by entirely different needs: pleasure seeking in the SA group, pain avoidance in the MOH group.