Obesity, alexithymia and psychopathology: a case-control study.

OBJECTIVE: The relationship between psychopathology and alexithymia in obese patients is uncertain. The present study was performed to evaluate this relationship in a clinical sample of patients attending a centre for the diagnosis and treatment of obesity compared to a matched sample of non-obese subjects. METHODS: 293 consecutive obese patients (48 males, 245 females, mean age 45, 41±13.55 yrs; mean BMI 35.60±6.20) were compared with a control group made of 293 non-obese subjects (48 males, 245 females, mean age 45, 66±13.86 yrs; mean BMI 21.8±2.06); all subjects were interviewed by means of SCID I and SCID II together with several self-evaluation instruments including the TAS-20 (Toronto Alexithymia Scale) and SCL-90 (Symptom Check List, Revised). RESULTS: Alexithymia was significantly more frequent among obese patients compared to "normal" controls (12.9% vs 6.9%, p=0.010); moreover obese patients achieved significantly higher mean scores on subscales 1 and 2 and on overall scale of the Toronto Alexithymia Scale; comorbidity with axis I/II disorders, in particular Binge Eating Disorder, was associated with a significantly higher frequency of alexithymic traits and higher scores at TAS. CONCLUSIONS: Alexithymia and psychopathology are strongly correlated among obese patients seeking treatment. Routine evaluation of personality traits and comorbid psychopathology may be relevant in treatment of obesity.

Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different "psychosocial" treatment approaches. A randomized clinical trial.

Our study belongs to the clinical trials in which the health-related quality of life (HQL) evaluation constitutes the primary endpoint. It was carried out with the aim of comparing the impact of three different types of psychological intervention, namely a psychopharmacological treatment alone, the same treatment plus social support carried out by volunteers (SSV) and a third treatment modality including "structured psychotherapy" (autogenous training), on improving the HQL of elderly cancer patients undergoing antineoplastic therapy with symptoms of anxiety and/or depression related to their disease. The eight questionnaires used for HQL evaluation were generally self-rated and multidimensional but unidimensional models were also employed. Seventy-four patients aged over 65 years with either solid tumors in different sites or hematological malignancies, generally in advanced stages (III-IV), were enrolled in the study. Of these patients, 72 (42 men and 30 women, mean age 70.68 years, range 66-85) were evaluable. Our study highlighted the usefulness of the pharmacological therapy (alprazolam + sulpiride) and of other specific ancillary treatments in reducing the incidence of the main HQL-related side-effects of antineoplastic therapy and the superiority of an "integrated" strategy, based both on psychopharmacology and psychosocial interventions, such as SSV with or without structured psychotherapy. The one-way analysis of variance carried out by us did not allow us to draw definitive conclusions about which of the two integrated treatments was to be considered the treatment of choice, as they proved to be almost equally effective.

[The family burden in chronic diseases. The study of validity and reproducibility of the questionnaire on the impact of the chronic disease on the family (IMPAT)]. / I1 carico familiare nelle malattie croniche. Studio di validazione e di riproducibilità del questionario sull'impatto della malattia cronica sulla famiglia (IMPAT).

OBJECTIVE: The "Questionario sull'Impatto della Malattia Cronica sulla Famiglia" (IMPAT) ("Impact-on-Family Scale", by Stein & Reissman) in its Italian version (by Casari & Fantino, modified) has been used to evaluate family burden in relatives of chronic patients with cancer, chronic patients with other internistic pathology and acute patients. The aims of the study were to evaluate validity and reliability of the Impat and to compare family burden and anxoius/depressive symptoms in the three groups of relatives. METHOD: 35 relatives of cancer patients, 20 relatives of patients with chronic, non neoplastic illness and 20 relatives of acute patients were studied. 85% of relatives of cancer patients was assisted continuously by volunteers and psychiatrists with regard to their psychological problems. Impat questionnaire, Beck Depression Inventory and State-Trait Anxiety Inventory were used for psychological evaluation. RESULTS: Validity of the Impat was confirmed. Mean scores from relatives of chronic patients were higher than scores from relatives of acute patients (ANOVA, f = 38.0; df = 2,72; p < 0.0001). Test-retest analysis was satisfactory (Person's test, N = 20 r = 0.77, p < 0.0001). Both groups of relatives of chronic patients showed higher level of anxious-depressive symptoms compared to relatives of acute subjects. No differences were found between relatives of neoplastic and non neoplastic chronic patients. CONCLUSIONS: The italian version of Impat has been confirmed as a useful and simple means of evaluation of family burden in this context. Psychosocial support seems to reduce distress in relatives of cancer patients.