Parental Burden and its Correlates in Families of Children with Autism Spectrum Disorder: A Multicentre Study with Two Comparison Groups.

BACKGROUND: The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions. OBJECTIVE: This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child's characteristics, and parents' coping resources and strategies. METHODS: The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child's clinical characteristics and parents' caregiving burden, psychological distress, coping resources and strategies were assessed. RESULTS: The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies. CONCLUSION: This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.

Measuring depression with questions about well-being: a study on psychiatric outpatients.

BACKGROUND: Most depression rating scales are characterized by negatively-phrased questions, exploring the presence of various symptoms. Questions such as those regarding suicidal ideation or painful experiences may reduce accept-ability or even lead the reader to withdraw participation in the study. Although positively-worded items may be useful, it should be acknowledged that without formal testing they cannot be assumed to be equivalent to negatively-worded ones. The aim of the present study was to test the reliability and validity of a depression rating scale including only positively-phrased items. METHODS: Two groups were enrolled in the study: the first comprised 104 adult psychiatric outpatients, the second 88 undergraduate students. All participants completed the depression scale of the Patient Health Questionnaire, the Zung Self-Rating Depression Scale, and the Positively-phrased Depression Scale (PDS), a 10-item self-report instrument in which the items are phrased in a positive way to reflect the absence of symptoms. Psychiatric outpatients also were rated by their clinician on the Hamilton Depression Rating Scale. RESULTS: The internal consistency of the PDS was satisfactory. The correlations between scores on the PDS and on the other depression scales were moderate to high. Mean PDS scores of patients with a diagnosis of depressive disorder were significantly higher than those of patients with other mental disorders. CONCLUSIONS: Despite some limitations, this study suggests that the PDS a valid and reliable instrument which might prove particularly useful for the assessment of depressive symptoms in studies where issues of acceptability are important, such as studies on non-clinical populations, occupational samples, and patients drawn from non-psychiatric settings.

Links between immunity and conditions leading to psychotherapy.

INTRODUCTION: People seeking for psychotherapeutic help present with a variety of conditions including stress, depression, anxiety, and maladaptive individual difference factors. This paper reviews the studies investigating the link between these conditions and immunity. FINDINGS: The relationship between stress-related conditions and immunity varies depending on the nature of the stressor. Acute time-limited stressors are associated with an upregulation of natural immunity, brief naturalistic stressors with a shift from cellular to humoral immunity, while long-term and chronic stressors with a decrease in most functional immune measures. Depression is associated with changes in both enumerative and functional immune measures. The most consistent association is with decreased cellular immunity. There is considerable heterogeneity in study findings that may be accounted for by clinical and demographic factors. Only limited evidence has been presented for an association between anxiety and changes in immune function. The results are somewhat inconsistent and no firm conclusions can be drawn from these studies. Relatively few studies investigated the relationship between maladaptive individual difference factors and immunity. Replicated findings include an association between alexithymia and impaired cellular immunity and altered cytokine balance with a shift towards proinflammatory mediators, and a link between Type C and Type C-related coping and HIV progression and impaired immunity. CONCLUSIONS: Several conditions leading people to psychotherapy are associated with changes in immune function. However, several findings are preliminary and demand replication. Also, most of the evidence is correlational and further studies allowing for causal inferences are needed. Future psychoimmunology studies should better clarify the clinical relevance of the findings.

Pilot study of light therapy and neurocognitive performance of attention and memory in healthy subjects.

The aim of this pilot study was to investigate whether light therapy improves healthy subjects' neurocognitive performance of attention, memory, and language. Ten subjects were treated with white bright light for 5 days and a control group of 10 with no treatment were assessed with a battery of neurocognitive tests which included the Stroop Colour Word Interference Test, the Verbal Fluency Test, the Story Recall Test, and the Word Pairs Recall Test. Analysis showed improvements in cognitive scores in both groups, although on all the cognitive tests the mean difference scores between baseline and endpoint were significantly larger in the light-treated group. These preliminary results suggest that short-term bright light may exert beneficial effects on cognitive functions.

[Psychiatry and psychiatrists in the U.S.A. cinema]. / Psichiatria e psichiatri nel cinema Americano.

United States cinema motion pictures from the beginning of 20th century to the present are characterized by massive use of sterotypes to represent psychiatrist's image, as well as psychiatric treatment and inpatients psychiatric facilities. Representation tends to undergo considerable changes between psychiatric different historical periods. Psychiatric disorders also are commonly depicted in movies, often in a not realistic way. The images of psychiatrist and mental disorders shown in movies are likely to impact on the beliefs and attitudes of people towards psychiatry.

[Predictive factors for further suicide attempts in individuals presenting to an emergency service for an attempted suicide. A one-year longitudinal study]. / Fattori predittivi di nuovi tentativi di suicidio in soggetti che accedono in pronto soccorso per un tentativo di suicidio. Uno studio longitudinale a un anno.

UNLABELLED: Suicide attempts (SA) have been recognized among the most important predictors of suicide. AIM: The aim of this study was to assess suicidal ideation, socio-demographic and clinical characteristics in patients admitted to the emergency room for a SA and to identify factors associated with clinical outcome. Admission to a Psychiatric Intensive Care Unit and further SA within one year were considered. MATERIALS AND METHODS: Patients that agreed to participate in the study were evaluated in the emergency room with a clinical interview and they were administered the Intent Score Scale. Patients were then contacted and interviewed by telephone 1, 6, and 12 months after the SA. Clinical outcomes and the occurrence of new SA were investigated. RESULTS: Seventy-four patients were enrolled and 49, 24, and 20 patients were reassessed at the 1, 6, and 12 month follow-up respectively. Eight patients reported at least one new SA within one year. Six SA occurred within the first month. Unemployment and underemployment were significantly associated with further SA. The time interval before a new SA was longer for patients admitted at the Psychiatric Intensive Care Unit and shorter for those with high suicidal intent at the first SA. CONCLUSIONS: Although with limitations, our study might suggest that future research should focus on the role of hospitalization in the management of SA.

[Evaluating the activity of the Italian Mental Health Services inpatient and residential facilities: the PRISM (Process Indicator System for Mental health) indicators]. / Valutare l'attività delle strutture ospedaliere e residenziali dei DSM: gli indicatori PRISM (PRocess Indicator System for Mental health).

UNLABELLED: This article describes the activities of a project aimed at developing a system of process and process/outcome indicators suitable to monitor over time the quality of psychiatric care of Italian inpatient and residential psychiatric facilities. This system, named PRISM (Process Indicator System for Mental health), was developed by means of a standardized evaluation made by a panel of experts and a consecutive pilot study in 17 inpatient and 13 residential psychiatric facilities. MATERIALS AND METHODS: A total of 28 indicators were selected from a set of 251 candidate indicators developed by the most relevant and qualified Italian and international authorities. These indicators are derived by data from medical records and information about characteristics of facilities, and they cover processes of care, operational equipment of facilities, staff training and working, relationships with external agencies, and sentinel events. RESULTS: The procedure followed for the development of the indicator system was reliable and innovative. The data collected from the pilot study suggested a favourable benefit-cost ratio between the workload associated with regular use of the indicators into the context of daily clinical activities and the advantages related to the information gathered through regular use of the indicators. CONCLUSIONS.:The PRISM system provides additional information about the healthcare processes with respect to the information gathered via routine information systems, and it might prove useful for both continuous quality improvement programs and health services research.

Suicide risk in skin disorders.

Suicide accounts for about 1,000,000 deaths worldwide every year and is among the leading causes of death in young adults. Reports of high prevalence of suicidal ideation and increased suicide risk in several skin diseases raised concerns about deliberate self-harm in dermatological patients. The literature consistently points to an increased suicide risk in patients with psoriasis, atopic dermatitis, and acne, with higher risk in patients in whom the skin condition is associated with clinically significant emotional distress, changes in body image, difficulties in close relationships, and impaired daily activities. Other risk factors for suicide include a history of suicide attempts, severe mental or physical disorders, alcoholism, unemployment, bereavement or divorce, and access to firearms or other lethal means. Dermatologists may play an important role in recognizing suicidal ideation and preventing fatal self-harm in their patients. Increasing dermatologists' awareness of the issue of suicide and developing mental health consultation-liaison services within dermatology settings would be instrumental in contributing to suicide prevention in this population.