Invasive pneumococcal infections in infants up to three years of age: results of a longitudinal surveillance in North-East Italy.

Pneumococcus is considered one of the main causes of the infections acquired in the community setting and also seems to be the most frequent cause of community-acquired pneumonia in children under 5 years of age. To establish suitable preventive measures as vaccination policy, it would be important to document the incidence of IPD. The main feature of this study was that it demanded a cooperative effort between family pediatricians and those working in the hospitals to estimate the real burden of IPD in children aged 0-36. From 1 January 2003 to 31 December 2003, a prospective active surveillance of clinical cases due to S. pneumoniae was conducted by 87 specifically-trained sentinel pediatricians [all family pediatricians] randomly selected from among those working in North-East Italy. Suspected pneumococcal infections were confirmed by blood cultures at the laboratories of the hospitals involved in the study. 32 cases were suspected, 12 of those proved positive on blood culture and 6 of these 12 confirmed cases were hospitalized. 2 were cases of meningitis, 1 of pneumonia and 9 of bacteremia. The cumulative annual incidence was 58.9 cases/100,000 infants aged 0-36 months (95% CI 30.38-102.71), meaning that North-East Italy can be classified as a mesoendemic area. This study demonstrated that the incidence of IPD in infants aged (0-36 months) is often under-estimated, documenting the importance of prospective active surveillance for assisting rational choices for public health issues.

Alexithymia in multiple sclerosis: relationship with fatigue and depression.

OBJECTIVE: The aim of this study was to investigate the prevalence of alexithymia in a sample of patients with multiple sclerosis (MS) and to further evaluate the association between alexithymia and the occurrence of common disabling MS-related symptoms such as fatigue and depression. METHODS: Fifty-eight relapsing-remitting MS patients treated with interferon (IFN)-beta-1a underwent a complete neurological evaluation, including Expanded Disability Status Scale score assessment. Alexithymia, depressive symptoms and fatigue were assessed using the 20-item Toronto Alexithymia Scale, Beck Depression Inventory and Fatigue Severity Scale. RESULTS: Prevalence of alexithymia was 13.8%, with 27.6% of patients presenting borderline alexithymia. Sixty-seven per cent of the patients complained of fatigue while 29.3% of them were depressed. Higher levels of fatigue and depression were found in alexithymic patients when compared with non-alexithymic patients. Results from logistic regressions showed that alexithymia significantly contributes to the severity of fatigue and depression. CONCLUSIONS: Alexithymia was associated with increased severity of fatigue and depression.

Brain abnormalities in schizophrenia. A qualitative comparative study of schizophrenic patients and control individuals assessed by magnetic resonance imaging.

The present study examined, by means of Magnetic Resonance Imaging (MRI), the qualitative brain abnormalities in a group of 58 schizophrenic patients compared to a group of 58 matched control individuals. The possible relationships between these abnormalities and the demographic and clinical features of the participants in the study were also investigated. Schizophrenic patients presented a higher percentage of bland-moderate enlargement of the periencephalic-subarachnoid spaces (p=0.01) and a widespread cerebral atrophy, the latter below the threshold of significance (p=0.06). In the subset of patients with ventricular asymmetry (right larger than left) the age was significantly lower compared to the age of patients without this abnormality (p=0.04). In the subset of patients with cerebellar cisterns enlargement the age as well as the age of onset was higher in comparison to the one of patients without this abnormality (p=0.02; p=0.006). Taking together with previous studies, these findings underline the importance of qualitative assessment of brain morphology in research and clinical evaluation of patients with schizophrenia.

Dimensional psychopathology of depression: detection of an 'activation' dimension in unipolar depressed outpatients.

BACKGROUND: Despite the high prevalence of bipolar spectrum disorders, most instruments currently available for the assessment of depression do not explore symptoms of 'activation' such as anger, irritability, aggressiveness, hostility, and psychomotor activation. METHODS: Two samples of adults with unipolar depression were studied. They had no comorbid DSM-IV disorder, and they were free from antidepressant drugs. The first sample (n = 380) was assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. The second sample (n = 143) was assessed with the MMPI-2. Factor analysis was performed on SVARAD items and MMPI-2 clinical scales. RESULTS: In both samples, we obtained a three-factor solution with factors interpreted as a depressive dimension, an anxious dimension, and an activation dimension. The latter dimension appeared to be clinically relevant in 20-27% of patients. LIMITATIONS: The presence of a comorbid disorder may have been missed in some cases. Also, some bipolar II patients might have been misdiagnosed as unipolar and included in the study. Further, our findings apply only to a selected psychiatric population, and it should be tested whether they generalize to other settings of care and other countries. CONCLUSIONS: Our results suggest that depressive mixed states are not rare even in patients diagnosed as unipolar, and that some unipolar patients might actually be 'pseudounipolar' and belong to the bipolar spectrum. More in general, our findings suggest that some depressed patients have prominent symptoms of activation that can easily go unnoticed using instruments that do not explore such symptoms. Detecting these symptoms has important treatment implications.

ACTH, beta-endorphin and met-enkephalin: peripheral modifications during the stress of human labor.

We investigated the psychoneuroendocrine and emotional correlates of the natural stress situation of human labor. State anxiety, subjective pain, plasma ACTH, peripheral plasma beta-lipotropin (Beta-LPH), beta-endorphin (Beta-EP), and met-enkephalin (Met-Enk) were serially evaluated at six predetermined time points before, and after labor in a sample of 14 women with normal pregnancies. State anxiety and subjective pain showed a progressive increase during labor, with a levelling during the final stage. Plasma Beta-EP and ACTH showed a similar progressive increasing from baseline until the end of labor. Beta-LPH showed no significant modification. Met-Enk remained at nearly baseline values throughout labor, with a marked progressive rise in the postpartum stage. The findings of this study seem to confirm the role of plasma Beta-EP as a stress hormone. Possible relationship between pain and anxiety curves and plasma Beta-EP are discussed in light of psychobiological studies on stress, the opioid system and analgesia. Plasma Met-Enk, according to our findings, should probably not be regarded as a stress hormone. Its rise in the postpartum stage might be as one of the psychoneuroendocrine mechanisms maintaining elevated prolactin levels during lactation.

Choroid plexus calcification as a possible clue of serotonin implication in schizophrenia.

Choroid plexus calcification (CPC) was measured on computed tomography (CT) scans of 87 schizophrenics and 46 controls divided into age subgroups. We studied the relationship between presence and size of CPC and age in both groups, whilst in the schizophrenic group we also investigated the possible correlation between CPC size and age of onset and duration of illness, duration of formal education, psychopathological features of the illness as well as some neuroradiological brain measures. CPC size correlated with age in healthy controls but not in schizophrenics. In the schizophrenic group, left choroid plexus calcification size correlated with the Scale for the Assessment of Positive Symptoms (SAPS) subscales scores of 'formal thought disorder' whilst right choroid plexus calcification size correlated with the ventricular brain ratio at frontal horns (VBRFH). The data are not conclusive, but a possible correlation with a dysgenetic or functional 5-HT alteration can be hypothesized.

Psychopathological dimensions of depression: a factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients.

BACKGROUND: Agreement on the factor structure of the Hamilton Depression Rating Scale (HDRS) has not been consistent among studies, and some investigators argued that the scale's factor structure is not reliable. This study aimed at shedding more light on this debated issue. METHODS: We studied 186 adults with unipolar depression (Major Depressive Disorder, n=80; Dysthymic Disorder, n=71; Depressive Disorder Not Otherwise Specified, n=25; Adjustment Disorder, n=10). They had no comorbid DSM-IV axis I or axis II disorders, and had received no treatment with antidepressant drugs in the previous 2 months. The factor structure of the scale was studied using the principal factor method, followed by oblique rotation. Factor scores were computed for each subject using the regression method. RESULTS: Using the scree-test criterion for factor extraction, we obtained a four-factor solution, explaining 43.8% of total variance. The four factors extracted were identified as (1) somatic anxiety/somatization factor; (2) a psychic anxiety dimension; (3) a pure depressive dimension; and (4) anorexia factor. Patients with Major Depressive Disorder scored significantly higher than patients with other diagnoses on the pure depressive dimension. LIMITATIONS: These results need to be replicated in different cultures, using analogous factoring techniques. CONCLUSIONS: Though not exhibiting factorial invariance in the stricter sense of the term, the 17-item HDRS did exhibit a relatively reliable factor structure. Our analysis provides further evidence that the scale is multidimensional. However, as long as the multidimensional character of the scale is taken into account the scale should be able to play a useful role in clinical research.

Effects of moclobemide on depressive symptoms and cognitive performance in a geriatric population: a controlled comparative study versus imipramine.

Moclobemide, a novel monoamine oxidase-A reversible inhibitor with demonstrated antidepressive efficacy, was administered double-blind versus imipramine to aged depressive subjects. The two drugs were given for 60 days in increasing doses up to 600 mg for moclobemide and 100 mg for imipramine. Fifteen patients received moclobemide and 15 received imipramine. Psychiatric conditions and symptoms were rated at 0, 7, 14, 30, 45, and 60 days after the beginning of the trial by means of the Scale for the Assessment of Psychoorganic Syndromes, Hamilton Rating Scale for Depression, Rome. Depression Inventory, Hamilton Anxiety Rating Scale, State-Trait Anxiety Inventory-X form, and the Clinical Global Impression Scale. Cognition was tested through the Benton visual retention test at days 0, 30, and 60 and the Digit Substitution Test of the Wechsler Adult Intelligence Scale at days 0 and 60. Side effects were assessed through the Dosage Record Emergent Symptoms at days 0, 7, 14, 30, 45, and 60. The dropout rate was significantly greater in the moclobemide group. Both drugs induced an improvement in depressive and anxious symptomatology, with moclobemide showing a faster onset. Furthermore, moclobemide showed an enhancing effect on cognition, which was not shown by imipramine. Such results indicate that moclobemide could prove to be the drug of choice in geriatric depression, given that cognitive effects are prominent in the aged.

Ultradian variation of nerve growth factor plasma levels in healthy and schizophrenic subjects.

Some studies in animal models showed that several neurotrophins may be implicated in the regulation of light-dependent suprachiasmatic pacemaker and in other functions implicated in long-term memory acquisition during sleep. However, no data are known about the role played by NGF in ultradian regulation in humans. The aim of this study was to investigate whether or not there is a natural diurnal fluctuation during daytime in healthy and schizophrenic subjects with a normal light/dark cycle. In a sample of 33 subjects (10 male schizophrenics and 23 healthy subjects) an ELISA assay was used to study the ultradian NGF cycle in blood samples at 9.00, 13.00 and 20.00 hours. The study showed an ultradian rhythm of NGF in healthy subjects with a "V" trend: higher at 9:00 and 20:00 and lower at 13:00. We also show significant differences between male and female controls. No NGF ultradian rhythm among schizophrenic patients compared to healthy subjects was found. The results of this study lead to a rhythmic NGF regulation that appears altered in schizophrenics, where higher levels in the morning and lower levels in the evening were observed, compared to the controls, and support the hypothesis of a role played by NGF in schizophrenia.

Depression in the community: results of the first Italian survey.

The 6-month prevalence of depression in the Italian community was evaluated by means of the modified-Mini-International-Neuropsychiatric Interview (MINI) administered with a computer-prompted interview to a representative panel of 3550 individuals. Major depression and minor depression accounted for 8.0% and 2.9% of the cases, respectively. Major depression was 1.3 times as prevalent in females (compared to males), while minor depression was 1.6 times as prevalent in males. Prevalence of major depression was maximal (11.9%) in subjects aged 30-49 years, and minimal (4.1%) in subjects aged 60 years or older. These results confirm prevalence figures for depression in the community reported with the modified-MINI for other European countries, and support the use of telematic data acquisition for health-related general population surveys.

Depression in the Italian community: epidemiology and socio-economic implications.

A survey on the 6-month prevalence of depression in the Italian community was performed using the modified-Mini-International Neuropsychiatric Interview (MINI) administered with a computer-prompted interview to a panel of 5566 individuals, which aimed to validate the results of a previous similar survey and evaluate the socio-economic consequences of the illness. Prevalence of major depression and minor depression accounted for 10.8% and 3.3% of the cases, respectively, thus confirming the previous results (8.0% and 2.9%, respectively). Major depression was 1.4-fold more prevalent in females compared to males, while minor depression was 2.6-fold more prevalent in males, thus confirming the previous results (1.3% and 1.6%, respectively). The majority of subjects of all MINI depression categories, including major depression (62.7% versus 83.9% of the minor depression and 82.3% of the depressive symptoms subjects), did not consult any healthcare professional with respect to their symptoms. Among the major depression subjects undergoing medical consultation, 34.2% of were not prescribed any therapy or intervention, while only 36.8% reportedly started a drug therapy (22.3% with an antidepressant). More than twice as many major depression subjects had at least three physician visits and drug therapies and more than three-fold as many had at least four instrumental examinations in the preceding 6 months compared to no depression subjects. Loss of work or global activity longer than 1 week was reported by approximately four-fold as many major depression subjects compared to no depression subjects. These results provide evidence for a higher frequency of under-recognition of depression as a medical illness in Italy compared to other European countries, while confirming the evidence from other countries on the small proportion of subjects with disabling symptoms who receive treatment, particularly specific treatment with antidepressants, and on the direct relationship between the impairment induced by the depressive symptoms and global healthcare resources use, as well as of work and activity days lost.

A double-blind study of fluoxetine and imipramine in major depression.

Eighteen outpatients with major depression (diagnosis was made according to DSM-III criteria) were treated in a 5-week double-blind parallel group comparison of the new antidepressant fluoxetine with imipramine. From these results it can be shown that the drugs were comparable in efficacy, although because of the small sample size a moderate clinical difference between treatments may not have been detected. Imipramine and fluoxetine have already been compared in other studies, but never at such a low dosage (20 mg) for fluoxetine. At this dosage the fluoxetine safety profile seems to be very different from previous scheduled studies with higher dosages. In fact clinical efficacy seems to remain comparable while side-effects are significantly less frequent.

Double-blind study of the efficacy and safety of sertraline versus fluoxetine in major depression.

An eight-week double-blind, multicentre study was performed to evaluate the efficacy and safety of sertraline vs. fluoxetine in the treatment of major depression (DSM-III-R). There were 108 out-patients, from nine Italian centres, entered into the study, of whom 88 were evaluable (48 sertraline, 40 fluoxetine). The final mean daily dose of sertraline was 72 mg and for fluoxetine it was 28 mg. Both treatment groups showed a statistically significant improvement from baseline at one week, and this was maintained until the end of treatment for all of the following measures: Hamilton Rating Scales for Depression and Anxiety, the Montgomery Asberg Depression Rating Scale, Clinical Global Impressions Scale, Zung Self-Rating Scale for Anxiety and the Leeds Sleep Evaluation Questionnaire. Although there was a numerical advantage for sertraline on several efficacy measures, there was no statistically significant difference found between the treatment groups. The incidence of adverse events was similar for both treatments; 40.4% for sertraline and 39.3% for fluoxetine. However, adverse events were generally rated by patients as of lower severity in the sertraline group. In addition, for the fluoxetine group, there was a higher incidence of agitation, anxiety and insomnia than for sertraline. Sertraline was considered to be better tolerated than fluoxetine overall, since only 9.6% of sertraline-treated patients discontinued treatment due to therapy failure whereas in the fluoxetine-treated group this figure was 19.6%. By contrast, 13.5% of sertraline-treated patients discontinued prematurely because of clinical improvement, compared with 10.7% of fluoxetine-treated patients.

Costs associated with outpatient diarrhoea in infants and toddlers: a nationwide study of the Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP).

BACKGROUND: As diarrhoea mortality is negligible in Italy, other costs should be considered when planning health strategies. Little is known about the costs associated with diarrhoea in Italian children. AIMS: To assess the costs associated with outpatient infantile diarrhoea in Italy. METHODS: Primary care paediatricians from five regions filled in a questionnaire for the first 10 children (1-47 months) they visited for acute diarrhoea during a 3-month period. RESULTS: We analysed 473 questionnaires. Mean age (standard deviation) of children was 21 (11) months; mean duration of diarrhoea (standard deviation) was 4.3 (2.6) days. An overall cost of 110 (137) euro per episode was estimated, with significant difference between children younger and older than 36 months (116 euro versus 72 euro). Missed work by relatives accounts for 75% of the cost. The parents of children attending a day-care centre had an increased risk to miss work (relative risk = 2.15). A weak relationship was found between days of diarrhoea and missed work (r = 0.30); it could be estimated that the diarrhoea should be shortened by about 4 days in order to save I day of missed work. CONCLUSIONS: Acute outpatient diarrhoea is associated with a significant financial burden in Italy. Simply shortening the diarrhoea does not seem to be the most expeditious way to reduce the cost of diarrhoea itself.

Noradrenergic and dopaminergic interrelation in schizophrenia.

Growth hormone (GH) and prolactin (PRL) responses to the acute administration of clonidine (150 micrograms) and apomorphine (0.5 mg) were investigated in parallel in 20 drug-free subchronic and chronic schizophrenic patients and in nine control subjects. Neither basal levels of the two hormones nor their mean responses to both stimuli differed significantly between the two groups. However, eight patients had blunted GH responses to clonidine and seven to apomorphine; only two patients showed blunted GH responses to both stimuli. The blunted GH response to apomorphine correlated with the chronicity of the disorder. A greater than normal GH response to clonidine stimulation was observed in paranoid patients. Significant correlations were observed between negative symptoms and GH responses to clonidine (negative), between negative symptoms and PRL responses to apomorphine (positive), and between positive symptoms and PRL responses to apomorphine (negative).

Severity of obstetric complications and risk of adult schizophrenia in male patients: a case-control study.

OBJECTIVE: Obstetric complications may be an etiologically important factor in the development of schizophrenia. The aim of this study was to evaluate whether the risk for developing schizophrenia in adult life is increased in individuals with more severe obstetric complications at birth. METHODS: To this end, mothers were interviewed to gather data about obstetric complications. The 'midwife protocol' of Parnas and colleagues was used to quantify the presence and entity of obstetric complications. We studied the frequency distribution and the severity of obstetric complications in 64 male DSM IV schizophrenic patients. The genetic load was reduced by using 81 brothers who were not psychiatric patients as controls. Odds ratios for the effects of obstetric complications, maternal age, birth order and birth weight were calculated using conditional logistic regression. RESULTS: The only factor found to have a significant effect on the risk of schizophrenia was the overall measure of obstetric complications at birth. The history of obstetric complications was higher in schizophrenic patients than in their siblings. CONCLUSION: The results seem to confirm the hypothesis that obstetric complications may contribute to increased vulnerability to the disease, in addition to genetic risk factors.

Correlation between a psychometric test and biochemical indices of hepatic encephalopathy in alcoholics.

BACKGROUND/AIMS: In alcohol abusers an alteration of responses to psychometric tests has been reported, even when clinical symptoms of hepatic encephalopathy (HE) are absent. Our research was intended to individualize a simple psychometric test, easy enough to be performed also at the patient's home, able to reveal an impending encephalopathy and, consequently, to facilitate earlier treatment. METHODOLOGY: Twenty-six consecutive male alcoholics were engaged and, after informed consent, the following schedule was applied: administration of a psychometric test, followed by a drawing of blood for the determination of many blood parameters. After 15 days of treatment to detoxicate patients, psychometric tests and blood examinations were repeated. RESULTS: The results confirmed that common blood examinations are not useful to monitor brain damage in chronic alcoholism, that a psychometric test is able to demonstrate a therapeutic improvement and that a positive and significant correlation has been observed between BBCA/AAA ratio and WAIS Score. CONCLUSIONS: These preliminary results suggest that it is possible to suspect dangerous biochemical changes by means of a simple psychometric test.

Computed tomography study of pineal calcification in schizophrenia.

Computed tomography studies concerning pineal calcification (PC) in schizophrenia have been conducted mainly by one author who correlated this calcification with several aspects of the illness. On the basis of these findings the aim of the present study was to analyze size and incidence of pineal gland calcification by CT in schizophrenics and healthy controls, and to verify the relationship between pineal calcification and age, and the possible correlation with psychopathologic variables. Pineal calcification was measured on CT scans of 87 schizophrenics and 46 controls divided into seven age subgroups of five years each. No significant differences in PC incidence and mean size between patients and controls were observed as far as the entire group was considered. PC size correlated with age both in schizophrenics and controls. We found a higher incidence of PC in schizophrenics in the age subgroup of 21-25 years, and a negative correlation with positive symptoms of schizophrenia in the overall group. These findings could suggest a premature calcific process in schizophrenics and a probable association with 'non-paranoid' aspects of the illness. Nevertheless the potential role of this process possibly related to some aspects of the altered neurodevelopment in schizophrenia is still unclear.

Burnout and health status in Italian air traffic controllers.

This study investigated burnout in air traffic controllers (ATC's). There were 109 Italian ATC's who filled out the Rome Burnout Inventory, a new tool for burnout assessment, during breaks in the working environment. The questionnaire assessed: 1) emotional-mental exhaustion (EME); 2) physical exhaustion (PE); 3) social support by components of the social network; 4) work- and nonwork-related stressors; 5) self-reported psychosomatic and psychiatric disorders. Our data show that the burnout syndrome is closely and positively related to age, years spent in air traffic control, professional dissatisfaction, and to work stressors, but not to nonwork stressors. In our sample, burnout was negatively correlated with social support provided by friends and family. The PE construct seemed to be unreliable in detecting physical burnout in Italian ATC's. Using analysis of variance, subjects with self-reported psychosomatic disorders did not show higher levels of EME scores. Further, EME was positively correlated with self-perceived psychological distress (anxiety, depression and impulse discontrol), but not with physician-rated psychopathology, as revealed by psychoactive drug intake. We suggest that burnout is a construct independent from clinical anxiety or depression.

Frontal hemisphere lateralization and depressive personality traits.

To assess the relationship between hemispheric differences in information processing and interhemispheric asymmetries in terms of brain bioelectrical activity, we correlated scores on the MMPI Depression scale with interhemispheric asymmetry, measured as peak amplitude and latency of the P3 component of somatosensory evoked potentials (SEPs) at the frontocortical region of 14 healthy unselected volunteers (8 men and 6 women) who were about to start a course in autogenic training. The sample was subdivided into two groups on the basis of the median score on the MMPI Depression scale. Subjects scoring above the median showed a right lateralization at the frontocentral region and a significantly shorter P3 latency at the right hemisphere compared to the left.