A multicenter investigation of consultation-liaison psychiatry in Italy. Italian C-L Group.

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.

[Affective disorders in general hospitals: the organic affective syndrome]. / I disturbi affettivi in ospedale generale: la sindrome affettiva organica.

After a survey of the literature on secondary depression and mania caused by physical illness or drugs, a retrospective study on 77 inpatients (seen in the hospital psychiatric consultation service) is reported. Forty per cent of patients presented a diagnosis of depression; 58% of depressed patients had at least one of the "risk factors" for secondary depression (physical illness and drugs known to cause affective disturbances) compared to 24% and 16% of patients with other or no mental disorders (p less than 0.05).

Chronic pain as a depressive equivalent.

In some cases, chronic pain is due not to an organic cause but rather to psychologic factors. Among these, chronic pain as a depressive equivalent is particularly interesting. By this term, we mean a painful state caused by depression and manifesting itself almost entirely in this somatic form, thus making diagnosis difficult. There are, however, some features that may positively orient diagnosis: age at onset and sex, clinical history, presence of a subdepressive state, attitude during the medical examination, absence of delusions and hallucinations, and the Rorschach test pattern. These features permit correct differential diagnosis and justify pharmacologic therapy with antidepressants.

Depressive equivalents: a clarification using the Rorschach test.

The authors present a study on 20 patients of uncertain diagnostic placement admitted to a neurological department. The patients are characterized by an atypical clinical neurological symptomatology and the absence of organic pathology. Through psychiatric examination and the Rorschach tests, which show some characteristics and constant aspects, the authors arrive at the diagnosis of depressive equivalents. It is emphasized that the Rorschach test offers a useful contribution to the often difficult diagnosis of these clinical pictures.

Psychological findings in chronic anal pain.

The psychological characteristics of 21 patients suffering from chronic anal pain were studied. They underwent a clinical interview and completed the Eysenck personality questionnaire, the Zung self-rating depression scale and an analogue scale for the assessment of perceived pain. Data derived from the self-rating scales were compared with those obtained from a matched control group afflicted with fissure-in-ano. The pain patients reported higher scores for neuroticism, psychoticism, depression and perceived pain than the controls. Fifty percent of the experimental group had suffered prior to the onset of pain from depressive disturbances, and 11 subjects reported at the clinical interview somatic symptoms which usually accompany depression. These results support the hypothesis that the pain symptom in some patients with chronic anal pain could represent the manifestation of an underlying depressive disturbance.

Personality, psychophysical stress and myopia progression. A prospective study on 57 university students.

Personality profile, psychophysical stress and cycloplegic refraction were evaluated at the baseline (T0) and after 12 months (T1) in 57 university students comprising 39 myopes and 18 emmetropes/hyperopes (controls) whose age, sex distribution and academic results were comparable. At T0, a tendency toward a higher degree of anxiety, somatization and inadequacy was found in myopes in comparison with controls; however, only the anxiety state was different (Wilcoxon signed-rank test P < 0.001). Personality profiles, psychophysical stress and blood levels of cortisol, ACTH, GH, prolactin were similar in myopes and controls. The myopes were classified at T1 as either well-corrected (if their lenses corresponded to refractometer values of +/- 0.50 D and were worn full-time) or undercorrected (if their lenses were > or = 0.75 D with respect to refractometric values and/or were worn part-time). When the spherical cycloplegic values at T0 and T1 were compared, a myopic shift was revealed only in the undercorrected myopes (P < 0.001 in both eyes). These findings suggest that personality profile and psychophysical stress do not play a primary pathogenetic role in myopia. Undercorrection seems to accelerate the progression of myopia.

Recognition memory in conversion hysteria: effect of sexual stimuli during learning.

Hysteria has two main explanatory models: a neurobiological and a psychodynamic. Both models can predict a memory deficit, as a consequence either of a neurophysiological inhibition or of a repression produced by a conflict. The existence of a conflict can also be proved by showing the stimulating, and not the inhibitory effect that conflictual material can have when appropriately shown. Ten female hysterical patients and 10 nonpsychiatric female patients were submitted to a short-term memory test consisting of pictures. In one session all pictures were neutral, while in a second session the neutral were mixed with mild sexually charged pictures, excluded from subsequent recall. The overall performances of the two groups were not significantly different, but the hysterical patients remembered better the pictures linked to the sexual ones, while the control group did the opposite. The results are consistent with the psychodynamic model, while they cannot be explained by the neurobiological.

Inhibitory effect of imipramine on epinephrine-dependent platelet aggregation: "in vitro" studies on platelets from healthy and depressed people.

Inhibitory effect of imipramine on platelet aggregation in healthy and depressed people was studied. A different sensitivity was observed between healthy and depressed people. Two groups (D I and D II) were identified among depressed patients on the basis of sensitivity to imipramine effect. ID50 was calculated for healthy subjects (59.5 +/- 22 microM) and depressed patients (D I: 20 +/- 7 microM - D II: 117 +/- 49).

[Use of DSM-III R and other psychometric tests in consultation psychiatry. Consideration of 85 patients]. / Utilizzo del DSM-III R e di alcuni test psicometrici in psichiatria di liaison. Considerazioni su 85 pazienti.

DSM-III R diagnostic categories were used in 85 consecutive patients attending consultation at the Liaison Psychiatry Service of Padua University School of Medicine. The aim was to render the diagnosis as objective as possible. The same patients were asked to fill in three well-known self-rating scales (Eysenck Personality Inventory, Illness Behaviour Questionnaire, Symptom Rating Test) and the scores obtained were correlated with the diagnostic categories. In the Authors' opinion, the use of diagnostic instruments in the traditional psychiatric setting of the consultation allows a marked improvement in the understanding of the content of the prescription written by the referring physician. DSM-III R is an instrument which meets such requirements. The same cannot be said of the rating scales used, which were found less useful.

Suicide attitude in breast cancer patients.

The suicide attitude in a group of 34 postmastectomy patients was much more marked than in two control groups consisting of 103 medical patients and in 40 healthy subjects, respectively. In a limited sample comprising 23 subjects obtained by excluding the extreme percentile values, certain psychosocial variables (irritability, psychoticism, number of confidants, number of persons in the same household) were observed to be significantly associated with the suicide attitude in postmastectomy patients. On the other hand, no differences were evident, both regarding the interval of time following initial diagnosis and between married and single patients.

Treating myopia with acoustic biofeedback: a prospective study on the evolution of visual acuity and psychological distress.

OBJECTIVE: The effects of a visual training technique on changes in myopia, visual acuity, and psychological distress were studied in a controlled prospective study. METHOD: A group of 33 female students with myopia < or = 3.50 diopters (D) underwent visual training using an acoustic biofeedback technique. A group of 22 female students with myopia and a group of 27 students with emmetropia formed the two control groups, matched for school, age, sex, and refractive error. Manifest and cycloplegic refraction, visual acuity, personality profile (CPI), and psychological distress (SCL-90) were measured at the baseline (T0), at 10 weeks (T1), and after 12 months (T2). RESULTS: At T2, myopia significantly progressed both in the treated and in the untreated students with myopia. Visual acuity improved only in the treated myopia group (despite refraction objectively being worse). No differences were found among the personality profiles in the three groups. All items indicative of psychological suffering improved in the group treated for myopia whose visual acuity was ameliorated. CONCLUSIONS: The visual training technique led to no improvement in objective measures of visual acuity, but did lead to an improvement in one relatively subjective measure of visual acuity and a parallel improvement in psychological conditions. The students with myopia who were treated consequently had a greater sense of general well-being.