Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study.

BACKGROUND: Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder, their implementation on a large scale remains limited. The aim of the present study is to identify obstacles for the feasibility of PFIs in routine care. METHODS: This was a multicentre, real-world, controlled, outpatient trial, carried out in 11 randomly recruited Italian mental health centres. Two mental health professionals from each center attended a modular training course on PFI and provided the intervention. Difficulties and benefits experienced by mental health professionals in implementing the intervention were assessed through the Family Intervention Schedule (FIS-R), which was administered six times. RESULTS: Sixteen out of the 22 recruited professionals completed the training and administered the PFI to 70 patients with bipolar I disorder and their relatives. The retention rate of families receiving the intervention was 93%. Mental health professionals reported high levels of organizational difficulties, several benefits in their daily clinical work and low levels of intervention-related difficulties. The most important organizational obstacles were related to the need to integrate the intervention with other work responsibilities and to the lack of time to carry out the intervention. These difficulties did not decrease over time. Intervention-related difficulties were rated as less problematic since the first time assessment and tended to improve over time. LIMITATIONS: Low number of recruited professionals; use of a not previously validated assessment instrument. CONCLUSIONS: PFIs are feasible in routine care for the treatment of patients with bipolar I disorder and their relatives, and main obstacles are related to the organization/structure of mental health centres, and not to the characteristics of the intervention itself.

Pattern of recurrence of illness after recovery from an episode of major depression: a prospective study.

OBJECTIVE: This study assessed prospectively the pattern of recurrence of illness after recovery from an episode of major depression. METHOD: Seventy-two patients who had recovered from an episode of primary, nonbipolar, nonpsychotic major depression were evaluated bimonthly with the Comprehensive Psychopathological Rating Scale for a period ranging from 20 to 108 months (median = 66 months). New ("prospective") episodes were ascertained with a structured diagnostic interview. The probabilities of remaining well after the index episode and after the first prospective episode were assessed by the life-table method. The severity and duration of prospective episodes and the index episode were compared by linear regression analysis. RESULTS: The probability of remaining well after recovery from the index episode was 76% at 6 months, 63% at 1 year, and 25% at 5 years. The risk of recurrence was lower among patients receiving prophylactic treatment with antidepressants and/or lithium and among those with histories of fewer than three previous episodes. The probability of remaining well was significantly lower 2 years after the first prospective episode than 2 years after the index episode. A pattern of increasing severity from the index episode to the first, second, and third prospective episodes was observed and was not affected by treatment. CONCLUSIONS: Major depression has a high rate of recurrence, even when bipolar and psychotic cases are excluded. The highest rate is observed during the first months after recovery from an episode. Prophylactic drug treatment reduces the risk of recurrence but apparently does not affect the trend toward increasing severity of subsequent episodes.

Baclofen-induced growth hormone secretion is blunted in chronic schizophrenics: neuroendocrine evidence for a GABA disturbance in schizophrenia.

To substantiate a previously reported disturbance of gamma-aminobutyric acid (GABA) in chronic schizophrenia, plasma growth hormone (GH) response to a direct GABA agonist (baclofen, 10 mg) was assessed in 12 unmedicated chronic schizophrenic males and 10 sex- and age-matched healthy controls. Baclofen and placebo were administered orally, in a double-blind design, and blood samples were collected before and 30, 60, 90, 120, 180, and 240 min after drug or placebo administration. Baclofen induced a clear-cut rise in plasma GH levels over baseline values, but the GH increase observed in the patients was significantly smaller than that in controls. These results support the idea that GABA mechanisms may be impaired in chronic schizophrenia.

Clinical and socio-demographic correlates of coping strategies in relatives of schizophrenic patients.

The study aimed to describe coping strategies in a sample of key-relatives of schizophrenic patients, and to explore their relationships with the following variables: patients' and key-relatives' socio-demographic characteristics; patients' and key-relatives' clinical status; and key-relatives' subjective burden. Significant correlations were found between the scores on coercion items and those on Present State Examination (PSE-9) factors "disorganized syndrome" and "psychomotor poverty syndrome". A long duration of illness was found to be associated with relatives' strategies characterized by positive communication and patient's social involvement. Coercion, avoidance and resignation coping strategies were significantly associated with the occurrence of anxiety and depressive symptoms in patients' key-relatives.

[Personality profile of cancer patients under ambulatory chemotherapeutic treatment]. / Il profilo della personalità nell'ammalato neoplastico in trattamento chemioterapico ambulatoriale.

The MMPI questionnaire was used as a personality test on 20 painfree cancer patients, otherwise in good health and undergoing outpatient chemotherapy. Analysis of the data shows that even in an early stage cancer can produce significant alterations in personality. 85% of the patients studied had emotional disorders with hypochondria and depression being the psychopathological profiles most commonly observed.

Severely and persistently mentally ill patients in Italy: an overview of epidemiological and psychosocial findings.

The aim of this paper is to provide an overview of epidemiological, clinical and psychosocial characteristics of patients needing long-term treatment. The data concerned the following aspects: prevalence and incidence from the five best-established Italian psychiatric case registers; needs for care; psychosocial and clinical outcome as assessed by means of follow-up studies; social disability and relatives' perceived burden. The one-year prevalence rate of "long-term users" is consistent in Northern Italy, higher in Middle Italy and lower in Southern Italy. The incidence rate was found to be around 4 per 100,000. Even in a community oriented mental health service, users' needs for care are only partially met. A good psychosocial outcome was found associated with the use of social and/or vocational skills training, while the average number of days per year of hospitalization in a psychiatric department was found associated with poor outcome. A moderate degree of social disability was found among patients needing long-term treatment. The resulting family burden presented to a marked or very marked degree in more than 50% of the relatives.

Prevalence of mental disorders in Tuscany: a community study in Lari (Pisa).

A number of population studies of mental disorders has been carried out using standardized diagnostic tools. We performed a study of this type in the small town of Lari (Pisa) with the objectives of estimating the prevalence of mental disorders, including "minor" disorders, and of comparing our estimates with similar studies carried out in UK and Greece using identical methods (PSE-IX and CATEGO). The prevalence of individuals with mental disorders in our study population was 15.4% similar to that observed in Greece (16%) and higher than that observed in London (10%). Prevalence of "obsessive neurosis" was higher in London as compared to Lari and Athens, while the opposite was true for "generalized anxiety".

[Evaluation of work styles using the clinical case method at the departments of mental health in the region of Campania]. / Valutazione degli stili di lavoro mediante il metodo dei casi clinici nei dipartimenti di salute mentale della regione Campania.

In the present study, designed after the Australian "Quality Assurance Project", the same 9 clinical "vignettes" relative to 3 schizophrenia cases, 3 depressives and 3 neurosis were read by 48 psychiatrists of the Campania Region (Italy). For each case, the psychiatrists were requested to give their opinions on best place of treatment, psycoactive drugs, psychotherapy, etc. A remarkable variability among psychiatrists was observed, regarding not only psycotherapy but drug therapy as well.

Burden on key relatives of patients with schizophrenia vs neurotic disorders: a pilot study.

The burden perceived by the key relatives of 27 schizophrenics and 19 patients with neurotic disorders, both with at least a minimal degree of personal/social disability and a current exacerbation of symptoms, was assessed by a self-administered questionnaire. Only modest quantitative and qualitative differences between the two samples of key relatives were found. The burden perceived by the relatives of schizophrenics was more closely related to the patients' personal/social disability than that reported by the relatives of neurotic patients. The psychopathological features of schizophrenic patients that were perceived as the most burdensome were "negative" symptoms, whereas the burden reported by the relatives of neurotic patients was predominantly related to obsessive/compulsive and anxiety symptoms.

The assessment of psychiatric disability in the community. A comparison of clinical, staff, and family interviews.

Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them. In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff.

Prevalence of psychiatric disorders among subjects exposed to a natural disaster.

A general practice study was carried out in 3 areas of the province of Naples, in southern Italy: Pozzuoli (PZ), a town exposed to significant seismic events in 1983, Monte Ruscello (MR), a village built to accommodate the victims of the earthquake, and Monte di Procida (MP), a town selected as a control since it is situated near PZ and was not significantly affected by the earthquake. The sociodemographic characteristics of the subjects examined were comparable in the 3 areas. The estimate of the real prevalence of psychiatric disorders according to Diamond & Lilienfeld was found to be higher in PZ and MR than in MP. Neurotic depression was the most frequent psychiatric diagnosis. The relative risk of mental disorders in subjects who reported none one or more social problems compared with those who reported none was more than 4 times greater in PZ and MR than in MP. Social problems also differed qualitatively, being more frequently related to living conditions in PZ and MR and to the primary social network in MP.

[Controlled clinical study on the effect of quazepam versus triazolam in patients with sleep disorders]. / Studio clinico controllato dell'effetto del quazepam vs triazolam in pazienti con disturbi del sonno.

Quazepam (QZP), a new long half-life benzodiazepine, seems to have a more specific hypnotic activity and a "physiological" mechanism of action. This study assessed its clinical efficacy and any withdrawal symptoms occurring after the treatment with QZP and triazolam (TRZ). Sixty-five patients (mean age 41.4 yrs +/- 12.43 SD) with sleep disorders were included in the study. The patients were treated with placebo for 4 days (run-in period) and if no amelioration of insomnia was observed, were then randomly allocated to 15 mg QZP (33 patients) or TRZ (32 patients) for 8 weeks and finally placebo for another week. Sleep quality, efficiency, side-effects and withdrawal effects were assessed by specific rating scales. In comparing data obtained from the two treatments, the following conclusions were drawn: 1) both drugs showed a hypnoinductive efficacy but patients treated with QZP had significantly fewer night awakenings; 2) at the end of treatment only patients treated with TRZ had longer awakenings and rebound symptoms; 3) a lower withdrawal symptom incidence was observed in patients treated with QZP. Therefore, QZP seems to have a good hypnotic effect without inducing withdrawal symptoms. In contrast TRZ turned out to be a merely hypno-inducing drug presenting higher risks of rebound effects after withdrawal.