Moderate Depression Promotes Posttraumatic Growth (Ptg): A Young Population Survey 2 Years after the 2009 L'Aquila Earthquake.

BACKGROUND: Earthquakes can result in a range of psychopathology and in negative and positive consequences for survivors. OBJECTIVE: To examine the association between clinical aftereffects (anxiety and depressive symptoms) and post-traumatic growth (PTG) among young survivors of the 2009 L'Aquila earthquake, Italy. METHOD: 316 young earthquake survivors enrolled in the University of L'Aquila were evaluated two years after the natural disaster. Participants completed three main questionnaires, including Patient Health Questionnaire-9 items (PHQ-9), Self-Rating Anxiety Scale (SAS), and Posttraumatic Growth Inventory (PTGI). RESULTS: 59.6% of the student sample showed different levels of depression, whereas 13.3% reported anxiety symptoms. In both clinical dimensions (anxiety and depression), gender differences were found: female gender was confirmed risk factor for a clinical post-traumatic response. Personal PTG, demonstrated by 18% of the L'Aquila youths included in our sample, was predicted by moderate levels of depression (O.R. 2.7). In our model, gender, age, and anxiety did not show any predictive value. CONCLUSION: In a post-traumatic setting, the development of individual cognitive strategies is crucial, whereas after a natural disaster, paradoxically, a moderate depressive condition and the related distress could promote the drive to overcome the psychological consequences of the traumatic event.

How does early cognitive behavioural therapy reduce postpartum depression?

Postpartum depression (PPD) is a frequent mood disorder. Early identification of mothers at risk is crucial to successful prevention. Cognitive Behavioural Therapy (CBT) is an effective preventing therapy. Objectives of this study are to identify mothers at risk for PPD using the Edinburgh Postnatal Depression Scale (EPDS) and evaluate the efficacy of CBT for the prevention of PPD in these mothers. Women were recruited during their second postpartum day. Two groups were selected: mothers with high risk (EPDS score ≥ 10) and mothers with low risk (EPDS score < 10) of PPD. The first group underwent CBT. Follow up was carried out at 40 days, three, six, and 12 months after childbirth. APGAR score, neonatal hospitalization, delayed breastfeeding, and cesarean section were significant obstetric risk factors. Mothers at high risk of PPD presented a statistically valid improvement of EPDS score. Mothers with low risk of PPD did not have CBT and showed a higher EPDS score than mother at high risk at 12 months. PPD prevention is possible through early identification of mothers at risk and early cognitive behavioural therapy.

PTSD Growth and Substance Abuse Among a College Student Community: Coping Strategies after 2009 L'aquila Earthquake.

Aim of the study was the assessment of coping strategies, specifically substance use and post-traumatic growth (PTG), in 411 college students two years after 2009 L'Aquila earthquake. Post-Traumatic Growth Inventory (PTGI) was used to assess PTG and one question about substance use (alcohol, tobacco, cannabis) was asked to verify if students had modified their use in the post-earthquake compared with the pre-earthquake period. The 77.1% of college students were exposed to L'Aquila earthquake. The PTGI mean score was 35.23, underlining low positive coping strategies among student community. About substance abuse, the 43.8% of college students reported a marked increase in alcohol use, 7.8% in cannabis and the 15.8% reported an increase in nicotine use in the post-earthquake period. Despite these data, 12.5 % of the students reported a decrease in alcohol use after the earthquake and 17.3% of the sample reported a PTG, showing positive behaviors and attitudes after the traumatic experience of the natural disaster (increase of social relationships, appreciation of new future possibilities, and development of a new deep meaning of life). Inferential analysis shows a strong negative correlation between direct earthquake exposure and PTGI total score. In post-disaster settings, a systematic framework of case identification, triage, and mental health interventions, including the improvement of positive coping strategies, like the PTG, should be integrated into emergency medicine and trauma care responses.

[Psychotropic-associated sexual dysfunctions: a survey of clinical pharmacology and medication-associated practice]. / Disfunzioni sessuali associate all'uso di farmaci psicotropi: una revisione per la pratica clinica quotidiana.

Epidemiological and clinical studies show that often persons affected by depression and schizophrenia can suffer of impairment of the sexual function. Most antidepressant and antipsychotic drugs have adverse sexual effects but it is difficult to identify if the impairment of the sexual function can be attributed to clinical picture or to the psychopharmacological treatments. Both antidepressants and novel and conventional antipsychotics are associated with significant sexual side effects and the presence of sexual side effects may affect compliance and adherence to treatment. In some specific clinical populations (e.g. youths), these specific side-effects turn out to be one of the most annoying and promote increased drop-out rates and poor adherence to treatment. Nevertheless, these clinical variables are often underestimated or not investigated in the course of follow-up of persons suffering from psychiatric disorders in treatment with psychotropic medications. Growing awareness of the adverse effects of psychotropic drugs has led to attempts to use adjuvants or substitute treatments to resolve sexual dysfunction. Effects on sexual function should be carefully diagnosed and treated; it should clearly discuss with patients in order to preserve an adequate quality of life, promote greater adherence to treatment and promote a good remission and recovery. The aim of this study is to review the most recent and significant literature data regarding association between sexual dysfunction and psychotropic medications, especially highlighting neurobiological and clinical data in order to improve the clinical pratice.

[Negative dimension, social cognition, insight and subjective experience in Schizophrenia]. / La dimensione negativa nel vissuto soggettivo dei pazienti schizofrenici.

INTRODUCTION: Investigation on subjective symptoms in schizophrenia has traditionally been limited to delusions and hallucinations, not considering the persistence of many others disorders and difficulties as residual negative symptoms and cognitive deficits that instead greatly affect the clinical and functional prognosis. The aim of the study is to investigate the differences between the subjective experience of the patient and the objective assessment regarding the negative dimension symptoms in patients with schizophrenia. MATERIALS AND METHODS: We evaluated 58 patients with a diagnosis of schizophrenia consecutively admitted at the L'Aquila Psychiatric inpatient ward (Italy) from April to September 2010; all of them were taking psychopharmacological treatment. The instruments used were: the PANSS for assessment of clinical symptoms and VGF for the assessment of the global functioning, the SENS, the Insight Self-Report Scale and the Scale Geople to investigate respectively the negative dimension subjectively perceived, the insight and the social cognition. RESULTS: The analysis of SENS showed a score of 95.43 (SD ± 9.1) in the awareness, pointing to a negative perception of the experience medium to high. The study of Social Cognition has shown the presence of a statistically significant discrepancy between the two evaluations (p <0.01). The inferential analysis between SENS and PANSS, reported significant correlations between the PANSS negative symptoms of the item of inability to feel the SENS (p <0.015). Finally, a positive correlation was found between the total score of SENS with GFR (p <0.02). CONCLUSION: The knowledge of the subjective experiences of patients with schizophrenia can be difficult because of social withdrawal and resistance to treatment, due mostly to the subjective suffering that is not adequately understood. The results, in line with the recent literature, have shown that the perception of negative symptoms does not always find a parallel in the clinical assessment and how this is a significant correlation with the global functioning. In this perspective, it is therefore necessary to consider the point of view of the patient in order to predict the adherence to the treatment and the global functioning outcome.

The narrative epidemiology of L'Aquila 2009 earthquake.

The authors describe their experience working and living in L'Aquila, where at 3.32 a.m., early in the morning of 6 April 2009, a 6.3 Richter magnitude earthquake caused serious damages to this 13th century town (with a population of 72 000 and a health district of 103 788), in the mountainous Abruzzo region and to several medieval hill villages in the surrounding areas: 309 residents were killed, over 1600 were injured, 66 000 residents were displaced, and, the centre of L'Aquila, the main historical and artistic centre of Abruzzo, was totally destroyed. Here is described the work done at the Psychiatric Unit of the General Hospital of L'Aquila and in the University. The Authors report the incidence rate of Acute Stress Disorder (ASD) in help-seekers (full ASD 4.9%, and partial ASD 39.3%), and of post-traumatic stress disorder (PTSD) found in different samples of population (range 12-37.5). The authors express their consideration about which real-world variables can reflect the population distress and the naturalistic process of recovery in such natural disasters. After the earthquake they hypothesize that a lot of residents had found their way to recover through 'writing, telling the story', by analogy with what narrative medicine asserts, thus estimating the positive effect of 'emotional disclosure' on health. A large number of materials (books, web-blogs, videos) were produced by residents and a database of memories was implemented. The suffering and struggle to recover in the aftermaths of a traumatic experience often yields remarkable transformations and positive growth. From this point of view, the authors underline the increased virtual relationships of residents through Facebook, to cope with the loss of previous social relationships, to get information about recreational opportunities, or to get organized for public events, despite their displacement. Many collective demonstrations were organized and showed the will to actively participate to the processes of reconstruction of the civil and scientific life of the town. The authors stress the need to prevent natural disasters, instead of preventing mental disorders following natural disasters, reporting that seven Italian seismologists and scientists are on trial for manslaughter, accused to have failed to evaluate the true risks of L'Aquila earthquake.

Neuronal basis of haedonic appraisal in early onset schizophrenia: FMRI investigation.

The most important symptoms associated with schizophrenia are affective flattening, decreased expression of emotions, anhedonia and social isolation. The purpose of the present study was to investigate the neural response to disgusting and pleasant visual stimuli in healthy subjects and in patients with first-episode schizophrenia. Twelve subjects in the first episode of schizophrenia (DSM-IV-R, APA, 2000) with a normal IQ and 12 healthy volunteers selected for age and education underwent functional magnetic resonance imaging (fMRI) during observation of pleasant and disgusting visual stimuli. Analysis showed that in healthy subjects, the prefrontal cortex and limbic areas are activated in response to pleasant and disgusting visual stimuli, whereas this does not occur in subjects with schizophrenia since the first episode of illness.

[Psychopathology, quality of life and social functioning in dialysis treatment and kidney transplantation patients]. / Psicopatologia, qualità di vita e funzionamento sociale in pazienti in trattamento dialitico e sottoposti a trapianto di rene.

OBJECTIVES: Psychiatric evaluation of organ transplant candidates is now routinely proposed also in Italy. This study purposed to assess the psychological status in patients on hemo-dialysis, peritoneal dialysis and renal transplantation; moreover other purpose is to investigate the possible differences among the three groups. MATERIALS AND METHODS: 157 subjects were consecutively enrolled, to the service of U.O. Trapianti d'Organo of San Salvatore Hospital in L'Aquila (Italy), between October 2007 and August 2009; 127 were in dialysis (80.9%), of which 101 were in hemodialysis (64.3%) (HD group) and 26 in peritoneal dialysis (16.6%) (PD group) and 30 (19.1%) Kidney transplant (PT group). The subjects were examined with clinical evaluation and through the following psychometric instruments: HAM-D, HAM-A, Jalowiec Coping Scale, STAI-Y1, STAI-Y2, DISS, SF-36. RESULTS: 30% out of our sample showed the presence of some psychopathological signs and symptoms, especially depression and anxiety. At HAM-D there were no differences between HD group (6.73; DS + 5.58) and PD group (5.27, DS + 5.63); the mean value at HAM-D in PT group was 4.4 (DS + 3.16) (p < 0.05). At HAM-A there were no differences between three groups. The HD group showed an higher value at STAI-Y1 (38.61; DS + 10.64) than PD (34.95; DS + 6.75) and PT (33.89; DS + 6.14) groups (p < 0.05). The quality of life (physical role, general health, vitality and role emotional) was lower in HD and PD groups, higher in group PT. The HD e PD groups showed a higher level of disability than PT group (p < 0.05). All subjects used "positive: coping styles. CONCLUSIONS: We consider essential to investigate the issues observed in this study, with the need to integrate psychosocial and functional needs assessment within a course of diagnosis and treatment for people who are undergoing dialysis procedures, or after waiting for a transplantation. Dialysis affects the quality of life, leading to limitations in activities and high level of disability. The PT group showed better quality of life and less impairment in functioning in the investigated areas. If the impact of psychological and/or psychiatric aid remains difficult to appraise, these results emphasize the impact of psychological status and the appropriateness of psychosocial support intervention on patients facing the transplant process or in dialysis treatments.

[Early diagnosis of dysmorphophobia and others dysmorphic disorders: a possible operative model]. / Dismorfofobia e diagnosi precoce: un modello operativo possibile.

AIMS: Body Dismorphic Disorder interest the 1-2% of the general population. It is characterized by an unfavorable prognosis and an elevated comorbidity with others psychiatric disorders. Approximately 6-15% of people with body image disorder refer for aesthetic surgery without any benefit indeed the outcome is, often, to request others surgery procedure. The aim of study has been to investigate the presence of dismorphophobia, others dismorphic disorders and psychiatric symptoms in a sample of patients candidates to aesthetic surgery procedure. MATERIALS AND METHODS: It has been recruited 109 patients of mean age 27.21 years, coming to the department of Plastic Surgery of L'Aquila (Italy). To all the patients have been delivered a questionnaire for socio-demographic data and two clinical standardized instruments: Self-report Symptom Inventory-Revised (SCL-90) and the Body Uneasiness Test (BUT). The psychometric and clinical evaluations have been performed by SMILE center (Service for Monitoring and early Intervention against psychoLogical and mEntal suffering in young people), the mission of which is to reduce the burden of mental suffering in young people by of an earlier recognition of signs and symptoms of psychiatric disorders. RESULTS: 42.67% of sample showed positive results to BUT, while 57.33% reported negative results. Moreover, BUT-positive subjects achieved significantly higher results in all SCL-90 items. CONCLUSIONS: A liaison between psychiatrists and plastic surgery equipe is essential for an early diagnosis of Dismorphophobia and others Dismorphic Disorders, to begin an eventual treatment and to supply indications for the surgical candidability. Our study confirm the high prevalence of body image disorders and the presence of other psychiatric symptoms and diseases in patients who demand aesthetic procedure. The detection of early signs of any psychiatric and psychological apparent discomfort represent a priority because this correlate, in most cases, with late diagnosis and intervention because awareness of these types of disease is usually very low and therefore the possibility that subjects with this type of problems are requested to psychiatric services is rare.

Severe tramadol addiction in a 61 year-old woman without a history of substance abuse.

We describe here the first case of Tramadol addiction and withdrawal in an elderly female patient in apparently good physical health. We report successful treatment with mirtazapine and clonidine. We believe that patients must be advised to take Tramadol regularly and to stop gradually especially after long treatment periods; moreover physicians must consider the potential physical dependence when they prescribe Tramadol for pain. Hence, we are observing some patients who continue to take Tramadol in order to achieve a feeling of well-being, even though their pain is controlled after disease regression. Finally, the establishing of an evidence-based Tramadol detoxification protocol would be highly desirable.

Subjective and psychopathological response in patients under different antipsychotic treatments: are there differences in real clinical practice?

The aim of this study is to investigate whether subjective well-being in patients under treatment with typical (ATPs) and atypical antipsychotic (ATPsA) compounds can be compared with the improvement of psychopathological state and to verify if both variables correlate to adherence to treatment. We assessed 106 consecutive patients receiving ATPs or ATPsA in the University Psychiatric Ward of L?Aquila, according to DSM-IV diagnosis of Schizophrenia and Bipolar Disorder. Psychopathological state was assessed by Brief Psychiatric Rating Scale-4.0 version (BPRS), adherence to treatment and subjective well-being was assessed by Drug Attitude Inventory (DAI-10) and Subjective Well-being under Neuroleptics (SWN), respectively. BPRS and DAI-10 were administered on admission (T0) and at the end of recovery (T1). The subjects enrolled in this study were divided into 2 groups according to ATP prescribed. We observed an improvement of BPRS and SWN total scores in each group, and increasing scores in DAI-10, from admission to discharge, both in total samples and in each group. There were statistical differences between the patients receiving ATPs and those receving ATPsA regardindg the SWN total score and its different dimensions. This study emphasizes that patients receiving ATPsA show better subjective response compared with patients undergoing ATP treatment, although the adherence to pharmacotherapy and clinical improvement do not differ between the groups.

[Risperidone-induced symptomatic hyperprolactinemia in youth with schizophrenia: efficacy and tolerability of cabergoline treatment]. / Iperprolattinemia sintomatica da risperidone in pazienti giovani affetti da schizofrenia e trattamento con cabergolina: studio di efficacia e tollerabilità.

OBJECTIVES: The aim of our study is to evaluate, in youth schizophrenic responders outpatients coming to the SMILE (Service for Monitoring and for early Intervention Looking at the fight against the onset of mental Even psychological suffering of youths of the Psychiatric Department of the University of L'Aquila), the efficacy and tolerability of a low dose of cabergoline, in the treatment of risperidone-induced symptomatic hyperprolactinemia. MATERIALS AND METHODS: Ten schizophrenic young patients (6 male and 4 female; mean age: 23.3 +/- 0.5 years) who were clinical responders to risperidone treatment and showed symptomatic hyperprolactinemia, were treated with low dosage of cabergoline, 0.125 to 0.250 mg/week for 16 weeks. Plasma prolactin level, clinical symptomatology of hyperprolactinemia (UKU) and psychopathology (PANSS) was assessed at baseline and for three times (4, 8 and 16 week) along the follow-up of the study. RESULTS: After cabergoline treatment, the mean decrease in plasma prolactin levels was statistically significant (p < 0.05) for the global sample of youths with schizophrenia. Nine of these patients showed remission of clinical signs of hyperprolactinemia with normalization of prolactin values. No side effect was observed neither patients' psychopathological worsening. CONCLUSIONS: Our data confirm previous studies results, suggesting that low-dose cabergoline treatment of risperidone-induced symptomatic hyperprolactinemia may be safe and clinically effective in a relevant number of schizophrenic patients. Our sample didn't show any side-effects associated to cabergoline use, neither any cardiopulmonary complications as recently reported in literature data. These therapeutic strategies seem to be not influencing psychopathological outcome and for such reason could be a good strategy in clinical practice for the treatment of youths with schizophrenia especially when the efficacy of risperidone is so good to not indicate its withdrawal.

[Antipsychotic-induced symptomatic hyperprolactinemia: clinical consequences and therapeutic strategies]. / Iperprolattinemia sintomatica da antipsicotici: conseguenze cliniche ed indicazioni terapeutiche.

Hyperprolactinemia is a clinical condition characterized by a stable and persistent increase in the ematic prolactin levels. That condition presents some serious health consequences for the affected subjects determining both sexual and endocrine not sexual dysfunctions. Drugs which act on the dopaminergic system and/or on the dopamine hypophysis receptors, could increase the prolactin levels. Traditional antipsychotics used in the treatment of the schizophrenia, are one of the pharmachological classes more involved in this condition and a wide data from international literature describes its clinical and phisiopathologic characteristics. Generally, the atypical antipsychotic induce a significant lower increase of prolactin levels as regards the traditional ones However, above all in young psychotic patients treated with these new drugs, it has been shown an increase of prolactin levels over the superior limit of the normal range, in 70% of them. One of the reasons which more frequently induce a psychotic patient to interrupt an antipsychotic treatment, is represented by the presence of side effects expecially in the sexual sphere. These consequences are greater and more significant in young patients. For such reasons, the therapeutic alternatives to be consider in symptomatic hyperprolactinemia depend on a complete evaluation of the risk/benefit relationship considering the possibility of shifting to another antipsychotic drug, or using drugs with dopaminergic activity which, however, could be associate to some side effects and could determine a worsening of psychotic symptoms.

[First episode psychoses: psychosocial, interpersonal and cognitive bases for a therapeutic approach]. / Le psicosi all'esordio: le basi psicosociali, interpersonali e cognitive per un razionale approccio terapeutico.

The occurrence of psychotic symptoms in first episode psychoses is the ultimate stage of a series of behavioural, cognitive and psychosocial signs. Among these, only a small set are pathognomonics, but more importantly, they continue to operate and to modify the clinical picture. The instability of diagnosis and outcome require a large series of multimodal and atheoretical treatment approaches. Interventions should be flexible, acceptable, intrinsically effective and evidence based. Clinical and therapeutic decisional algorithms will be presented to be adopted in mental health services for people at first episode psychoses.

Neonatal eating epilepsy: pathophysiological and pharmacologic aspects.

We report a case of neonatal Eating Epilepsy. The baby was admitted to the Neonatal Intensive Care Unit of Chieti after delivery, with respiratory distress syndrome. In the first day of life the baby had an episode of arterial desaturation and cyanosis with EEG alterations. After laboratory and instrumental investigations we found a correlation between EEG abnormalities and GER. So we administered a combination of anticonvulsive and antacid therapy and, considering the total improvement of EEG, we diagnosed a neonatal form of "eating epilepsy".

A case of Smith-Lemli-Opitz Syndrome, defect of cholesterol biosynthesis.

We report the case of a child with Smith-Lemli-Opitz Syndrome. The pregnancy was complicated by prenatal growth retardation. The baby was admitted to the Neonatal Intensive Care Unit of Chieti when she was five months old. She showed postnatal growth retardation, trouble sucking and swallowing, microcephaly and multiple major and minor malformations, including characteristic facial features and 2-3 syndactyly of the toes. We found correlations between multiple congenital malformations, failure to thrive and low plasmatic cholesterol measurement.

[Efficacy of adjunctive donepezil for cognitive impairments in patients with schizophrenia]. / Studio dell'efficacia del donepezil sulle funzioni cognitive nel trattamento farmacologico di pazienti affetti da schizofrenia.

Schizophrenia generally manifests cognitive disorders of subjects affected by this illness. Acetylcholine is the main neurotrasmettitor involved in the modulation of cognitive processes as attention, memory and executive functions. The aim of our study is to examine the effects of anticholinesterasic drugs in addiction to atypical antipsychotics on cognitive functions in subjects with schizophrenia. Participant to the study 14 subjects affected by schizophrenia. Subjects have been divided in two sub-groups on the grounds of pharmachological treatment used. A first group (N= 8) it's been treated only with risperidone (monotherapy group); the second one (N=7) it's been treated with donepezil in addition to risperidone (donepezil+ risperidone group). The group treated with donepezil + risperidone evidenced, after 3 and 6 months, statistically significant improvements in attention, in executive functions and in understanding first order Theory of Mind. Our findings are in agreement with those reported by MacEwan et al. (2001). Even if preliminary, our results prove the effectiveness of using anticholinesterasics drugs in addition to atypical antipsychotic treatment, especially in improving attentive functioning.

The interhemispheric transcallosal-transversal approach to the lesions of the anterior and middle third ventricle: surgical validity and neuropsychological evaluation of the outcome.

Based on the observation of the course of callosal fibres and of their artero-venous support as appearing in a microanatomic study, the Authors propose a variant of standard callosotomy procedure by the introduction of the transverse section of callosal fibres. This technique would allow the surgeon to spare a larger number of callosal fibres by the combined effect of a lower direct mechanical traction on fibres and a lower impact on artero-venous microcircle. The neuropsychological outcome of the patients who underwent this kind of procedure was evaluated. Fourteen patients affected by occupying-space lesions involving the anterior and middle third ventricle were included in the study. Ten patients underwent transverse callosotomy, four subjects received standard sagittal callosotomy. A control group was also included in the study. All patients underwent a pre-operative and six months post-operative neuropsychological evaluation focused on performance at cognitive and attentional tasks. No disturbances in executive function were observed in either group. Patients receiving transverse callosotomy performed as well as control group subjects in attentive tasks, which is not the case of patients undergoing sagittal callosotomy who show a marked deficit in selective attention for left side visual field. The observed more favourable neuropsychological outcome supports transverse callosotomy as a valid alternative method to standard longitudinal callosotomy in third ventricle surgery.

[Social cognition and atypical antipsychotic agents in the treatment of persons with schizophrenia: preliminary data from a naturalistic study]. / Cognizione sociale ed antipsicotici atipici nel trattamento di persone affette da schizofrenia: dati preliminari da uno studio naturalistico.

Schizophrenia is a chronic disorder that begins in adolescence or in early adulthood. In schizophrenic disorder there are relevant deficits in social interaction. The aim of this study was to evaluate the efficacy of atypical antipsychotic drugs compared to a conventional antipsychotic in the treatment of psychotic symptoms and on cognitive functions of a group of people affected by schizophrenia. Effects of novel antipsychotic drugs on social functioning improvement, regarded as improvement in the ability to represent mental states, were thoroughly assessed. Our study was conducted in the form of naturalistic observation of a sample of 45 people affected by schizophrenia treated with haloperidol, clozapine and risperidone. Our results show that after one year of treatment there were significant positive results in social competence abilities in the group of people being treated with risperidone. Theses results may have a relevant impact on the improvement of quality of life in people affected by schizophrenia.