Childhood adversity, symptoms, and cortisol in first episode psychosis: a cross-sectional, secondary, observational analysis of a subsample of FEP patients.

BACKGROUND: Although it has been proposed that childhood adversities (CAs) may affect the hypothalamic-pituitary-adrenal (HPA) axis activity and psychotic symptoms severity, these associations have not been fully confirmed in first-episode psychosis (FEP). This study explored the association between CA, cortisol and psychotic symptoms in FEP patients. METHODS: 81 FEP patients were enrolled. CAs were evaluated by the Childhood Experience of Care and Abuse Questionnaire and a semi-structured interview. Psychotic symptoms were evaluated by the Positive and Negative Syndrome Scale. Cortisol level was collected using saliva samples. ANCOVA and partial correlation analyses were run. RESULTS: FEP patients with childhood abuse reported severe positive symptoms than those without CA. FEP patients with at least one CA had higher levels of cortisol awaking, cortisol at 12 a.m., and cortisol at 8 p.m. Morning cortisol levels were negatively correlated with the severity of negative symptoms and positively correlated with the severity of general psychopathology. Evening cortisol levels were positively correlated with severity of general psychopathology. CONCLUSION: FEP patients with CAs, compared with those without CA, might report more severe positive symptoms and higher cortisol, even though these findings as prone to bias due to the small sample size, and should be seen in the larger perspective of conflicting evidence in the field.

Underestimated Needs for Lymphoma Patients: An Assessment Issue.

BACKGROUND AND AIM OF THE WORK: The aim of the current study was to explore under-considered psychosocial needs for lymphoma cancer group. A model of the role of psychosocial factors and Stressful Life Events was operationalized. METHOD: We used Discriminant Analysis to test predictive power of the model. 103 oncological patients (gender: 42.7 % vs 49.3 % of females 55.2 ±15.6 vs 53.7±14.9) were matched with 140healthy control groups in the study. The following instruments were utilized to conduct the study: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery. RESULTS: The model satisfied the assumption criteria and were significant (Ʌ= .665, χ2= 105.83, p< .001). CONCLUSION: Stressful events, depression and anxiety were adequate markers of the psychological status of lymphoma patients. Our results point out the relevance of taking into account psychosocial factors in hematology.

Stressful life events and psychosis: Gender differences.

There is evidence that stressful events are associated with psychosis. This study aimed to explore sex differences in the association between stressful life events occurring during childhood and adulthood and psychosis. A total of 78 psychotic patients and 156 controls were enrolled. Childhood adversities were evaluated using a validated semi-structured interview and the Childhood Experience of Care and Abuse Questionnaire. Recent life events were recorded using a semi-structured interview with a normative and contextual approach. The diagnosis of psychosis was made according to Jablensky's criteria. χ2 and t-test statistical analyses were run. Odds ratios were calculated in logistic regression. People with psychosis reported more exposure to both childhood adversities and recent events than the general population. An excess of childhood physical abuse was found among male psychotic patients, whereas both childhood sexual abuse and recent life events were overrepresented among female patients in comparison with the general population. There was a cumulative effect of stressful life events on psychosis, although it was stronger among females than in males. It is likely that there are gender differences in the association between stressful life events and psychosis.

Assessing psychological needs in female cancer patients: a tailored model.

BACKGROUND AND AIM OF THE WORK: Psychosocial needs in cancer patients seem to be underestimated and undertreated. The present research was designed to explore under-considered psychosocial needs (e.g., stressful life events, perceived social support, sense of mastery and depressive/anxious symptoms) of a female cancer group. The aim of the study was to test an assessment psycho-oncological model for female cancer patients. An assessment model of psychosocial needs and Stressful Life Events was operationalized and tests its predictive power. METHODS: We used Discriminant Analysis to test predictive power of the model and of the single variables included in it. 236 oncological patients (mean age 55.50 ± 13.09) were matched with 232 healthy control groups in the study. The following instruments were chosen: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery. RESULTS: The model satisfied the assumption criteria and was significant (Ʌ= .680, X2 = 109.73, p< .001). CONCLUSIONS: Stressful events, depression and anxiety were adequate markers of the assessment psycho-oncological model proposed for female cancer patients. The present study provides contributions in a clinical perspective: the results support the relevance of considering an assessment psychosocial model to use in female oncology for an accurate estimation of the women's needs. Women affected by female cancer with an history of Stressful Early and Recent life events and high level of anxiety and depression could positively benefit from a psychotherapy treatment.

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy.

OBJECTIVE: Current nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL). METHODS: Community survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL. RESULTS: In the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5-2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9-24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00. CONCLUSION: One out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.

The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews.

BACKGROUND: Generalized anxiety disorder (GAD) is one of the most reported diagnoses in psychiatry, but there is some discrepancy between the cases identified in community studies and those identified in tertiary care. This study set out to evaluate whether the use of clinicians as interviewers may provide estimates in a community survey close to those observed in primary or specialized care. METHODS: This is a community survey on a randomly selected sample of 2338 adult subjects. The Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) was administered by clinicians, providing lifetime diagnosis based on the DSM-IV-TR. Health-related quality of life (HR-QoL) was measured with the Short-Form Health Survey (SF-12). RESULTS: Overall, 55 (2.3%) subjects met the criteria for GAD, with greater prevalence in women (3.6%) than in men (0.9%): OR = 4.02; 95%CI: 1.96-8.26. Up to 40% of those with GAD had at least another diagnosis of mood, anxiety, or eating disorders. The mean score of SF-12 in people with GAD was 32.33 ± 6.8, with a higher attributable burden than in other conditions except for major depressive disorder. CONCLUSIONS: We found a relatively lower lifetime prevalence of GAD than in community surveys based on lay interviewers and a structured interview. The identified cases of GAD showed a strong impact on the quality of life regardless of co-morbidity and high risk in women, suggesting a profile similar to the one identified from studies in primary and specialized care.

The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey.

Background: The impact of the comorbidity between Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder Spectrum (BDS) remains to be clarified. The objective of this study was to examine the lifetime prevalence of OCD, the strength of the association of OCD with comorbid BDS and the role of comorbidity of OCD with BDS in the impairment of health-related quality of life (HRQoL) in an Italian community survey. Methods: The study is a community survey. The sample (N = 2,267; women: 55.3%) was randomly selected after stratification by sex and four age groups from the municipal records of the adult population of one urban, one suburban, and at least one rural area in six Italian regions. Physicians using a semi-structured interview (Advanced Tools and Neuropsychiatric Assessment Schedule, ANTAS-SCID) made Diagnostic and Statistical Manual of Mental Disorders - 4th revision (DSM-IV) diagnoses of OCD, Major Depressive Disorder (MDD) and Bipolar Disorder (BD). HR-QoL was measured by the Health Survey Short Form (SF-12). Lifetime Hypomania and subthreshold hypomania were screened by the Mood Disorder Questionnaire (MDQ). BDS was defined as the sum of people shown to be positive for hypomania by the MDQ-with or without a mood disorder diagnosis-plus people with a BD-DSMIV diagnosis even if negative for hypomania at the MDQ. Results: Overall, 44 subjects were diagnosed with OCD, 6 with MDD and 1 with BD. The lifetime prevalence of OCD was 1.8% in men (n = 18) and 2.0% in women (n = 26). MDD with lifetime subthreshold hypomania (i.e., people screened positive at the MDQ, even without diagnosed mania or hypomania at the interview) was associated with OCD (OR = 18.15, CI 95% 2.45-103.67); MDD without subthreshold hypomania (and screened negative at the MDQ) was not (OR = 2.33, CI 95% 0.69-7.01). People with BDS were strongly associated with OCD (OR = 10.5, CI 95% 4.90-12.16,). People with OCD and BDS showed significantly poorer HR-QoL than people with OCD without BDS (F = 9.492; P < 0.003). Discussion: The study found a strong association between BDS and OCD. BDS comorbid with OCD was associated with more severe impairment of HR-QoL than OCD without comorbid BDS. Identification of symptoms of hypomania, including subthreshold symptoms, may therefore be important in people with OCD as they might predict a course with poorer HR-QoL.

Childhood trauma and glucose metabolism in patients with first-episode psychosis.

Although the associations between first-episode psychosis (FEP) and metabolic abnormalities on one side, and childhood trauma (CT) and risk of developing psychosis on the other are both well established, evidence on the relationship between CT and metabolic dysregulation in terms of abnormal glucose metabolism is very limited. We tested whether, already at illness onset, FEP patients with a history of CT show dysregulation of a broad range of glucose metabolism markers. In particular, in 148 FEP patients we evaluated serum concentrations of c-peptide, insulin, plasminogen-activator-inhibitor-1 (PAI-1), resistin, visfatin, glucagon, glucagon-like peptide-1 (GLP-1), gastric-inhibitor-peptide (GIP), leptin, and ghrelin. We also assessed CT with the Childhood Experience of Care and Abuse Questionnaire, and stressful life events (SLEs) with a semi-structured interview. Psychopathology, cannabis and tobacco habits, Body Mass Index (BMI) were recorded. Serum concentrations of markers were analyzed from peripheral blood. Ninety-five patients (56 % males, mean age 29.5) reported CT. Multivariate models showed that CT is associated only with the concentrations of c-peptide and insulin after adjusting for age, sex, BMI and SLEs. FEP patients who had experienced CT showed higher c-peptide and insulin serum concentrations. Our study reports that CT might be associated with the metabolic abnormalities in the first stage of psychosis, suggesting that a thorough anamnestic evaluation at psychosis onset that would include the history of CT could be helpful for clinicians in order to implement early programmes of healthy lifestyle education and to guide choice of therapeutic interventions for trauma.

The Prevalence of Specific Phobia by Age in an Italian Nationwide Survey: How Much Does it Affect the Quality of Life?

INTRODUCTION: The study aimed to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews shows lifetime prevalence rates of Specific Phobia (SP) similar to those found by surveys carried out by lay interviewers and if the high level of impairment found in SP may be confirmed. METHODS: This is a community survey on an Italian nationwide sample randomly selected from registers of municipalities. Tools: semi-structured ANTAS psychiatric interview derived from the SCID-DSM-IV, carried out by clinicians (psychologists or physicians); Short Form Health Survey (SF-12) as a measure of Quality of Life (QoL). Analyses: means of the χ 2 test odds ratios were adopted to test several associations regarding SP prevalence. One-way ANOVA was used to compare different groups on attributable burden due to SP and/or other disorders in worsening QoL. RESULTS: The lifetime prevalence of SP was 2.3%. No difference was found by age class. Females showed more than twice the frequency of males (p<0.0001). The disorders showing the closest association with SP were: social phobia (OR=17.53); general anxiety disorder (OR=11.57); anorexia (OR=11.13) and agoraphobia (OR=10.03), but also obsessive compulsive disorders (OR=8.8), eating disorders (OR=7.2), panic disorder (OR=5.9), post-traumatic stress disorder (OR=5.8), and major depressive disorder (OR=4.8) presented an association that achieved statistical significance. The QoL of people with SP and at least one disorder of anxiety, mood or eating in comorbidity, measured as a score at SF12, was worse than controls without SP (p <0.001) but that of people with SP without co-morbidity was not (p = 0.809). CONCLUSION: An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP, at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.

Impairment of Quality of Life Associated With Lifetime Diagnosis of Post-traumatic Stress Disorder in Women - A National Survey in Italy.

INTRODUCTION: The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL). METHODS: Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ). RESULTS: Lifetime prevalence of PTSD in women was 1.3%, (1.4% in<45 years aged, 1.3% in >44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson's Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD. CONCLUSION: The attributable burden in worsening women' perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson's Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.

Parental style and Cloninger's model in psychosis.

Parental style and Cloninger's dimensions are associated with psychosis, but it is still unclear whether temperament, character and parenting variables are linked to specific psychotic symptoms. This study extends previous research exploring these issues. 78 patients with psychosis and 156 control subjects were recruited. Parental style was evaluated using the Measure of Parental Style. Temperament and character were evaluated using the Temperament and Character Inventory-Revised. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. T-tests, correlations and moderation and mediation analyses were performed. Patients reported dysfunctional parenting and had higher scores for harm avoidance (HA) and self transcendence (ST), and lower scores for self directedness (SD) and cooperativeness (CO) than controls. Maternal indifference, abuse and overcontrol were correlated with positive symptoms (PS). Novelty seeking (NS), reward dependence, SD, CO were correlated with PS; HA and ST were correlated with negative symptoms. After adjusting for age, gender and family history of psychopathology lower CO partially mediated the relationship between maternal abuse and PS; the positive NS-maternal abuse interaction was associated with PS. Different parenting and personality variables may be associated with different psychotic symptoms. NS and CO may be part of a pathway between maternal abuse and PS.

Childhood Adversity, Cortisol Levels, and Psychosis: A Retrospective Investigation.

Although it has been proposed that the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may act as a possible pathway linking early life stress to psychosis, this relationship has not yet been fully confirmed. This study aimed to investigate the relationship between childhood adversity (CA), cortisol levels, and psychosis. Eighty-five patients with psychosis and 170 control subjects were enrolled in the study. CA was evaluated using the Florence Psychiatric Interview, and Childhood Experience of Care and Abuse Questionnaire. Positive symptoms (PS) were assessed using the Positive and Negative Syndrome Scale. Cortisol levels were evaluated in saliva samples. Patients experienced more CA and showed higher cortisol levels than controls. Patients with CA showed higher morning cortisol levels and more severe PS than those without CA. Patients with higher morning cortisol levels showed severe delusions. These findings suggest that both CA and dysregulation of the HPA axis could be related to psychosis.

Recent life events and psychosis: The role of childhood adversities.

Life events are commonly reported to be related to psychosis. However, less attention has been given to the role that recent events play on psychosis, in relation to exposure to childhood adversity. The current study aimed to evaluate the relationship between recent events and psychosis, taking into account the role of early adversities. 78 psychotic patients and 156 controls were enrolled. Childhood adversity was evaluated using a validated semi-structured interview and the Childhood Experience of Care and Abuse Questionnaire. Recent events were recorded using a semi-structured interview with a normative and contextual approach. The diagnosis of psychosis was made according to Jablenski's criteria. Chi-square, t-test, odds ratio, and binary logistic regression statistical analyses were performed. Psychotic patients reported an excess of recent events. The occurrence of more than one recent event increased the risk of psychosis; there was a cumulative effect between recent and childhood events on psychosis. Recent events were significantly related to psychosis, even in the absence of childhood adversity or when adjusted for it. Our findings suggested that the effect of recent events on psychosis may be amplified by previous exposure to early adversity. Recent events alone, could be also linked to psychosis independently of childhood adversity.

Assessment of depression and suicidal behaviour among medical students in Portugal.

OBJECTIVES: To examine depression and suicidal behaviour and associated factors in a sample of medical students in Portugal. METHODS: We conducted a cross-sectional study design of 456 native Portuguese medical students from the 4th and 5th year at the University of Lisbon. Participants answered a self-report survey including questions on demographic and clinical variables. Statistical analyses were conducted using the chi-square test, with a Monte Carlo simulation when appropriate. RESULTS: Depression among medical students was 6.1% (n=28) and suicidal behaviour 3.9% (n=18). Higher depression scores were noted in female medical students (χ2=4.870,df=2,p=0.027), students who lived alone (χ2=8.491,df=3,p=0.037), those with poor physical health (χ2=48.269,df=2,p<0.001), with poor economic status (χ2=8.579,df=2,p=0.014), students with a psychiatric diagnosis (χ2=44.846,df=1,p=0.009), students with a family history of psychiatric disorders (χ2=5.284,df=1,p=0.022) and students with high levels of anxiety (χ2=104.8, df=3, p<0.001).  Depression scores were also higher in students with suicidal ideation (χ2=85.0,df=1,p<0.001), suicidal plan (χ2=47.9,df=1,p<0.001) and suicidal attempt (χ2=19.2,df=1,p<0.001). Suicidal behaviour was higher in medical students who lived alone (χ2=16.936,df=3,p=0.001), who had poor physical health (χ2=18,929,df=2,p=0.001), poor economic status (χ2=9.181,df=2,p=0.01), who are/were in psychopharmacology treatment (χ2=30.108,df =1,p<0.001), and who had high alcohol use (χ2=7.547,df=2,p=0.023), severe depression (χ2=88.875,df=3,p<0.001) and high anxiety levels (χ2=50.343,df=3,p<0.001). The results also revealed that there were no differences between students in the 4th and 5th years of medical school regarding rate of depression and suicidal behaviour. CONCLUSIONS: Since depression and suicidal behaviour are mental health problems affecting a significant proportion of medical students, medical schools should implement programs that promote mental health wellness, physical health and economic status between other factors.

Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life.

OBJECTIVE: It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis). METHOD: Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions. TOOLS: MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians. RESULTS: Positives at MDQ show worsening QoL with an attributable burden of 2.8 ± 1.8 lower than in MDD (5.6 ± 3.6, p < 0.001) or Eating Disorders (4.4 ± 6.6, p < 0.03) and similar to Panic Disorder (2.9 ± 0.9, p = 0.44). The burden is lower in the middle-aged (25-59 years) than in the young (18-24) (4.65 ± 4.5 vs 2.58 ± 2.0, p=0.007) or in the elderly (≥60) (4.12 ± 3.2; p = 0.024). In the elderly the burden is independent from comorbid psychiatric disorders. LIMITATIONS: This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only. CONCLUSIONS: The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is "subthreshold" to the psychiatric diagnosis, and relevant for public health.

Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants.

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.

The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy.

INTRODUCTION/OBJECTIVE: The aim was to measure the lifetime prevalence of panic disorder (PD) in an Italian community sample, and to estimate the burden attributable to PD in compromising the quality of life (QoL) of people diagnosed with it. METHODS: Community survey was conducted on a sample of 4,999 randomly selected adult subjects. Instruments used were semi-structured clinical interview Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians and allowing diagnosis according to Diagnostic and Statistical Manual of Mental Disorder (4th ed.; DSM-IV); Short Form Health Survey (SF-12). RESULTS: The lifetime prevalence of PD was 3.6% (4.4% in females, 2.5% in males; p = .002). People with PD had a lower SF-12 score than the standardized community sample (35.5 ± 6.5 vs. 38.4 ± 5.9; p < .0001) with a mean difference (attributable burden) of 2.9 ± 0.7, that is, lower than PD with agoraphobia (AP; 4.2 ± 2.4). Wilson Disease (WD), Multiple Sclerosis, Major Depressive Disorder and Eating Disorders (ED) show a higher attributable burden in impaired QoL than PD, while the attributable burden of PD with AP is not lower than in ED and WD. CONCLUSIONS: The burden attributable to the impairment of QoL following a lifetime diagnosis of PD was found to be not so great compared to the impairment caused by Major Depressive Disorder (MDD) or neurological conditions. The comorbidity of PD with AP worsens QoL significantly.

Is feeling extraneous from one's own body a core vulnerability feature in eating disorders?

OBJECTIVE: To identify core vulnerability features capable of discriminating subjects who are more prone to develop eating disorders. SAMPLING AND METHODS: A nonclinical group composed of 253 university students was studied by means of the Identity and Eating Disorders questionnaire (IDEA), exploring abnormal attitudes toward one's own body and difficulties in the definition of one's own identity, the Body Uneasiness Test (BUT) and different self-reported questionnaires evaluating the specific and general psychopathology of eating disorders. The results were compared with those of a clinical eating disorder group. RESULTS: In the student sample, a group composed of 35 subjects with abnormal eating patterns and a group (218 subjects) without such features were identified. The IDEA total and subscale scores were found to be significantly higher in subjects with abnormal eating patterns than in subjects without them (all p < 0.001). Positive correlations between the IDEA total and subscale scores and the BUT global score were observed in both groups (all p < 0.01). The comparison of the scores on the IDEA between the clinical group (patients with full-blown eating disorders) and the subjects with abnormal over-threshold eating patterns yields a significant difference in the 'feeling extraneous from one's own body' subscale of the IDEA. CONCLUSIONS: The IDEA resulted in being a valid instrument to identify a vulnerability to eating disorders in subjects with abnormal eating patterns in the general population and to recognize the presence of a significant discomfort related to the body. Feeling extraneous from one's own body is the experience that discriminates most between clinical and nonclinical subjects.

Temperament and emotional eating: a crucial relationship in eating disorders.

Specific personality traits are related to Eating Disorders (EDs) specific and general psychopathology. Recent studies suggested that Emotional Eating (EE) is a common dimension in all EDs, irrespective of binge eating. The present study was aimed to explore the relationship of temperamental features with EE and eating symptomatology in a sample of EDs patients, adjusting for general psychopathology. One hundred and sixty six female patients were enrolled at the Eating Disorders Outpatient Clinic of the Careggi Teaching-Hospital of Florence. Participants completed the emotional eating scale, the temperament and character inventory, the eating disorder examination questionnaire and the symptom checklist 90-revised. Novelty seeking and self directedness showed significant correlations with EE after adjustment for general psychopathology. Patients with binge eating displayed significant associations between EE and novelty seeking and self directedness. Among patients without binge eating, no significant correlation between EE and temperamental features was observed. Specific temperamental features are associated to EE in EDs. A clear, different pattern of association in patients with different eating attitudes and behavior was found. Considering that treatments of EDs are largely based on psychotherapeutic interventions, focused on emotions and cognitions, the present data provide some hints which could be helpful for the development of more appropriate psychotherapeutic strategies.