Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders.

Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.

Circadian rhythms disruptions and eating disorders: clinical impact and possible psychopathological correlates.

BACKGROUND: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. METHODS: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). RESULTS: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. CONCLUSIONS: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities.

Oral versus long-acting injectable antipsychotics: hospitalisation rate of psychotic patients discharged from an Italian Psychiatric Unit.

OBJECTIVE: The primary aim is to verify the efficacy of long-acting injectable (LAI) and oral antipsychotics (AP) in terms of re-hospitalisation rate of patients with psychotic disorders. The second aim is to evaluate socio-demographic and clinical differences in patients that were re-hospitalised after the index discharge compared to patients that were not re-hospitalised. Finally, socio-demographic and clinical differences of re-hospitalised patients that were prescribed at discharge with oral or LAI AP were analysed. METHODS: A retrospective observational study including all patients discharged with diagnosis of psychotic disorders from July 2011 to July 2013 was conducted. Patients discharged with LAI or with oral AP were included. Re-hospitalisations occurred during a follow-up period of 24 months after the index discharge were considered. Chi-square test or Student's t-test were used for comparisons. Odds ratios (OR) and 95% confidence intervals (CI) for the incidence of re-hospitalisation for LAI or oral AP were provided. RESULTS: No significant differences between LAI and oral AP in terms of re-hospitalisation rate in a 24-month period were found. Clinical and socio-demographic characteristics did not significantly differ between the groups. CONCLUSIONS: LAI seemed to be similar to oral AP in terms of prevention of re-hospitalisation in psychotic patients.

Psychopathological characteristics of patients with first-episode psychosis and chronic schizophrenia: a descriptive comparison.

Only few studies have compared the psychopathological features in first episode psychosis (FEP) and chronic schizophrenia (CS) patients. The aim of our study was to compare sociodemographic and clinical aspects of FEP and CS inpatients using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) in order to better characterize FEP. We did not find significant socio-demographic differences between the two groups apart from age and nationality. About PANSS we found that conceptual disorganization, poor rapport and lack of insight items scores were significantly higher in patients with FEP. Related to BPRS the items of somatic concerns, grandiosity and motor hyperactivity were significantly higher in the CS group; uncooperativeness was significantly higher in FEP group. Our study offers a characterization of FEP patients that confirms evidence and adds some information from the current literature. FEP patients seem to be more uncooperative with a worse interpersonal empathy and insight into the illness than CS patients; this could reduce their compliance with the treatment.

Personality and psychotic symptoms as predictors of self-harm and attempted suicide.

BACKGROUND: Nonfatal suicidal behaviours (NSB), including suicide ideation, suicide plan and suicide attempt, constitute a serious problem for public healthcare services. Suicide gesture (SG) which refers to self-injurious behaviour with no intent to die, differs from NSB in a variety of important ways. The aim of this study was to investigate demographic and clinical characteristics of NSB and SG to examine whether self-injurers with intent to die differ significantly from self injurers without such intent. METHODS: All admissions for NSB and SG to the Psychiatric Inpatient Unit of University / General Hospital Santa Maria della Misericordia, Perugia, Umbria, Italy, from January 2015 to June 2015 were included in a medical record review. Basic descriptive statistics and distributional properties of all variables were first examined. Bivariate analyses were performed using Chi-square tests for group comparisons and t-test for independent samples used when appropriated. RESULTS: The study sample included 38 patients. Of these 23 had committed NSB (13.1%), 15 had commetted SG (8.5%). Number of married NSB was significantly higher than the number of married SG (p=0.08). We found a significant difference between NSB and SG related to the item of impulse control that was poorer in SG than NSB (p=0.010). BPRS items of hostility (p=0.082), suspiciousness (p=0.042) and excitement (p=0.02) were found to be significantly higher in SG than NSB. Borderline personality disorder (p=0.032) and Passive-Aggressive personality disorder (p=0,082) diagnosed by the means of the SCID-II, were more represented in SG than NSB (p=0.044). Schizoid personality disorder was significantly related to NSB (p=0.042). No others significant differences were found. CONCLUSIONS: NSB and SG are different for many psychopathological characteristics. These results confirm the importance of classifying individuals on the basis of the intent to die. Additional research is needed to understand and elucidate psychopatological and clinical characteristics of the different categories of self-injurers to find risk factors specific to suicide attempts.