Age of onset of mood disorders and complexity of personality traits.

Objective. The aim of the present study is to evaluate the link between the age of onset of mood disorders and the complexity of the personality traits. Methods. 209 patients with major depressive or manic/hypomanic episodes were assessed using the Structured Clinical Interview for DSM Axis I diagnoses and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Results. 17.2% of the patients had no elevated MCMI-III scores, 45.9% had one peak, and 36.9% had a complex personality disorder with two or more elevated scores. Mood disorders onset of 29 years or less was the variable most related to the complexity of personality disorders as indicated from a recursive partitioning analysis. Conclusions. The relationship between mood disorders and personality traits differ in reference to age of onset of the mood disorder. In younger patients, maladaptive personality traits can evolve both in a mood disorder onset and in a complex personality disorder, while the later development of a severe mood disorder can increase the personality symptomatology. Our results suggest a threshold of mood disorder onset higher compared to previous studies. Maladaptive personality traits should be assessed not only during adolescence but also in young adults to identify and treat potential severe mood disorders.

Lack of interaction between a polymorphism in the dopamine D2 receptor gene and the clinical features of migraine.

The purpose of this study was to evaluate whether a particular genotype of the dopamine D2 receptor (DRD2) gene would affect the clinical features of migraine. In a group of 118 migraineurs (55 migraine with aura and 63 migraine without aura patients), we tested the association of the biallelic C/T NcoI DRD2 polymorphism with several characteristics of the disease. Genotype and allele frequencies resulted similarly distributed in migraine with aura and migraine without aura patients (chi2 = 1.58, P = 0.45 and chi2 = 0.09, P = 0.77, respectively). The different DRD2 genotypes (C/C, C/T and T/T) had no significant effects on age at onset of migraine, presence of premonitory phenomena, frequency of headache attacks, associated symptoms, psychological features and quality of life of our migraine patients. The results of our study do not support a role for the DRD2 gene in modifying the clinical features of migraine.

Cognitive and psychomotor effects of paroxetine and sertraline on healthy elderly volunteers.

The authors evaluated the cognitive and psychomotor effects of serotonin reuptake inhibitors in healthy elderly volunteers. Paroxetine, sertraline, and placebo were compared for 3 weeks of testing in a double-blind study with behavioral testing at baseline and at the end of each week. MANOVA models demonstrated no between-group differences; however, mixed-model random regression analyses revealed that Day 14 plasma paroxetine levels correlated negatively with delayed verbal recall and paired-associate learning scores. In contrast, plasma sertraline levels correlated positively with Day 7 immediate verbal recall, Day 14 tapping, and Day 21 delayed verbal recall scores, and negatively with divided-attention task scores on Day 21. Plasma paroxetine levels were associated with mild behavioral impairment at Day 14, with no other significant adverse effects. Plasma sertraline levels were associated with mild and transient behavioral changes, as well as early termination in several subjects.

Abnormal salivary cortisol levels in social phobic patients in response to acute psychological but not physical stress.

BACKGROUND: Little is known about the hypothalamic-pituitary-adrenal axis response to acute stressful behavioral challenges in patients with social phobia. METHODS: Eighteen patients with social phobia and 17 normal volunteers participated in two behavioral stressors: a speech task and physical exercise. RESULTS: Normal volunteers (n = 14) demonstrated a significant 50% increase in salivary cortisol levels to the speech task. Three nonresponding normal volunteers demonstrated a 17% decrease. In contrast, patients with social phobia demonstrated dichotomous changes. Seven social phobia patients demonstrated a significantly higher 90% increase in salivary cortisol to the speech task, whereas the remaining patients (n = 11) were nonresponders demonstrating a 32% decrease in cortisol. Both patient groups were significantly more anxious than the normal volunteers. In contrast to the response to a speech task, social phobics showed a cortisol response to physical exercise of similar magnitude as normal volunteers. CONCLUSIONS: The results indicated dichotomies in magnitude and in distribution of the cortisol response to a speech task between social phobia patients and normal volunteers. Social phobia patients responded differently than normal volunteers to a stressor associated with social evaluation but not to physical exercise. These results suggest adaptation of distinct biological processes specific to different stressful conditions in social phobia.

Comparison of the effects of zaleplon, zolpidem, and triazolam on memory, learning, and psychomotor performance.

Twenty-four healthy male and female subjects, who participated in this randomized, double-blind, crossover study, received single nighttime doses of zaleplon 10 mg (therapeutic dose), zaleplon 20 mg, zolpidem 10 mg (therapeutic dose), zolpidem 20 mg, triazolam 0.25 mg (positive control), and placebo. Subjective behavioral ratings and psychomotor tests were completed before and 1.25 and 8.25 hours after administration of the study drug. The Immediate and Delayed Word Recall tests and the Digit Span Test were used to assess memory. The Digit-Symbol Substitution Test, Paired Associates Learning Test, and Divided Attention Test were used to assess other cognitive skills. Zaleplon 10 mg did not produce any significant changes in memory or learning compared with placebo. All other active treatments, including zolpidem 10 mg, caused psychomotor impairment at the 1.25-hour test battery. Zolpidem 20 mg (twice the therapeutic dose) produced more psychomotor impairment at the 1.25-hour assessment than did any of the other active treatments, including zaleplon 20 mg. At the 8.25-hour time point, test scores for subjects who received zaleplon 10 mg and 20 mg did not differ from the test scores for those who received placebo. However, cognitive impairment persisted up to the 8.25-hour observation for subjects who were administered triazolam 0.25 mg and zolpidem 20 mg. Adverse events associated with the use of zaleplon were transient and mild-to-moderate in severity. Overall, this study shows that zaleplon is a safe hypnotic that does not affect memory, learning, or psychomotor skills associated with vigilance.

[Psychosexual problems in patients with neoplasms]. / Problematiche psicosessuologiche nei pazienti neoplastici.

The Author's aim is to highlight the importance of psychic dynamics which play a role when a patient, suffering from cancer, turns to a therapist for sexual rehabilitation.

The importance of developing an informatics framework for mental health.

Though mental health services are important in human terms, and account for a tenth of health expenditure, they are not well served in informatics developments. There are no specific mental health components in the European Union's health telematics programmes, and there is similar under-representation in national programmes. Yet telematics has much to offer mental health services and their management, and can address directly current service anxieties. Telematics concepts which could benefit mental health include integrated, multi-disciplinary records, real-time multi-site record access, and structured programmes to plan, schedule, and monitor care delivery. The power of information systems to sort data, and to represent them graphically, can sift like data items from complex records, and can present them in displays which highlight their significance. Above all, quality of care can be enhanced by monitoring, and by improved outcome measurement. However, a planned programme of research and development is needed, to relate and adjust current health informatics techniques to the special attributes of mental health. The World Health Organisation has identified the potential of such a programme, but greater vision and commitment is needed at policy level if mental health services and patients are to receive the benefits from health informatics which are available to the physically ill.

Salivary cortisol and daily events in nursing home residents.

The authors evaluated the feasibility of using salivary cortisol as a noninvasive measure of hypothalamic-pituitary-adrenal (HPA)-axis responses to stressful events of daily living in elderly nursing home residents. Ten medically stable male nursing home residents (age 81.7 +/- 12.42) gave salivary samples before and after an assisted bath, and at corresponding times on the subsequent (control) day. Regression models, with measures of salivary cortisol on the bath and control days for two timepoints before the bath and four timepoints after the bath as the dependent variables, yielded significant effects of time, bath status, and day. Salivary cortisol testing is noninvasive and easy to collect from long-term care patients, including those with moderate degrees of dementia. It may be of use as a tool for studying the stressors associated with care, the determinants of HPA responses, and the consequences of hypercortisolemia in these vulnerable patients.

[Psychosexual interventions combined with biologic therapy of erectile dysfunction]. / Considerazioni sull'intervento psicosessuologico in associazione alle terapie biologiche della disfunzione erettile.

The authors, beginning from che concept of erectile disorder with mixed pathogenesis, describe its clinical dimension. The psychic variables which prevent the use of biologic-andrologic therapy (FIC, penis prosthesis) are then considered: 1) psycho-sexual difficulties before the onset of the organic lesion; 2) the partner's relationship with the biologic-andrologic therapy; 3) the patients' relationship with the biologic therapy. A model of intervention (Group Psycho-sexologic Intervention) on the psychic variables interfering with the use of the biologic-andrologic therapy is then described. The authors end by considering the psychological impact and the possible psychoiatrogenicity of biologic-andrologic therapies.

[Penile prosthesis]. / Gli impianti protesici.

In this article the Authors, after describing the history of the penile prosthesis surgery and analyzing the technical progresses made in the last twenty years, offer their personal experience and data from the most recent literature about treatment of erectile dysfunction through the application af penile prosthesis, about the indications for the operation and the choice of the type of prosthesis. They also explain all the possible complications and eventual mechanical failures, which have considerably decreased in the last few years.

[Psychological problems related to the sexual stimulation video (SSV) test in the diagnosis of erectile disorders]. / Problemi psicologici relativi al test di video stimolazione sessuale (VSS) nella diagnostica dei disturbi erettili.

The Authors analyze scientific community's attitude towards VSS test. Related psychological problems are examined: the doctor's fear to be accused of voyeurism, the doctor's inadequacy in "invading" patient's field of intimacy, the doctor's relationship with his own erotic fantasies and with pornography, the "castrating" aspects in hospital environment and so on.

[Intervention models in andrology in adult-elderly patients with psychogenic erectile dysfunction]. / Modelli di intervento in andrologia su pazienti adulto-anziani affetti da disfunzione erettile psicogena.

The Authors deals of the principal models of management in andrologic ambit on patients adult-elder affected by psychogenic impotence. Yet they made a critic remark of these models and show a different management model named "within treatment". The authors presents the results achieved using this model in the S. Luigi Gonzaga Hospital surgery for male sexual diseases.

[Psychiatric emergency and first level intervention. Analysis of a series of attempted suicides at a Turin First Aid station]. / Urgenza psichiatrica e intervento di primo livello. Analisi di un gruppo di tentati suicidi in un Pronto Soccorso della Città di Torino.

The present study was carried out in a Turin Hospital and considers interventions for attempted suicide in the period March-May 1988, examining psychopathological and social characteristics. No epidemiological evaluation was made of the problem but rather an analysis of the specialist and general assistance given to these patients in First Aid structures, the therapeutic protocols that preceded the attempted suicide, motivations and modalities involved. In addition, a three-month follow-up looked at the therapeutic destiny of the cases. In the last analysis, an attempt was made to evaluate the therapeutic interaction between local psychiatric services and the First Aid facility of a general hospital: in fact, according to the health service reform law and the application of Law 180, the DEA, as a hospital structure, forms part of the structures delegated to the treatment of mental disturbances.

The image of self and of the environment in drug abusers: a comparative study using the TAT.

This study attempted to add to our understanding of the heroin abusers' identity problems, using images of the self and the environment. Murray's Thematic Apperception Test (TAT) was applied to a group of male drug users undergoing withdrawal treatment with methadone and also to a group of male, non-drug using controls. The needs of the subjects and the demands of the environment, plus interaction between the two, were compared between the two groups to obtain information about the self and lifestyle. Among the data which emerged, is an increased need for destructive aggression and an environment experienced as coercive and emarginating. Among the interactions we observed coerced imagination, difficulties in identification, personal relationships based on abandonment with persecutory projection of the female figure and a tendency toward immature defences such as avoidance, denial and acting out. This information is discussed in relation to possible means of treatment.

[Preventive psychology and andrological problems]. / Psicologia preventiva e problemi andrologici.

The Authors focus the main aspects and the secondary prophylaxis of the psychogenic sexual disorders, showing some interdisciplinary methodological aspects between andrology and psychiatry and illustrating the emotional-cultural requisites of the physician who is going on to prophylactically operate. In the second part a protocol of psychological prophylaxis structures in sequential issues is presented, this protocol is the one used by the University Urological Division of S. Luigi Gonzaga Hospital with the collaboration of the Psychiatric Division of the same Hospital. This protocol is to be presented to patients scheduled for surgery on the genital area.

[Attitudes, knowledge and methods of assistance used by general practitioners in Novara in treating drug addicts. Study of 100 doctors]. / Atteggiamenti, conoscenza e modalitàa assistenziali dei medici di base della cittàa di Novara verso i soggetti tossicodipendenti. Studio su 100 medici.

The study examines the relationship between the general practitioner and the drug addict and aims to evaluate some aspects of the work of the health service, above all with reference to the methods of assistance, attitudes and knowledge relating to the problem of treating drug addicts. A questionnaire was sent to 100 general practitioners in Novara; it consisted of 15 questions relation to the doctor's opinion of the drug addict, the methods and place of intervention, the doctor's judgement regarding his/her own preparation and function, and the frequency of contact with drug addicts. The findings show that the majority of doctors have a positive attitude towards the problem, but that there is also a widespread feeling of impotency, dislike, loneliness, disinformation, and in addiction a feeling of educational inadequacy on the subject.

[Hospital emergencies in drug addiction. Analysis and interpretation of data recorded at 3 DEAs of the Turin area]. / L'emergenza ospedaliera nelle tossicodipendenze. Analisi ed interpretazione dei dati condotta in tre DEA dell'area torinese.

The present research forms part of a wider research organised as part of an NRC sub-project on the psychotherapy of drug addiction. It aims to examine drug addiction services in order to assess the interrelations between these services, their ways of operating and the use drug addicts make of them. An attempt is also made to identify the response models offered by these structures and their relation to the specific demand by the drug addicted users, the aim being to show that the initial response has in itself a largely unexploited capacity to direct the requirements of the drug addicted patients.