Quality of Life in Carotid Atherosclerosis: The Role of Co-morbid Mood Disorders.

INTRODUCTION/OBJECTIVE: To study in severe carotid atherosclerosis (CA): the frequency of mood disorders (MD); the impairment of quality of life (QoL); the role of co-morbid MD in such impairment. METHODS: Case-control study. CASES: consecutive in-patients with CA (stenosis ≥ 50%). CONTROLS: subjects with no diagnosis of CA randomized from a database of a community survey. Psychiatric diagnosis according to DSM-IV made by clinicians and semi-structured interview, QoL measured by the Short Form Health Survey (SF-12). RESULTS: This is the first study on comorbidity on CA disease and MD in which psychiatric diagnoses are conducted by clinicians according to DSM-IV diagnostic criteria. Major Depressive Disorder (MDD) (17.4% vs 2.72%, P <0.0001) but not Bipolar Disorders (BD) (4.3% vs 0.5%, P = 0.99) was higher in cases (N=46) than in controls (N= 184). SF-12 scores in cases were lower than in controls (30.56±8.12 vs 36.81±6:40; p <0.001) with QoL comparable to serious chronic diseases of the central nervous system. The burden of a concomitant MDD or BD amplifies QoL impairment. CONCLUSION: Comorbid MD aggravates the impairment of QoL in CA. Unlike autoimmune diseases or degenerative diseases of the Central Nervous System, CA shows a strong risk of MDD than BD.

Patients with carotid atherosclerosis who underwent or did not undergo carotid endarterectomy: outcome on mood, cognition and quality of life.

BACKGROUND: To compare the six-month outcome on mood, cognition and quality of life (QoL) in patients with severe carotid atherosclerosis (CA) who underwent carotid endarterectomy (CEA) with subjects who refused treatment. METHODS: Cohort study on consecutive inpatients with CA (stenosis ≥ 50 %) (N = 46; age 72.56 ± 7.26; male 65.2 %). Intervention cohort: subjects who decided to undergo CEA (N = 35); Control cohort patients who refused CEA (N = 11). DSM-IV-Psychiatric diagnosis made by clinicians using interviews, QoL measured by Short Form Health Survey (SF-12); cognitive performance by WAIS Intelligent Coefficient (IC). RESULTS: The study showed a better improvement during six months in Overall IC, Performance IC and Verbal IC in the group that underwent CEA. QoL in the two cohorts did not reach statistical significance. Percentages of patients who improved in the CEA group were significantly higher with regard to Overall and Verbal IC scores, and at the limits of statistical significance in Performance IC. The differences of subject with improvement in SF-12 score in the two groups did not reach statistical significance. Ages below 68 were found to be determinant of a good outcome in Overall IC score. Limit: study conducted with a small sample size. CONCLUSIONS: Patients with severe carotid atherosclerosis who underwent CEA enhanced their cognitive performance.

The Burden of Depressive and Bipolar Disorders in Celiac Disease.

AIMS: to measure the association between Celiac Disease (CD) and affective disorders, particularly Bipolar Disorder (BD), since it has not been studied yet, and to measure how much the quality of life (QoL) of a person with CD is affected by comorbidity with these disorders. DESIGN: Case-control study. CASES: 60 consecutive patients with CD. CONTROLS: 240 subjects without CD, randomly selected after sex- and age-matching from a database of an epidemiological study. Psychiatric diagnoses according to DSM-IV carried out by physicians using structured interview tools (ANTAS-SCID). QoL was measured by means of SF-12. RESULTS: The lifetime prevalence of Major Depressive Disorder (MDD) was higher in CD than in controls (30.0% vs 8.3%, P<0.0001) as well as Panic Disorder (PD) (18.3% vs 5.4%, P<0.001) and BD (4.3% vs 0.4%, P<0.005). Patients with CD show a lower mean score than controls on SF12 (35.8±5.7 vs. 38.2±6.4; p=0.010), but those without comorbidity with MDD, PD and BD do not. The attributable burden of CD in worsening QoL - when comorbid with these disorders - was found comparable to that of serious chronic diseases like Wilson's Disease, and lower than Multiple Sclerosis only. CONCLUSION: MDD, PD and BD are strictly associated with CD. The comorbidity with these disorders is the key determinant of impaired quality of life in CD. Thus a preventive action on mood and anxiety disorders in patients suffering from CD is required. Moreover a screening for CD in people with affective disorders and showing key symptoms or family history of CD is recommended.

Integrating children with psychiatric disorders in the classroom: a systematic review.

BACKGROUND: The school setting may be the optimal context for early screening of and intervention on child mental health problems, because of its large reach and intertwinement with various participants (child, teacher, parent, other community services). But this setting also exposes children to the risk of stigma, peer rejection and social exclusion. This systematic literature review investigates the efficacy of mental health interventions addressed to children and adolescents in school settings, and it evaluates which programs explicitly take into account social inclusion indicators. METHOD: Only randomized controlled trials conducted on clinical populations of students and carried out in school settings were selected: 27 studies overall. Most studies applied group Cognitive Behavioural Therapy or Interpersonal Psychotherapy. RESULTS: Findings were suggestive of the effectiveness of school-based intervention programs in reducing symptoms of most mental disorders. Some evidence was found about the idea that effective studies on clinical populations may promote the social inclusion of children with an ongoing mental disorder and avoid the risk of being highly stigmatized. CONCLUSION: School programs are still needed that implement standardized models with verifiable and evidence-based practices involving the whole school community.