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Introduction: Cardiac surgery with cardiopulmonary bypass represents a severe source of stress and has been reported to be associated to the development of Posttraumatic Stress Disorder (PTSD). This disorder leads to a significant disability that might greatly decrease the benefits of surgery. Research rarely focused on the role of attachment styles in the development of PTSD, and no studies addressed this issue in patients undergoing cardiac surgery. Objectives: To assess the influence of attachment styles on the development of PTSD. Aims: The identification of specific personological traits predictive of the development of PTSD. Methods: Participants were recruited among patients scheduled for elective cardiac surgery with cardiopulmonary bypass and evaluated through [a)] Experiences in Close Relationships (ECR) [b)] Post-traumatic 10 Stress Symptom Inventory - Modified (PTSS-10) [c)] Perceived Stress Scale (PSS). Six months after surgery, participants were mailed the PTSS-10 and the PSS. Multiple logistic regression analysis was performed with PTSD as dependent variable, and attachment-related avoidance and anxiety, sex, age and perceived stress as independent variables. Results: One hundred twenty-one patients (94% of candidates for elective cardiac surgery who met study inclusion criteria) underwent surgery; 61(59%) were assessed after 6 months. Fourteen subjects (19.7%) scored ≥35 on the PTSS-10 at followup and were considered as having a probable diagnosis of PTSD. Attachment related avoidance at baseline predicted the development of PTSD at follow-up (p<0.017), after controlling for age, sex and perceived stress. Conclusions: Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery. [Copyright &y& Elsevier]

Introduction: First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals. Aim: The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder. Methods: One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records. Results: The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007). Conclusions: Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals. [Copyright &y& Elsevier]

Objective: There is considerable uncertainty about whether depression screening programs in primary care may improve outcomes and what specific features of such programs may contribute to success. We tested the effectiveness of a program involving substantial commitment from local mental health services.Methods: Prospective, randomised, patient- and evaluator-masked, parallel-group, controlled study. Participants were recruited in several urban primary care practices where they completed the PC-SAD screener and WHOQOL-Bref. Those who screened positive and did not report suicidal ideation (N=115) were randomised to an intervention group (communication of the result and offer of psychiatric evaluation and treatment free of charge; N=56) or a control group (no feedback on test result for 3 months; N=59). After 3 months, 100 patients agreed to a follow-up telephone interview including the administration of the PC-SAD5 and WHOQOL-Bref.Results: Depression severity and quality of life improved significantly in both groups. Intent-to-treat analysis showed no effect of the intervention. As only 37% of patients randomised to the intervention group actually contacted the study outpatient clinic, we performed a per-protocol analysis to determine whether the intervention, if delivered as planned, had been effective. This analysis revealed a significant positive effect of the intervention on severity of depressive symptoms, and on response and remission rate. Complier average causal effect analysis yielded similar results.Conclusion: Due to the relatively small sample size, our findings should be regarded as preliminary and have limited generalizability. They suggest that there are considerable barriers on the part of many patients to the implementation of depression screening programs in primary care. While such programs can be effective, they should be designed based on the understanding of patients' perspectives. [ABSTRACT FROM AUTHOR]

The aim of the study was to perform a dimensional assessment of subjective stress in the Municipal Police of the City of Rome. We assessed two random samples of 590 traffic police and 590 clerical police officers of both sexes for subjective stress through the administration of the ‘Rapid Stress-Assessment Scale’ (RSA), a self-rated tool; subjects completed the questionnaire during a non-working day. Subsequently, from each sample we randomly included two subsamples of 115 subjects each, to whom we administered the RSA at the beginning and at the end of their shift. Significant differences between traffic and clerical police officers were found in the RSA total score, which was higher among traffic agents. Traffic police officers were found significantly more often in the ‘high stress class’. Gender differences analysis showed higher scores among women. The analysis of the subsample of 230 persons showed a significantly greater degree of the RSA ‘depression’ cluster at the end of the shift only in traffic police officers. The assessment of over-the-counter drug use (NSAID, analgesics, etc.) showed that, among police officers habitually using such drugs, only the traffic police subgroup scored higher on the RSA. Our results could be taken to mean that the stress response of Municipal Police officers who work outdoors is more maladaptive than that of officers working in the office; this could be compatible with the existence of different occupational stressors between the two groups. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction The admission experience survey (AES) is a reliable tool for measuring perceived coercion in mental hospital admission. We developed the Italian AES through translation back-translation and administered it to acutely hospitalized psychiatric patients. Objectives/Aims To verify psychometric characteristics of the Italian AES. To Examine the AES factor structure. Methods n = 156 acutely hospitalized patients (48% women, 69% voluntary) were recruited in two university hospitals in Rome (Umberto I Policlinic, Sant’Andrea Hospital) and were administered the Italian AES. We conducted a principal component analysis (PCA) with equamax rotation. Results Socio-demographic and clinical characteristics of the sample are reported in Table 1. The Italian AES had good internal consistency (Cronbach's alpha = 0.90); Guttmann split-half reliability coefficient was 0.90. AES total score significantly differed between voluntary and involuntary patients (5.08 ± 4.1 vs. 8.1 ± 4.9, P < 0.05). PCA disclosed a three-factor solution explaining 59.3 of the variance. Significant correlations emerged between AES total score and clinical variables (Table 2). Pearson's correlation coefficient disclosed a significant correlation between perceived coercion and psychiatric symptoms severity (BPRS total score). Conclusions The Italian version of AES and proposed new factor structure proved reliable. [ABSTRACT FROM AUTHOR]

Introduction Despite the potential theoretical and clinical relevance of psychopathological dimensions in Obsessive-Compulsive Disorder (OCD), few studies to date have investigated their possible association with obsession subtypes. Objectives/Aims We aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes. Methods We consecutively recruited 57 first-visit DSM-V OCD patients (females = 66.7%; age range = 18–63 years) at the Psychiatric Outpatient Clinic of our University Hospital. These patients were affected by severe OCD, as shown by a median (1st quartile–3rd quartile) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 27.0 (23.0–32.5). We used the point-biserial coefficient ( r pbi ) to measure the correlation between psychopathological dimensions, as assessed with the Scale for the Rapid Assessment of Psychopathology (SVARAD), and obsession subtypes, as evaluated with the Y-BOCS. Results We found significant correlations ( P -values < 0.05) between: anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; apprehension/fear dimension and contamination, religious, and somatic obsessions; sadness/demoralization dimension and contamination and somatic obsessions; obsessiveness/iterativity dimension and all obsession subtypes; impulsivity dimension and aggressive and sexual obsessions; somatic concern/somatization dimension and contamination and somatic obsessions. We also found, by using the Mann-Whitney U -test, that OCD patients with comorbid Obsessive-Compulsive Personality Disorder–but not Schizotypal or Histrionic ones–showed higher levels ( P < 0.05) of obsessiveness/iterativity and anger/aggressiveness than OCD patients without the personality disorder. Conclusions Anger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD. [ABSTRACT FROM AUTHOR]

Objectives: To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental disorder, as compared to matched acute voluntary hospitalized patients (VHP). To evaluate the effect of psychopathology severity and cognitive dysfunction on decisional capacity. Methods: Cases were recruited among ICP at the Umberto I Hospital, ‘Sapienza’ University of Rome; controls were age- and sex-matched VHP, in the same ward and time period. Subjects were diagnosed according to DSM-IV-TR criteria and further evaluated through a) MacArthur Competence Assessment Tool for Treatment (MacCAT-T) b) Brief Psychiatric Rating Scale-24 (BPRS) c) Raven''s Colored Progressive Matrices (CPM) d) Mini Mental State Examination (MMSE). Results: Eighteen cases were enrolled (67% women), mean age was 25.1±2.8 years. There were no differences between groups in: diagnostic distribution (40% schizophrenic spectrum disorders, 40% mood disorders, 20% other diagnosis), disease duration, MMSE. ICP had higher BPRS total scores (mean difference ± S.D.= 10.3±19.4; [95% C.I.= 0.6 ÷ -20.0]), and performed worse than VHP in MacCAT-T comprehension (-1.0±1.3; [95% C.I.= -1.6 ÷ -0.3]), appreciation (-1,7±2.0; [95% C.I.= -3.0 ÷ -0.7]), reasoning (-2.1±2.9; [95% C.I.= -3.6 ÷ -0.7]) and expression of a choice (-0.8±1.0 [95% C.I.= -1.3 ÷ -0.3]). Competence to give informed consent was associated with psychopathological dimensions but not with MMSE and CPM scores, in the sample overall. Conclusion: Competence to consent to treatment was reduced in ICP compared to VHP. Involuntary commitment was not necessarily associated with incapability of making treatment decisions. [Copyright &y& Elsevier]

Background The prevalence of depressive disorders is high among patients with skin disease. The PC-SAD is a 37-item self-administered depression screening questionnaire that has been validated in dermatological patients. Objective The aim of this study was to develop and validate a brief depression severity instrument derived from the PC-SAD that can be used to assess severity and monitor ongoing clinical course. Methods Two patient samples participated in the study: 72 adult dermatological inpatients and 73 adults attending six primary care practices. Psychiatric assessment included the Structured Clinical Interview for DSM-IV and an 18-item version of the PC-SAD; moreover, dermatological patients completed the Patient Health Questionnaire depression scale (PHQ-9), while primary care patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS). A subset of five PC-SAD items showing the best psychometric properties were selected, and the reliability and validity of the resulting instrument (PC-SAD5) were examined. Results The PC-SAD5 showed satisfactory internal consistency in both samples. There was a high correlation between PC-SAD5 and PHQ-9 and MADRS scores. Multiple regression analysis revealed a gradient of PC-SAD5 scores from patients with no mental disorder, those with milder forms of depression, to those with Major Depressive Disorder. Similar results were observed for the 18-item version of the PC-SAD. Conclusion The availability of valid and reliable continuous measures of depression severity derived from the PC-SAD extends its field of application from depression screening to use as a follow-up measure of depression severity in routine clinical practice. A validated very short instrument such as the PC-SAD5 may have substantial clinical value. [ABSTRACT FROM AUTHOR]

We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A ( P = 0.0108 and P = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P = 0.016, and 23%, OR 0.18, P = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P = 0.047) and 12 months (OR 2.75, P = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM. [ABSTRACT FROM AUTHOR]

Objective – The aim of this study was to investigate the prevalence of alexithymia in a sample of patients with multiple sclerosis (MS) and to further evaluate the association between alexithymia and the occurrence of common disabling MS-related symptoms such as fatigue and depression. Methods – Fifty-eight relapsing–remitting MS patients treated with interferon (IFN)-beta-1a underwent a complete neurological evaluation, including Expanded Disability Status Scale score assessment. Alexithymia, depressive symptoms and fatigue were assessed using the 20-item Toronto Alexithymia Scale, Beck Depression Inventory and Fatigue Severity Scale. Results – Prevalence of alexithymia was 13.8%, with 27.6% of patients presenting borderline alexithymia. Sixty-seven per cent of the patients complained of fatigue while 29.3% of them were depressed. Higher levels of fatigue and depression were found in alexithymic patients when compared with non-alexithymic patients. Results from logistic regressions showed that alexithymia significantly contributes to the severity of fatigue and depression. Conclusions – Alexithymia was associated with increased severity of fatigue and depression. [ABSTRACT FROM AUTHOR]

Introduction: Studies indicate that war-affected and displaced groups, compared to local non-refugee populations, suffer variable but generally higher rates of stress-related somatic symptoms. The relation between traumatic events and somatization is poorly explored. Objectives: To assess the impact of trauma on somatic symptoms in forced migrants recently hosted in Italy. Methods: First generation asylum seekers/refugees of age over 18 referred to Umberto I Hospital, Rome, for a routine infectivologic screening were consecutively enrolled. The following tools were administered: Somatic Symptom Scale 8 (SSS-8), Life Events Check List (LEC-5), and Stress-related Vulnerability Scale (SVS). Results: Eighty-five subjects participated to the study (males=80 (94.1%); mean age= 28.3 SD=7.4). Fifty-eight (68%) participants reported at least one clinically significant somatic symptom and all reported at least one severe traumatic event in the LEC-5. Pearson Correlation Coefficients of SSS-8 total score with respect to LEC-5 and SVS lack of Social Support Subscale score were r=0,327 (p=0.003), r=0.529 (p=0.0001). A stepwise linear regression confirmed that LEC-5 total score (Beta standardized correlation coefficient = 0.151; p = 0.027) and SVS lack of Social Support Subscale (Beta standardized correlation coefficient = -0.309; p = 0.010) were significant predictors of SSS-8 total score. Conclusions: High levels of somatization were associated to the number of lifetime traumatic events and to perceived lack of social support in forced migrants. It is important to correctly recognize somatic symptoms in traumatized forced migrants. [ABSTRACT FROM AUTHOR]