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Introduction: Longer treatment times, more comorbidity, more severe impairments in social, psychological, and emotional functioning, increased healthcare use, and more hospitalizations are all factors that are related to dysthymia. Given the significant prevalence of dysthymia (including persistent depressive disorder) worldwide, its comorbidity with several mental disorders, and the detrimental effects of these comorbidities, it is important to conduct a systematic review to compare the effects of pharmacological acute and maintenance treatments for dysthymia with placebo and standard care in the last 10 years, based on the publication of DSM5., Areas Covered: This systematic review was performed according to PRISMA guidelines. Databases, including PubMed and Cochrane Central Register of Controlled Trials, were searched to assess the effects of pharmacological acute and maintenance treatments for dysthymia in comparison with placebo and treatment as usual., Expert Opinion: Our review shows that SSRIs and SNRIs present efficacy for dysthymia treatment, and L-Acetylcarnitine should be investigated further for this condition in elderly patients. The comparison of antidepressant medication versus placebo showed coherent results based on three studies favoring pharmacotherapy as an effective treatment for participants with dysthymia. However, the scarcity of research on continuation and maintenance therapy in people with dysthymia highlights the need for more primary research.

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.

Background: Public beliefs about appropriate treatment impact, help-seeking and treatment adherence., Aim: To determine the recommendations of the Sardinian public for the treatment of depression., Methods: In 2012, a population-based survey was conducted by phone in Sardinia (N = 1,200). In the context of a fully structured interview, respondents were presented with a vignette depicting a case of depression. Subsequently, they were asked about their treatment recommendations. The results are contrasted with findings from a similar survey which had been conducted in Vienna 3 years before., Results: In Sardinia as in Vienna, psychotherapy was the uncontested favorite, while antidepressant medication was recommended by relatively few respondents. In Sardinia, there were also no marked differences between urban and rural areas with regard to these two treatments. However, between Sardinia and Vienna, as well as within Sardinia, great differences were found with regard to autogenic training and 'alternative' methods like homeopathic medicines and acupuncture., Conclusion: Cross-cultural comparisons may help better understand treatment preferences of the public. In Sardinia, as in Vienna, there seems to be a need for improving the public's knowledge about the appropriate treatment of depression., (© The Author(s) 2013.)

Objective: With the exception of bereavement, the diagnosis of major depressive disorder in the DSM-IV does not take into account the context in which the symptoms occur. Recent criticism has maintained that common sense suggests making a distinction between depression as mental disorder and sorrow as 'normal' reaction to social stress. This study sets out to investigate whether the public does in fact make this distinction., Method: In spring 2009, a population-based survey was conducted by phone in the city of Vienna (n = 1205). A fully structured interview was carried out which began with the presentation of a vignette describing a diagnostically unlabeled case of depression, with or without provision of information about preceding stressful life events., Results: Respondents presented with vignettes containing information on loss events were less likely to define depressive symptoms as indication of mental illness. They were also not as willing to recommend professional help. And if they were, they tended to less frequently recommend seeking help from someone with a medical background., Conclusion: In contrast to the conceptualization in the DSM-IV, the public tends to perceive depressive symptoms differently depending on the context in which they occur., (© 2011 John Wiley & Sons A/S.)

The clinical relevance of Recurrent Brief Depression (RBD) has not received sufficient attention to date and continues to represent a controversial issue. The present study was carried out in a community sample to evaluate the lifetime prevalence of RDB, the degree of comorbidity, as well as possible risk factors. Subjects from a community survey in Sardinia (Italy) were randomly selected from registers of a rural, an urban and a mining area (n=1040, 461 males, 579 females). Interviews were carried out by physicians using the Italian version of the Composite International Diagnostic Interview Simplified which had been modified for the purpose of this study. Lifetime prevalence of RBD was 7.6%; 5.8% in males, 9% in females. Subjects aged 18 to 24 years presented higher frequencies (13.8%, OR 2.2) than those aged 25 or over. Comorbidity with Major Depression was particularly frequent. RBD was furthermore associated with suicide attempts and substance abuse, thereby constituting an effective health problem. Further epidemiological and clinical studies of RBD are warranted in order to develop specific treatments and prevention strategies.

Objective: To evaluate the association between celiac disease and specific anxiety and depressive disorders and to identify potential common pathogenetic links, with particular regard to thyroid function and autoimmunity., Methods: Cases included 36 adult celiac patients, 25 females and 11 males, aged 18-64 years. Controls comprised 144 healthy subjects matched by sex and age with no clinical evidence or family history of celiac disease. Diagnosis of celiac disease was made on the basis of clinical history and serological criteria. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview, according to DSM-IV criteria. Thyroid was evaluated by palpation, echography and measurement of serum-free thyroid hormones (FT4, FT3), thyroid-stimulating hormone (TSH) and antithyroid autoantibodies (anti-TPO)., Results: Compared to controls, a significantly higher number of celiac patients met criteria for lifetime [15 (41.7%) versus 30 (29.8%), P < .01] and 6-month [7 (19.4%) versus 9 (6.2%), OR = 3.2, chi(2) = 5.2, P < .05] major depressive disorder (MDD) and lifetime [5 (13.9%) versus 3 (2.1%), P < .001] and 6-month [3 (8.1%) versus 2 (1.4%), P < .05] panic disorder (PD). Anti-TPO prevalence was significantly higher in celiac patients than in the control group (11/36 = 30.5% versus 14/144 = 9.7%, P < .001). A higher frequency of PD and MDD was found in celiac patients with positive anti-TPO when compared to negative anti-TPO patients (4/11 = 36.4% PD in TPO+ versus 1/25 = 4% PD in TPO-, P < .01; 9/11 = 81.8% MD in TPO+ versus 6/25 = 9.5% MD in TPO-, P < .01)., Conclusion: Patients affected by celiac disease tend to show a high prevalence of PD and MDD and association with subclinical thyroid disease appears to represent a significant risk factor for these psychiatric disorders., (Copyright 2002 Elsevier Science Inc.)

The subjective quality of life (QOL) (i.e. individual evaluation of one's life experiences) has been studied according to a series of different parameters such as resource availability, and sociodemographic and clinical variables, at times yielding contradictory results. Subjective quality of life and standard of life from a selected sample of 45 chronic out-patients (25 schizophrenics, and 20 patients with major depression) were evaluated by means of structured interviews. Statistical analysis revealed that subjective QOL was largely independent of standard of living (so long as basic needs were satisfied), diagnosis, and clinical course of illness, and only partly dependent on sociodemographic variables. No correlation was found between clinically evaluated symptoms (both psychotic and depressive) and subjective QOL. On the contrary, significant correlations were found between self-ratings of depression, depressive cognitive attitudes and subjective ratings of QOL.

The accuracy of the 14-item Italian version of the Dysfunctional Attitudes Scale (IDAS-14) as a screening tool for depression among elderly people is evaluated and compared with the BDI. Results for the IDAS-14 are most satisfactory, since high levels of both specificity (0.95) and sensitivity (0.89) may be obtained at a given cut-off score (56).

This study was carried out to evaluate the lifetime prevalence of brief recurrent depression (BRD) in a general population sample and related risk factors. Subjects (n = 493, 51.9% females, 48.1% males) randomly selected from electoral registers of an urban and a rural area in Sardinia were interviewed with the Italian version of the Composite International Diagnostic Interview Simplified, slightly modified for the purposes of the study. We found that BRD was not uncommon in the general population; the lifetime prevalence was 6.9%, without any statistical difference according to age and sex. A significantly higher risk was detected in separated/widowed/divorced people. Comorbidity with other psychiatric disorders was particularly frequent, in particular major depression. BRD was associated with a significant major risk for suicide attempts and alcohol dependence. These results (the frequency of BRD in the general population and its correlation with suicide risk and alcohol consumption) justify further epidemiological and clinical studies in order to develop specific treatment and prevention strategies.

Epidemiological data about depressive disorders emerging from European and North American community surveys are not easily comparable due to several methodological differences. Only in recent years have studies performed with the Composite International Diagnostic Interview (CIDI) supplied comparable data. They support the evidence of higher prevalence rates of major depression (DSM-IIIR criteria) in European than in US and Canadian community studies carried out in the 1980s. Moreover, a new nationwide USA survey, using CIDI, confirmed a higher frequency of depressive disorders compared to ECA results. This report is part of a survey ('Health in Sardinia') which involved five urban districts of Cagliari, three rural areas and the same mining district involved in a previous community study. The present data concern four of the five urban districts and one rural area. Subjects were clinically interviewed with the CIDI Simplified, in the Italian version. Diagnoses were made according to DSM-IIIR criteria. Our study seems to confirm the general trend toward higher prevalence rates of major depression (lifetime prevalence 13.3) shown in earlier community studies.

A total of 317 elderly subjects randomly selected among people living in the community in 1 urban and 2 rural areas were studied by means of a semistructured clinical interview, the Social Adjustment Scale, and the Beck Depression Inventory. An emerging trend was demonstrated towards a higher rate of prevalence of depression among females and urban residents. Widowhood, absence of a confidant, poor education and financial difficulties (only among urban elderly people) were significantly correlated with rates of depression. Physical impairments and diseases were also associated with depression, independently of whether subjects lived alone. The findings are discussed using a psychosocial frame of reference.