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Objective: Current nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL)., Methods: Community survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL., Results: In the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5-2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9-24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00., Conclusion: One out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.

Background: Generalized anxiety disorder (GAD) is one of the most reported diagnoses in psychiatry, but there is some discrepancy between the cases identified in community studies and those identified in tertiary care. This study set out to evaluate whether the use of clinicians as interviewers may provide estimates in a community survey close to those observed in primary or specialized care., Methods: This is a community survey on a randomly selected sample of 2338 adult subjects. The Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) was administered by clinicians, providing lifetime diagnosis based on the DSM-IV-TR. Health-related quality of life (HR-QoL) was measured with the Short-Form Health Survey (SF-12)., Results: Overall, 55 (2.3%) subjects met the criteria for GAD, with greater prevalence in women (3.6%) than in men (0.9%): OR = 4.02; 95%CI: 1.96-8.26. Up to 40% of those with GAD had at least another diagnosis of mood, anxiety, or eating disorders. The mean score of SF-12 in people with GAD was 32.33 ± 6.8, with a higher attributable burden than in other conditions except for major depressive disorder., Conclusions: We found a relatively lower lifetime prevalence of GAD than in community surveys based on lay interviewers and a structured interview. The identified cases of GAD showed a strong impact on the quality of life regardless of co-morbidity and high risk in women, suggesting a profile similar to the one identified from studies in primary and specialized care.

Background: The impact of the comorbidity between Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder Spectrum (BDS) remains to be clarified. The objective of this study was to examine the lifetime prevalence of OCD, the strength of the association of OCD with comorbid BDS and the role of comorbidity of OCD with BDS in the impairment of health-related quality of life (HRQoL) in an Italian community survey. Methods: The study is a community survey. The sample ( N = 2,267; women: 55.3%) was randomly selected after stratification by sex and four age groups from the municipal records of the adult population of one urban, one suburban, and at least one rural area in six Italian regions. Physicians using a semi-structured interview (Advanced Tools and Neuropsychiatric Assessment Schedule, ANTAS-SCID) made Diagnostic and Statistical Manual of Mental Disorders - 4th revision (DSM-IV) diagnoses of OCD, Major Depressive Disorder (MDD) and Bipolar Disorder (BD). HR-QoL was measured by the Health Survey Short Form (SF-12). Lifetime Hypomania and subthreshold hypomania were screened by the Mood Disorder Questionnaire (MDQ). BDS was defined as the sum of people shown to be positive for hypomania by the MDQ-with or without a mood disorder diagnosis-plus people with a BD-DSMIV diagnosis even if negative for hypomania at the MDQ. Results: Overall, 44 subjects were diagnosed with OCD, 6 with MDD and 1 with BD. The lifetime prevalence of OCD was 1.8% in men ( n = 18) and 2.0% in women ( n = 26). MDD with lifetime subthreshold hypomania (i.e., people screened positive at the MDQ, even without diagnosed mania or hypomania at the interview) was associated with OCD (OR = 18.15, CI 95% 2.45-103.67); MDD without subthreshold hypomania (and screened negative at the MDQ) was not (OR = 2.33, CI 95% 0.69-7.01). People with BDS were strongly associated with OCD (OR = 10.5, CI 95% 4.90-12.16,). People with OCD and BDS showed significantly poorer HR-QoL than people with OCD without BDS ( F = 9.492; P < 0.003). Discussion: The study found a strong association between BDS and OCD. BDS comorbid with OCD was associated with more severe impairment of HR-QoL than OCD without comorbid BDS. Identification of symptoms of hypomania, including subthreshold symptoms, may therefore be important in people with OCD as they might predict a course with poorer HR-QoL., (Copyright © 2020 Carta, Fineberg, Moro, Preti, Romano, Balestrieri, Caraci, Dell'Osso, Disciascio, Drago, Hardoy, Roncone, Minerba, Faravelli and Angst.)

Introduction: The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL)., Methods: Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ)., Results: Lifetime prevalence of PTSD in women was 1.3%, (1.4% in<45 years aged, 1.3% in >44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson's Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD., Conclusion: The attributable burden in worsening women' perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson's Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.

Introduction: The study aimed to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews shows lifetime prevalence rates of Specific Phobia (SP) similar to those found by surveys carried out by lay interviewers and if the high level of impairment found in SP may be confirmed., Methods: This is a community survey on an Italian nationwide sample randomly selected from registers of municipalities. Tools: semi-structured ANTAS psychiatric interview derived from the SCID-DSM-IV, carried out by clinicians (psychologists or physicians); Short Form Health Survey (SF-12) as a measure of Quality of Life (QoL). Analyses: means of the χ 2 test odds ratios were adopted to test several associations regarding SP prevalence. One-way ANOVA was used to compare different groups on attributable burden due to SP and/or other disorders in worsening QoL., Results: The lifetime prevalence of SP was 2.3%. No difference was found by age class. Females showed more than twice the frequency of males ( p <0.0001). The disorders showing the closest association with SP were: social phobia (OR=17.53); general anxiety disorder (OR=11.57); anorexia (OR=11.13) and agoraphobia (OR=10.03), but also obsessive compulsive disorders (OR=8.8), eating disorders (OR=7.2), panic disorder (OR=5.9), post-traumatic stress disorder (OR=5.8), and major depressive disorder (OR=4.8) presented an association that achieved statistical significance. The QoL of people with SP and at least one disorder of anxiety, mood or eating in comorbidity, measured as a score at SF12, was worse than controls without SP ( p <0.001) but that of people with SP without co-morbidity was not ( p = 0.809)., Conclusion: An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP, at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.

Introduction/objective: The aim was to measure the lifetime prevalence of panic disorder (PD) in an Italian community sample, and to estimate the burden attributable to PD in compromising the quality of life (QoL) of people diagnosed with it., Methods: Community survey was conducted on a sample of 4,999 randomly selected adult subjects. Instruments used were semi-structured clinical interview Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians and allowing diagnosis according to Diagnostic and Statistical Manual of Mental Disorder (4th ed.; DSM-IV); Short Form Health Survey (SF-12)., Results: The lifetime prevalence of PD was 3.6% (4.4% in females, 2.5% in males; p = .002). People with PD had a lower SF-12 score than the standardized community sample (35.5 ± 6.5 vs. 38.4 ± 5.9; p < .0001) with a mean difference (attributable burden) of 2.9 ± 0.7, that is, lower than PD with agoraphobia (AP; 4.2 ± 2.4). Wilson Disease (WD), Multiple Sclerosis, Major Depressive Disorder and Eating Disorders (ED) show a higher attributable burden in impaired QoL than PD, while the attributable burden of PD with AP is not lower than in ED and WD., Conclusions: The burden attributable to the impairment of QoL following a lifetime diagnosis of PD was found to be not so great compared to the impairment caused by Major Depressive Disorder (MDD) or neurological conditions. The comorbidity of PD with AP worsens QoL significantly., (© The Author(s) 2015.)

Objective: It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis)., Method: Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions., Tools: MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians., Results: Positives at MDQ show worsening QoL with an attributable burden of 2.8 ± 1.8 lower than in MDD (5.6 ± 3.6, p < 0.001) or Eating Disorders (4.4 ± 6.6, p < 0.03) and similar to Panic Disorder (2.9 ± 0.9, p = 0.44). The burden is lower in the middle-aged (25-59 years) than in the young (18-24) (4.65 ± 4.5 vs 2.58 ± 2.0, p=0.007) or in the elderly (≥60) (4.12 ± 3.2; p = 0.024). In the elderly the burden is independent from comorbid psychiatric disorders., Limitations: This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only., Conclusions: The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is "subthreshold" to the psychiatric diagnosis, and relevant for public health., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The prevalence of eating disorders (ED) in the community is still under debate, as well as the measure of their impact on the well-being of individuals. It was decided to evaluate the prevalence of eating disorders in an Italian community sample as well as to measure the burden of the quality of life of people and to compare it to those attributable to other chronic illnesses. A community survey of 4,999 people using a questionnaire on health services utilization, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), a semi-structured clinical interview derived from the non-patient version of the DSM-IV (SCID/NP) and Short Form Health Survey (SF-12) was conducted. A total of 3,398 individuals were interviewed (68% of those recruited). Lifetime prevalence for overall ED was 1.7%; for anorexia 0.7%; for bulimia 0.6% and for binge eating disorder 0.5%. ED was more frequent in women than in men. No cases of anorexia in men were identified. ED showed an attributable burden in impairing quality of life with no statistically significant differences with those due to major depressive disorder, bipolar spectrum disorders and Wilson's disease. Of the pathological conditions considered, only multiple sclerosis showed a worsening attributable burden. ED thus has a non-negligible frequency in Italy, with severe impact on quality of life comparable to that produced by severe chronic psychiatric and general medical conditions. These elements emphasize that ED is a serious public health issue.

Background: The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied., Methods: The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model., Results: The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability., Limitations: Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations., Conclusions: Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences., (© 2013 Elsevier B.V. All rights reserved.)

Background: Depressive syndromes, including recurrent brief depression (RBD), have frequently been observed in association with chronic diseases characterized by immune activation, such as autoimmune thyroiditis or celiac disease. However, the association of RBD with chronic hepatitis C (CHC), a disease with an increased incidence of major depressive disorders, is unknown., Cases: 135 (83 males, 52 females) consecutive treatment-naïve patients with CHC., Exclusion Criteria: previous treatment with IFN-alpha, co-infection with hepatitis C virus (HCV) and hepatitis B virus, infection with human immunodeficiency virus (HIV), drug or alcohol abuse, or malignancy., Controls: 540 (332 males, 208 females) subjects without evidence of hepatitis, randomly extracted from the database of a previous epidemiological study. The psychiatric diagnosis was based on the Composite International Diagnostic Interview Simplified (CIDI-S), containing a specific section on RBD., Results: A significantly higher rate of RBD was observed among both male and female patients with CHC (n=21, 15.5%) as compared to controls (n=34, 6.3%) (OR=2.6, CI 95% from 1.37 to 4.93)., Conclusion: The present study provides the first evidence of an association between CHC and RBD, independent of treatment with IFN-alpha and not influenced by substance or alcohol abuse. The results are similar to those found in other conditions with immune activation. RBD may be another expression of mood disorders in such conditions., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: The purpose of this population-based study is to examine the association between subjective quality of life and rural/urban residence in six Italian regions, including age and gender into the analysis., Study Design: community survey., Study Population: Samples stratified according to sex and age, drawn from municipal records., Sample Size: 4999 people 18 years and older, from seven communities within six regions of Italy., Tools: Ad-hoc form to assess basic demographic data; SF-12. Interviewers were trained psychologists or medical doctors., Results: 3398 subjects were interviewed (68% of recruited sample). The mean score of SF-12 in the overall sample was 38.4±6.1, SF-12 was higher in men than in in women (38.4±6.1 vs 37.5±5.9 F=99.18, df 1, 3396, 3397, p<0.0001); SF-12 score decreased from the youngest to the oldest age group, with significant differences between all ages groups; men showed higher scores in all age groups. The urban/rural difference of mean scores of SF-12 did not achieve statistical significance in women. Young men with urban residence had higher SF-12 scores than their counterparts with rural residence. Maen aged 65 years and older with rural residence showed, by contrast, higher scores than men from the same age group with urban residence., Conclusions: Men show a higher subjective quality of life than women. Subjective quality of life decreases with age in both genders.Men are more sensitive to urban/rural residence than women.Young men live better in cities, elderly men better in rural areas.

Background: To determine the use of antidepressants (ADs) in people with sub-threshold depression (SD); the lifetime prevalence of mania and hypomania in SD and the link between ADs use, bipolarity and anxiety disorders in SD., Study Design: community survey., Study Population: samples randomly drawn, after stratification from the adult population of municipal records., Sample Size: 4999 people from seven areas within six Italian regions. Tools: Questionnaire on psychotropic drug consumption, prescription; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Hamilton Depression Rating Scale (HAM-D); Mood Disorder Questionnaire (MDQ); Short Form Health Survey (SF-12). SD definition: HAM-D > 10 without lifetime diagnosis of Depressive Episode (DE)., Results: SD point prevalence is 5.0%. The lifetime prevalence of mania and hypomania episodes in SD is 7.3%. Benzodiazepines (BDZ) consumption in SD is 24.1%, followed by ADs (19.7%). In SD, positive for MDQ and comorbidity with Panic Disorder (PD) or Generalized Anxiety Disorders (GAD) are associated with ADs use, whereas the association between a positive MDQ and ADs use, without a diagnosis of PD or GAD, is not significant. Only in people with DE the well-being (SF-12) is higher among those using first-line antidepressants compared to those not using any medication. In people with SD no significant differences were found in terms of SF-12 score according to drug use., Conclusions: This study suggests caution in prescribing ADs to people with SD. In people with concomitant anxiety disorders and SD, it should be mandatory to perform a well-designed assessment and evaluate the presence of previous manic or hypomanic symptoms prior to prescribing ADs.

Background: This study aims to evaluate relationship between three different clinical conditions: Major Depressive Disorders (MDD), Hashimoto Thyroiditis (HT) and reduction in regional Cerebral Blood Flow (rCBF) in order to explore the possibility that patients with HT and MDD have specific pattern(s) of cerebral perfusion., Design: Analysis of data derived from two separate data banks., Sample: 54 subjects, 32 with HT (29 women, mean age 38.8 ± 13.9); 22 without HT (19 women, mean age 36.5 ± 12.25)., Assessment: Psychiatric diagnosis was carried out by Simplified Composite International Diagnostic Interview (CIDIS) using DSM-IV categories; cerebral perfusion was measured by (99 m)Tc-ECD SPECT. Statistical analysis was done through logistic regression., Results: MDD appears to be associated with left frontal hypoperfusion, left temporal hypoperfusion, diffuse hypoperfusion and parietal perfusion asymmetry. A statistically significant association between parietal perfusion asymmetry and MDD was found only in the HT group., Conclusion: In HT, MDD is characterized by a parietal flow asymmetry. However, the specificity of rCBF in MDD with HT should be confirmed in a control sample with consideration for other health conditions. Moreover, this should be investigated with a longitudinally designed study in order to determine a possible pathogenic cause. Future studies with a much larger sample size should clarify whether a particular perfusion pattern is associated with a specific course or symptom cluster of MDD.

The present study is aimed at evaluating the efficacy of an introductory mini tennis programme as a therapeutic aid in the psychosocial rehabilitation of participants affected by mild/moderate intellectual disability in semi-residential care.Two groups (N=12) of participants diagnosed with intellectual disability, one of which followed the mini tennis rehabilitation programme, were compared at time t0, t1 (after 2 months) and t2 (after 6 months).Psychopathological status was assessed by means of the Italian version of the Assessment and Information Rating Profile (AIRP). Motor coordination, lateral dominance and body scheme were assessed by means of structured tools.Psychopathological total scores showed a statistically significant decrease in the experimental group in comparison with the control group. A statistical decrease in the group with the mini tennis rehabilitation programme was found also in the anxiety sub-scale while the sub-scales schizophrenia, depression, adjustment disorder, personality problems, somatoform disorders and psychosexual disorders did not reach any statistical difference between groups.A statistically significant increase in the visuo manual coordination was highlighted in the experimental versus the control group. No statistically significant differences were reported with regard to general movement skills, dynamic balance and coordination.In spite of the limitations of this study, the results obtained are encouraging and suggest the potential efficacy of mini tennis as an auxiliary aid in rehabilitation programmes, particularly to improve visuo manual coordination skills and to boost the patient/participants' self esteem. These findings warrant confirmation by further research studies.

Background: The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs., Objectives: To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians., Study Design: community survey., Study Population: samples randomly drawn, after stratification from the adult population of municipal records., Sample Size: 4.999 people were drawn in 7 centres of 6 Italian regions., Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors., Results: 3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs., Conclusions: Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.

The topic of early response to antidepressant treatment has been extensively studied in major depressive disorder (MDD). We serendipitous observed an increase tolerability, a rapid response to therapy and an early onset of antidepressant fluvoxamine activity when associated with amisulpride in patients with major depressive disorder. The purpose of this study was to investigate our preliminary observations.

Background: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments., Methods: the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED., Results: After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies., Conclusion: AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.

Objectives: Females with a lifetime diagnosis of major mood disorder (Bipolar Disorder BD, Major Depressive Disorder MMD) investigated during the luteal phase of their menstrual cycle and in a condition of clinical well-being showed higher blood serum concentrations of progesterone and allopregnanolone compared to healthy controls. Women with BD presented even higher levels than those affected by MDD. This study attempted to verify, in line with a dimensional approach, if the possible differences in neurohormonal levels may be directly linked to some syndromal clusters (dimensions) of the mood spectrum disorders indipendently of diagnosis., Methods: Premenstrual concentrations of allopregnanolone, THDOC, progesterone, and cortisol were measured in 3 groups of women: 17 BD and 14 MDD outpatients, and 16 control subjects. Psychiatric evaluation was performed with the SCID-I interview and the SCI-MOODS-SR questionnaire. The correlation between steroid levels and mood disorder syndromal cluster (SCI-MOODS-SR domains and sub-domains) was evaluated by means of analysis of main components with Varimax rotation and Kaiser's normalization (which provided for inclusion of all components with an Eigen value >1)., Results: Analysis of the main components evidenced the presence of 3 components: 1) mania, 2) depression both with mixed component 3) steroid + manic cognitivity and suicidal ideas., Conclusion: Levels of allopregnanolone and progesterone do not correlate with the association of the depressive and manic syndromes, but rather with mixed symptomatological aspects, and in particular with cognitive manic and depressive (with suicidal thoughts) dimensions. Further studies should be carried out to confirm these findings.

Background: The aim of the study was to compare the change in quality of life over 32 weeks in depressed women assuming antidepressant drug with (experimental group) or without (control group) physical exercise from a study which results on objective dimension of outcome were already published., Methods: Trial with randomized naturalistic control. Patients selected from the clinical activity registries of a Psychiatric University Unit., Inclusion Criteria: female, between 40 and 60 years, diagnosis of Major Depressive Disorders (MMD, DSM-IV TR) resistant to ongoing treatment., Exclusion Criteria: diagnosis of psychotic disorders; any contraindications to physical activity. 30 patients (71.4% of the eligible) participated to the study., Cases: 10 randomized patients undergoing pharmacological treatment plus physical activity., Controls: 20 patients undergoing only pharmacological therapy. Quality of life was measured by means of WHOQOL-Bref., Results: The patients that made physical activity had their WHOQOL-Bref physical score improved from T0 to T8, the differences was statistically significant. In the control group WHOQOL-Bref physical remains the same and, consequentially, the difference between T0 and T8 do not reach any statistical significance.The perceived quality of life in the other domains did not change during the treatment in both groups. Thus no other differences were found between and within groups., Discussion and Conclusion: The data presented in the previous paper found that physical activity seems a good adjunctive treatment in the long term management of patients with MDD. These new data indicated that physical activity may also improve the perceived physical quality of life. The dimensions related with social functioning, environment and psychical well being seem do not improved, unexpectedly, during the trial. Two objective dimension not strictly related to the depressive symptoms improved: social functioning and Clinical Global Impression, this discrepancy with a subjective and objective dimension of the well being may supported the Goldberg point of view that subjective quality of life in bipolar and unipolar severe depression patients may not accurately reflect objective functional outcome status, potentially due to diminished insight, demoralization, or altered life expectations over time. It may be that physical activity improve the self perception of physical well being. The physical domains of WHOQOL-Bref inquiry about conditions as sleep, pain, energy, body satisfaction that seems frequently problematic also in remission due to the pharmacotherapy and may be risk factor for relapse/recurrence. Thus physical therapy seems to determinate improvement in depressive aspects not frequently responsive to the drug treatment.

Background: Depressive episodes in elderly patients with cerebrovascular damage are characterized by poor responses to standard antidepressants. Recent reports have suggested that the atypical antipsychotic, quetiapine may have antidepressant properties and, in mice, may prevents memory impairment and hippocampus neurodegeneration induced by global cerebral ischemia., Objective: To evaluate the efficacy of combination therapy with quetiapine in depressed elderly patients with cerebrovascular damage., Methods: An open-label, 6-month follow-up study of patients with major depressive disorder (DSM-IV) and cerebral abnormalities (assessed by MRI) without severe cognitive impairment. Patients who had not responded to standard antidepressants (months of treatment 6.5 +/- 7.2) additionally received quetiapine (300 +/- 111 mg/d). Patients were evaluated at baseline (t0) and Months 1, 3, and 6 (t1, t3, t6) using the Clinical Global Impressions Scale for Severity (CGI-S) and the Hamilton Depression Rating Scale (HAM-D)., Results: Nine patients were included in the study, with a mean age of 72.8 +/- 9.4 years. CGI-S scores decreased from baseline to Month 6: 5.8 +/- 0.7 (t0), 5.4 +/- 0.7 (t1), 5.0 +/- 0.8 (t3), and 4.5 +/- 1.0 (t6), with a significant improvement at 6 months compared with baseline (P = 0.006). A significant improvement over the 6-month period was also observed with HAM-D scores (t0 = 27.2 +/- 4.0, t6 = 14.8 +/- 3.8, P < 0.001)., Conclusion: In this study, quetiapine was efficacious as combination therapy in depressed elderly patients with cerebrovascular damage. The promising results from this study warrant confirmation in large, randomized, double-blind, placebo-controlled studies.

Background: Mood and anxiety symptoms in chronic hepatitis C (CHC) may be related to the patient awareness of the diagnosis and prognosis, to side effects induced by interferon (IFN)-alpha treatment, as well as to substance abuse. However, the observation of metabolic alterations in patients with CHC has led to hypothesize a direct effect of hepatitis C virus (HCV) on brain function. This study was aimed at elucidating whether CHC is associated with specific anxiety or mood disorders independently of confounding factors., Methods: Patient cohort: consecutive patients, 135 with CHC and 76 with chronic hepatitis B (CHB)., Exclusion Criteria: previous treatment with IFN-alpha, co-infection with HCV and hepatitis B virus, infection with human immunodeficiency virus, drug or alcohol abuse, or malignancies., Controls: subjects without evidence of hepatitis randomly extracted from the database of a previous epidemiological study; they were divided into two groups of 540 (332 males) and 304 (220 males) as controls for patients with CHC and CHB, respectively. The psychiatric diagnosis was formulated by means of the Composite International Diagnostic Interview Simplified carried out by a physician according to DSM-IV criteria., Results: A higher lifetime prevalence of major depressive disorder (MDD) was observed among CHC compared to CHB or controls. The risk of MDD was not statistically different between CHB and controls. Both the CHC and CHB groups showed a significantly higher frequency of panic disorder when compared to controls. No statistical differences were observed in the prevalence of general anxiety disorder and social phobia when CHC or CHB were compared to controls., Conclusion: The present study provides the first evidence of an association between CHC and MDD, diagnosed on the basis of well-defined international criteria. This association is independent of treatment with IFN-alpha and is not influenced by substance or alcohol abuse. By contrast, anxiety disorders do not appear to be specifically associated with CHC.

Objective: To assess the long-term response to add-on quetiapine therapy in patients with bipolar I disorder who were not adequately responding to standard medications., Methods: Outpatients with bipolar I disorder (DSM-IV-TR) responding inadequately to standard treatment were observed before and after the addition of quetiapine. Symptom severity was evaluated using the Clinical Global Impressions scale for Bipolar Disorder (CGI-BP) each month. Relapses included hospitalization, treatment in a day hospital or clinic, scores >/= 1 point higher than previous CGI-BP scores and/or upward titration of quetiapine or other medications., Results: Sixty-one patients (age range of 18-68 years) were observed prospectively for an average of 7.5 months (range 3-18 months) prior to addition of quetiapine and subsequently followed for an average of 15.7 months (range 6-42 months). The final mean quetiapine dose was 537.1 +/- 91.7 mg/d. Prior to quetiapine addition, an annual relapse rate of 2.09 episodes was recorded, relating to 0.94 depressive and 1.15 manic or mixed episodes. Following quetiapine addition, annual relapse rates were reduced to 0.61 episodes, representing 0.14 depressive and 0.46 manic or mixed episodes. Compared with the period of add-on quetiapine treatment, the relative risk of relapse prior to quetiapine therapy was 3.4 for all episodes (chi2 = 24.8, P < 0.001), 6.7 for depressive episodes (chi2 = 24.7, P < 0.001), and 2.5 for manic or mixed episodes (chi2 = 9.0, P < 0.05)., Conclusion: This naturalistic follow-up study provides preliminary evidence for the efficacy of long-term add-on quetiapine treatment in the prevention of relapses of manic or mixed and depressive episodes of bipolar I disorder, and particularly in the prevention of depressive episodes.

Background: No controlled trials have evaluated the long term efficacy of exercise activity to improve the treatment of patients with Major Depressive Disorders. The aim of the present study was to confirm the efficacy of the adjunctive physical activity in the treatment of major depressive disorders, with a long term follow up (8 months)., Methods: Trial with randomized naturalistic control. Patients selected from the clinical activity registries of the Psychiatric Unit of the University of Cagliari, Italy., Inclusion Criteria: female, between 40 and 60 years, diagnosis of Major Depressive Disorders (DSM-IV TR) resistant to the ongoing treatment., Exclusion Criteria: diagnosis of psychotic disorders; any contraindications to physical activity.30 patients (71.4% of the eligible) participated to the study., Cases: 10 randomized patients undergoing pharmacological treatment plus physical activity., Controls: 20 patients undergoing only pharmacological therapy.The following tools were collected from each patient by two different psychiatric physicians at baseline and 8 month after the beginning of exercise program: SCID-I, HAM-D, CGI (Clinical Global Impression), GAF., Results: The patients that made physical activity had their HAM-D, GAF and CGI score improved from T0 to T8, all differences were statistically significant. In the control group HAM-D, GAF and CGI scores do not show any statistically significant differences between T0 and T8., Limits: Small sample size limited to female in adult age; control group was not subject to any structured rehabilitation activity or placebo so it was impossible to evaluate if the improvement was due to a non specific therapeutic effect associated with taking part in a social activity., Conclusion: Physical activity seems a good adjunctive treatment in the long term management of patients with MDD. Randomized placebo controlled trials are needed to confirm the results.

Background: Mood disorders were found associated with fibromyalgia (FM) and clinical studies have revealed the efficacy of antidepressant drugs in the treatment of FM. However no specific instruments to identify manic symptoms were used., Objectives: To assess the frequency of anxiety and mood disorders (particularly bipolar disorders and manic symptoms) in a consecutive sample of women affected by FM using standardized diagnostic tools and to compare the prevalence of these disorders with that observed in a sample of healthy controls from the general population., Cases: consecutive series of women (N = 37, mean age 50.1 +/- 21.0) attending a Rheumatology outpatient Unit at the University of Cagliari., Controls: 148 women, drawn from the data bank of an epidemiological study matched for sex and age with controls according to a randomisation "after blocks" method. The Italian version of the Composite International Diagnostic Interview Simplified were carried out by physicians. Psychiatric diagnosis was formulated according to DSM-IV criteria. The Italian version of the Mood Disorder Questionnaire (MDQ) was administered to identify manic symptoms and bipolar disorders. Diagnosis of FM were carried out by rheumatologist according to the criteria of American College of Rheumatology., Results: Subjects with FM showed a higher comorbidity with Generalised Anxiety Disorder, Panic Disorder and Major Depressive Disorder than controls. The study showed a high frequency of manic symptoms (MDQ positive) in the sample of fibromyalgic patients (59%), approximately double that found in the control sample (P < 0.001)., Discussion: Clinical studies have shown the efficacy of antidepressants, especially tricyclic antidepressants, in the treatment of FM. The clinical difficulty in identifying hypomanic episodes is well known particularly where previous and not present episodes are concerned as in depressive patients. These data would suggest further studies on the subject are needed and more caution also in prescribing antidepressants in a population apparently at high risk for bipolar disorders.

Background: Atypical antipsychotics are widely used in the treatment of bipolar disorders. Amisulpride is an atypical antipsychotic that has been proven to be effective in treatment of schizophrenia, major depressive disorder and, more recently, acute mania. At the moment, however, no study has assessed the effectiveness of this compound in maintenance therapy of bipolar disorders. The purpose of this study was to assess the long-term effectiveness of amisulpride in combination with standard treatments in patients with bipolar I disorder who have shown inadequate responses to ongoing standard therapies., Methods: The study enrolled fourteen bipolar I outpatients, not responding to ongoing standard therapy. Three patients discontinued treatment but 11 were followed-up for 11.7 +/- 8.2 months before (range 3-24 months) and 5.2 +/- 2.7 months after the introduction of amisulpride (range 3-9 months). Relapse rates before and during treatment with amisulpride were calculated in accordance to an increase of 1 or more in Clinical Global Impressions Scale-Bipolar Version (CGI-BP) score that was accompanied by a change in therapy or to an exacerbation of the symptoms that required hospitalization., Results: A statistically significant decrease in overall relapse rate was observed during the period of amisulpride therapy compared with months previous to the introduction of amisulpride. The relative risk of relapse in the absence of amisulpride therapy was 3.1 (chi2 = 4.2, P < 0.05). Similarly, the rates of manic/mixed and depressive relapse were decreased but only manic episodes reached statistical significance (RR = 5.3, chi2 = 5.2, P < 0.02)., Discussion and Conclusion: This open-label study suggests that long-term therapy with amisulpride may benefit patients by improving global symptoms of bipolar disorder and reducing the rate of manic/mixed relapses. Large, randomized, double-blind, placebo-controlled studies are needed to explore the benefits of adding long-term amisulpride to standard therapies for bipolar disorder.

Changes in the plasma concentrations of neuroactive steroids have been associated with various neuropsychiatric disorders. However, the possible role of neuroactive steroids in bipolar disorder (BD) has remained unknown. We therefore determined the plasma levels of neuroactive steroids during the luteal phase of the menstrual cycle in women with BD or major depressive disorder (MDD). The plasma concentrations of 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-THPROG), 3alpha,21-dihydroxy-5alpha-pregnan-20-one, progesterone, and cortisol were determined in 17 outpatients with BD, 14 outpatients with MDD, and 16 healthy control subjects. All patients were in a state of well-being and without relapse or recurrence for at least 3 months. Plasma concentrations of progesterone and 3alpha,5alpha-THPROG were significantly greater in patients than in controls, also being higher in BD patients than in MDD patients. Drug-free patients with BD or MDD showed similar differences in steroid concentrations relative to controls, as did drug-treated patients. Comorbidity with panic disorder, obsessive-compulsive disorder, or eating disorder had no effect on the association of mood disorders with steroid concentrations. Women with BD or MDD in a state of well-being showed higher plasma concentrations of progesterone and 3alpha,5alpha-THPROG in the luteal phase than did healthy controls. These differences did not seem to be attributable simply to drug treatment or to comorbidity with other psychiatric conditions in the patients.

Background/objective: To compare the frequency of ICD-10 depressive episodes in a community sample of Sardinian immigrants in Argentina and a community sample of Sardinian residents in Sardinia, Italy., Method: A search of telephone directories provided all subscribers with Sardinian surnames in the Argentinean area involved. A 75.8% of all subjects thus identified took part in the study (n = 210). The characteristics of randomisation methods used to identify the community sample in Sardinia (n = 1040) have already been published elsewhere. All subjects were interviewed using the Composite International Diagnostic Interview Simplified., Results: A higher frequency of depressive disorders was observed among the Sardinian immigrants in Argentina (26.7 vs. 13.5%, P < 0.0001). Females in particular showed a higher risk with respect to the Sardinian sample resident in Sardinia., Discussion: On comparison of the present findings with the lifetime rate of depressive episodes in Sardinian immigrants in Paris (France), reported in a previous research study, a lower prevalence was observed among the latter group than in Sardinian immigrants in Argentina but the young male immigrants in Paris were at risk., Conclusion: The results obtained seem to suggest that emigration to a country where economic conditions have since dramatically changed may predispose subjects to depressive disorders, particularly when compared to the percentage of affected subjects in their native population and among subjects who had emigrated to more economically stable countries. Further epidemiological studies are warranted in order to confirm the present results and to clarify the determinants of the major risk for females in such a condition.

Background: The study measured the accuracy of the Italian version of the Hypomania Checklist (HCL-32) for self-assessment as a screening instrument for bipolar disorder (BPD) in a psychiatric setting and compared results with a previous study, carried out in a comparable sample and in the same setting, using the Mood Disorder Questionnaire (MDQ)., Methods: 123 consecutive subjects attending a psychiatric division were screened for BPD using the Italian translation of the HCL-32, and diagnostically interviewed with the SCID by physicians. The sample of the previous study using the MDQ consisted of 154 subjects., Results: On the basis of the SCID: 26 received a diagnosis of bipolar/schizoaffective disorder, 57 were diagnosed as having at least another psychiatric disorder in Axis-I, whilst 40 were unaffected by any type of psychiatric disorder. Comparing the bipolar with all other patients the HCL-32 showed a good accuracy: cut-off 8: sensitivity 0.92-specificity 0.48; cut-off 10: sensitivity 0.88-specificity 0.54; cut-off 12: sensitivity 0.85-specificity 0.61. The accuracy for BPD-II (10) remains good: cut-off 8: sensitivity 0.90-specificity 0.42; cut-off 10: sensitivity 0.80-specificity 0.47; cut-off 12: sensitivity 0.80-specificity 0.54. The comparison with the MDQ performance shows that both screening tools may show good results, but HCL-32 seems to be more sensitive in detecting BPD-II., Conclusion: Our results seem to indicate good accuracy of HCL-32 as a screening instrument for BPD in a psychiatric setting, with a low rate of false negatives, and a fairly good degree of identification of BPD-II.

Objective: To evaluate the association between mood and anxiety disorders in Hashimoto disease and Euthyroid Goitre in a case control study., Methods: Cases included 19 subjects with Hashimoto disease in euthyroid phase, 19 subjects with euthyroid goitre, 2 control groups each of 76 subjects matched (4/1) according to age and sex drawn from the data base of a community based sample. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified, according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO)., Results: Subjects with Hashimoto disease showed higher frequencies of lifetime Depressive Episode (OR = 6.6, C.L. 95% 1.2-25.7), Generalized Anxiety Disorders (OR = 4,9 Cl 95% 1.5-25.4) and Social Phobia (OR = 20.0, CL 95% 2.3-153.3) whilst no differences were found between subjects with goitre and controls., Conclusion: The study seems to confirm that risk for depressive disorders in subjects with thyroiditis is independent of the thyroid function detected by routine tests and indicates that not only mood but also anxiety disorders may be associated with Hashimoto disease.

Background: This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe., Methods: The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe., Results: Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Unlabelled: The study measured the accuracy of the Italian version of the Mood Disorder Questionnaire (MDQ) as a screening instrument for bipolar disorders in a psychiatric setting., Methods: 154 consecutive subjects attending the Division of Psychiatry of the University of Cagliari (Italy), were screened for bipolar disorders using the Italian translation of the MDQ, and diagnostically interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by physicians., Results: On the basis of the SCID: 51 (33.1%) received a diagnosis of bipolar or schizoaffective bipolar type disorders, 63 (40.9%) were diagnosed as having at least one psychiatric disorder in Axis I (other than bipolar or schizoaffective bipolar type disorders), whilst 40 (25.9%) were unaffected by any type of psychiatric disorder. MDQ showed a good accuracy for bipolar or schizoaffective bipolar type disorders: the cut-off 4 had sensitivity 0.90 and specificity 0.58; the cut-off 5 had sensitivity 0.84 and specificity 0.70; and the cut-off 6 had sensitivity 0.76 and specificity 0.86. The accuracy for bipolar II disorders was sufficient but not excellent: the cut-off 4 had sensitivity 0.80 and specificity 0.45; the cut-off 5 had sensitivity 0.70 and specificity 0.55; and the cut-off 6 had sensitivity 0.55 and specificity 0.65., Conclusion: Our results seem to indicate a good accuracy of MDQ, and confirm the results of recent surveys conducted in the USA. Moreover the instrument needs to be validated in other settings (e.g. in general practice).

Clinical Practice and Epidemiology in Mental Health will encompass all aspects of clinical and epidemiological research in psychiatry and mental health, and will aim to build a bridge between clinical and epidemiological research. There are several outstanding mental heath journals covering all aspects of this dynamic field, but none of these journals is devoted to bridging clinical and epidemiological research. The Open Access online distribution of the journal and its inclusion in the leading data bases (such as PubMed Central) will ensure widespread and ready visibility, which are indispensable given the demand for immediate debate and comparison of scientific findings. This launch Editorial provides an overview of the field, and highlights some of the journal policies.

Background: Evidence that high levels of aircraft noise lead to psychiatric disorders in the community is contradictory. The aim of the present study was to investigate the frequency of mental disorders in a sample living in the immediate surroundings of an airport compared with those from a sample of residents from the same region who had not been exposed to the risk of aircraft noise., Methods: Exposed subjects were residents in Giliaquas in the vicinity of Elmas airport (Sardinia, Italy). The control sample was drawn from a database of a large community survey, after matching for sex, age and employment status. All subjects were interviewed using a simplified version of the Composite International Diagnostic Interview., Results: Exposed subjects showed a higher frequency of Generalized Anxiety Disorder and Anxiety Disorder Not Otherwise Specified (NOS)., Conclusions: Previous studies generally suggested that high levels of environmental noise are associated with subsyndromal states (psychiatric symptoms) more than with specific syndromes. The present study shows an increased risk for long-lasting syndromal anxiety states (Generalized Anxiety Disorder and Anxiety Disorder NOS), thus supporting the hypothesis of a sustained central autonomic arousal due to chronic exposure to noise.

Background: This paper reports the findings of an analytical comparison of several macro indicators collected routinely from institutional sources in Europe., Methods: We carried out a review of macro indicators capable of providing a synthetic description of mental health status and the availability of psychiatric care in European countries. These were collected routinely from sources such as WHO, OECD, EUROSTAT, and IMS. The evaluation of temporal trends in each nation permits subsequent comparisons between countries., Results: In all European countries, a decreased trend of suicides was observed in the period 1980-2000, with the exception of Ireland and (partially) of Spain. In Ireland, the increased trend was particularly strong, with a high risk in young and adult males. Portugal and Greece had respectively the highest and the lowest rates of undetermined causes of death. Most countries that were high consumers of alcohol in the initial period of observation had a rate above the national mean until 1980, after which consumption decreased. Most nations that were low consumers in 1960 had rates below the mean until 1980,when the rates progressively increased. However, a general decrease of alcohol-related deaths was apparent in all countries. Mortality associated with mental disorder increased, most clearly during the mid 1980s. The number of psychiatrists per 100,000 inhabitants ranged from 3.6 in Spain to 17.5 in Finland; of child psychiatrists, from 0.9 in Germany to 5.1 in Portugal. Psychiatric beds ranged from 0.4 per 1,000 inhabitants in Italy and Spain to 1.3 in Ireland. Nine countries showed a trend towards a reduction in psychiatric beds, whilst in a further five countries no change was observed. Rates of long-stay patients varied from 9.5 in the UK to 84 in Belgium, with a generally decreasing trend. The use of outpatient facilities differed markedly between countries, although there was a general increase over time. Official data were scarce in relation to the sale of psychotropic drugs. IMS data indicated increasing consumption in all European countries for antidepressant and antipsychotic medication., Conclusions: The official data resources available for European countries seem to indicate some discrepancies, probably relating to methods of recording. Better co-ordination in the collection of data about mental health status in the European Union and an improvement of the quality in available services is needed.

Background: The lifetime prevalence of Social Phobia (SP) in European countries other than Italy has been estimated to range from 3.5% to 16.0%. The aim of this study was to assess the frequency of SP in Sardinia (Italy) in order to verify the evidence of a lower frequency of SP in Italy observed in previous studies (from 1.0% to 3.1%)., Methods: A randomised cross sample of 1040 subjects, living in Cagliari, in rural areas, and in a mining district in Sardinia were interviewed using a Simplified version of the Composite International Diagnostic Interview (CIDIS). Diagnoses were made according to the 10th International Classification of Diseases (ICD-10)., Results: Lifetime prevalence of SP was 2.2% (males: 1.5%, females: 2.8%) whereas 6-month prevalence resulted in 1.5% (males: 0.9%, females: 2.1%). Mean age at onset was 16.2 +/- 9.3 years. A statistically significant association was found with Depressive Episode, Dysthymia and Generalized Anxiety Disorder., Conclusions: The study is consistent with findings reported in several previous studies of a lower prevalence of SP in Italy. Furthermore, the results confirm the fact that SP, due to its early onset, might constitute an ideal target for early treatment aimed at preventing both the accumulation of social disabilities and impairments caused by anxiety and avoidance behaviour, as well as the onset of more serious, associated complications in later stages of the illness.

Background: To evaluate the association between mood and anxiety disorders and thyroid autoimmunity in a community sample., Methods: A community based sample of 222 subjects was examined. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified (CIDIS), according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO)., Results: 16.6% of the overall sample had an anti-TPO value above the normal cut-off. Subjects with at least one diagnosis of anxiety disorders (OR = 4.2, C.L. 95% 1.9-38.8) or mood disorders (OR = 2.9, Cl 95% 1.4-6.6, P < 0.011) were positive for serum anti-TPO more frequently than subjects without mood or anxiety disorders. A statistically significant association with anti-TPO+ was found in Anxiety Disorder Not Otherwise Specified (OR = 4.0, CL 95% 1.1-15.5), in Major Depressive Episode (OR = 2.7, CL 95% 1.1-6.7) and Depressive Disorder Not Otherwise Specified (OR = 4.4, S CL 95% 1-19.3)., Conclusions: The study seems to suggest that individuals in the community with thyroid autoimmunity may be at high risk for mood and anxiety disorders. The psychiatric disorders and the autoimmune reaction seem to be rooted in a same (and not easy correctable) aberrancy in the immuno-endocrine system. Should our results be confirmed, the findings may be of great interest for future preventive and case finding projects.

The Judgment of Line Orientation Test, a visuospatial processing task, was administered to normal subjects, to schizophrenic patients and to patients with delusional disorder. Significantly better performance was seen in the normal subjects than in the schizophrenic and delusional patients. Delusional patients, in turn, showed better performance than the schizophrenic patients., (Copyright 2004 Elsevier Ireland Ltd.)

Purpose: Tardive Dyskinesia (TD) is an adverse effect of several psychotropic drugs for long-term therapy for schizophrenia and other psychoses. TD is considered an important issue for public health for its invalidating characteristics. An extensive review of the literature on studies concerning efficacious treatments for TD has been carried out., Materials and Methods: A computer-generated search of the biomedical literature up to and including December 2002 was undertaken to identify studies., Results: Some evidence supports the switch from typical neuroleptics to atypical antipsychotics in patients with TD (particularly clozapine and olanzapine) and supports the use of atypical antipsychotics as first choice treatments. Other than the new antipsychotics, the gabaergic compounds, the new anticolinergics and some antioxidants as melatonin seem to be clinically useful. However, their tolerability and efficacy have to be confirmed by randomized clinical trials., Conclusions: The recent introduction of atypical antipsychotics seems to reduce the risk of TD in patients with long-term and maintenance therapies. Available literature data show that TD is less frequent with the new antipsychotics but still remains a well-known complication. The future research sould be directed to confirm the efficacy of these new drugs and to offer other treatment opportunities for patients that cannot change typical with atypical antipsychotics or for patients where the onset of the TD appears during therapy with atypical compounds.

Aims: To present the results of an epidemiologic research about psychotropic drug use in Sardinia., Methods: Cross-sectional study on a sample of 1040 subjects randomly selected from registers., Setting: Community survey on three areas of Sardinia region., Evaluation: Interviews carried out by physicians by means of Italian version of the Composite International Diagnostic Interview Simplified. Drug consumption was evaluated concerning last week before the interview., Main Outcome Measures: Point prevalence., Results: The rate of adults of the general population that consumed benzodiazepines was 10.1%, antidepressants 4.2%, 14.7% of the sample was using psychotropic drugs. 60% of subjects with diagnosis of ICD-10 Depressive Episod did not have the right pharmacologic treatment. A relevant proportion of subjects without lifetime psychiatric diagnosis (anxiety and/or depression) used antidepressants (0.8%). The pharmacologic therapies were managed by psychiatrics in 44.2% of cases, antidepressants were managed by general practitioners in 31.8% of subjects., Conclusions: The research underlines an increase of meet needs in subjects affected by depressive episodes against a previous Sardinian survey carried out over ten years ago. This change is parallel to a more frequent management of therapies by general practitioners. Their role seems to become more relevant in treating depressive illness.