Search

Introduction: Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress. Objective: to assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. Methods: we conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score >= 3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. Results: four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52-1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29-0.87). Conclusions: this is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified., European Union (EU); Horizon 2020; European Commission (EC); RE-DEFINE: Refugee Emergency: DEFining and Implementing Novel Evidence-based Psychosocial Interventions

Introduction: The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept. Objective: The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. Methods: 112 patients were recruited in two university hospitals. Severity of psychiatric symptoms (Positive and Negative Syndrome Scale, PANSS), basic symptoms (Frankfurt Complaint Questionnaire, FCQ), perceived stress (Stress-related Vulnerability Scale, SVS), and life events (Paykel’s interview for recent life events) were assessed. Results: Patients affected by bipolar disorder (both with and without psychotic symptoms) showed a higher number of independent life events (p < 0.01) and tended to report more frequently at least 1 life event in the previous 6 months (p < 0.01) than patients affected by SZ or SA disorder. No differences emerged between the study groups in perceived stress nor in measures of basic symptoms. In the whole sample, a logistic regression analysis showed that the SVS total score (p < 0.05) and PANSS total score (p < 0.001) were associated with the presence of psychotic symptoms. Conclusions: In the study sample, life events and basic symptoms did not play a major role in influencing psychotic symptoms, compared to the subjective perception of stress and the severity of psychopathology. Taken together, these results can be informative for rehabilitation therapies aimed at enhancing resilience and coping strategies in this vulnerable group of patients.

Background In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, public health and mental health implications. The aim of this study is to (1) describe the level of psychological distress and frequency of psychiatric disorders in a sample of male asylum seekers and refugees across different ethnic groups resettled in Italy; (2) establish whether the number of traumatic events experienced before, during and after the migration process is associated with level of psychological distress and depressive symptoms. Methods In two large Italian catchment areas, over a period of 1 year a consecutive series of male asylum seekers and refugees, aged 18 or above and included in the Italian protection system, were screened for psychological distress and psychiatric disorders using validated questionnaires. Results During the study period, 252 male asylum seekers or refugees were recruited. More than one-third of the participants (34.5%) showed clinically relevant psychological distress, and one-fourth (22.2%), met the criteria for a psychiatric diagnosis, mainly Post Traumatic Stress Disorder and depressive disorders. The number of traumatic events turned out to be a risk factor for both clinically relevant psychological distress and depressive disorders. Receiving good social support emerged as a protective factor, while migrants with unclear status were at higher risk of psychological distress than those holding or awaiting a permission. Discussion In an unselected sample of male asylum seekers and refugees, after around 1 year of resettlement in Italy, the frequency of psychological distress and psychiatric disorders was substantial and clinically relevant. The association between traumatic events, especially post-migration problems, and mental health conditions suggests the need of developing services to assist refugees and asylum seekers to address the multi-faceted problems they experience, such as social support in host country, legal problems concerning permit status and asylum procedure, and family reunification, as well as addressing trauma and mental health issues.

One of the most consistent models investigating the relationship between premorbid personality and depression was described by Tellenbach. According to this model, concern with orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity are the core features of Typus Melancholicus (TM). Previous studies showed a relationship between unipolar depression and TM. The primary hypothesis of this study was that patients affected by unipolar depressive disorders bare more of TM-related features of concern with orderliness and conscientiousness than healthy subjects.In this single center cross-sectional study we recruited 74 patients affected by unipolar depressive disorders according to DSM-5 criteria and 60 healthy controls. In order to assess the presence of TM's orderliness and conscientiousness we adopted the factors of Kasahara's Inventory for the Melancholic Type Personality (KIMTP) named "harmony in personal relationships" and "social norms". Stress-Related Vulnerability Scale (SVS) was administered to explore the relationship between measures of TM and perceived stress.Independent sample t test disclosed significantly higher scores on KIMTP "harmony in personal relationships" (orderliness) but not on "social norms" (conscientiousness) in the clinical sample (p0.001) compared to the non-clinical sample. Pearson's correlation disclosed a significant positive correlation between stress scores and KIMTP'S "harmony in personal relationships" subscale.KIMTP's "harmony in personal relationships" (orderliness) was higher in patients with unipolar depression than in non-clinical subjects, and positively associated with perceived stress, while KIMTP's "social norms" (conscientiousness) was (i) similarly represented across the two groups, and (ii) not correlated with perceived stress. This raises the possibility that, among the core features of TM, concern with orderliness can be considered as a relevant and potentially premorbid personality factor in relation to unipolar depressive disorders.

Background Demoralization, as assessed through the Diagnostic Criteria for Psychosomatic Research–Demoralization (DCPR/D) interview or the Demoralization Scale (DS), has been found to affect about 30% of patients with medical disorders, while few studies have been done in patients with psychiatric disorders. Methods A convenience sample of 377 patients with ICD-10 diagnoses of mood, anxiety, stress-related disorders or other non-psychotic disorders was recruited from two Italian university psychiatry centers. The DCPR/D interview and the Italian version of the DS (DS-IT) were used to assess demoralization and the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Results Demoralization was diagnosable in more than 50% of the patients. Factor analysis of the DS-IT indicated four main factors, Meaninglessness/Helplessness, Disheartenment, Dysphoria and Sense of Failure, explaining 62% of the variance of the scale. Patients with bipolar or unipolar major depression and personality disorders had the highest prevalence of demoralization (DCPR/D) and the highest scores on all the DS-IT factors in comparison with patients with adjustment or anxiety disorders. About 50% of patients with moderate demoralization (DS-IT) were not clinically depressed (PHQ-9 Limitations Prospective studies on larger samples with other psychiatric disorders, also taking into account subjective incompetence, are needed. Since the DCPR/D assesses demoralization as a categorical construct, a dimensional framework should be necessary. Conclusions The findings enrich the research on demoralization, showing for the first time the importance of this construct, as measured by the DCPR/D and the DS-IT, in patients with psychiatric disorders.

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.

Gilles de la Tourette syndrome is characterized by motor/vocal tics commonly associated with psychiatric disorders, including obsessive-compulsive disorder. We investigated primary motor cortex and brainstem plasticity in Tourette patients, exposed and unexposed to chronic drug treatment, with and without psychiatric disturbances. We also investigated primary motor cortex and brainstem plasticity in obsessive-compulsive disorder. We studied 20 Tourette patients with and without psychiatric disturbances, 15 with obsessive-compulsive disorder, and 20 healthy subjects. All groups included drug-naive patients. We conditioned the left primary motor cortex with intermittent/continuous theta-burst stimulation and recorded motor evoked potentials. We conditioned the supraorbital nerve with facilitatory/inhibitory high-frequency stimulation and recorded the blink reflex late response area. In healthy subjects, intermittent theta-burst increased and continuous theta-burst stimulation decreased motor evoked potentials. Differently, intermittent theta-burst failed to increase and continuous theta-burst stimulation failed to decrease motor evoked potentials in Tourette patients, with and without psychiatric disturbances. In obsessive-compulsive disorder, intermittent/continuous theta-burst stimulation elicited normal responses. In healthy subjects and in subjects with obsessive-compulsive disorder, the blink reflex late response area increased after facilitatory high-frequency and decreased after inhibitory high-frequency stimulation. Conversely, in Tourette patients, with and without psychiatric disturbances, facilitatory/inhibitory high-frequency stimulation left the blink reflex late response area unchanged. Theta-burst and high-frequency stimulation elicited similar responses in drug-naive and chronically treated patients. Tourette patients have reduced plasticity regardless of psychiatric disturbances. These findings suggest that abnormal plasticity contributes to the pathophysiology of Gilles de la Tourette syndrome. However, obsessive-compulsive disorder patients have normal cortical and brainstem plasticity. © 2014 International Parkinson and Movement Disorder Society

Background: Despite the theoretical and clinical relevance of psychopathological dimensions in obsessive-compulsive disorder (OCD), no studies to date have investigated their possible association with obsession subtypes. Thus, 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 OCD patients (66.7% female, mean age 34 years) at our Psychiatric Outpatient Clinic. We used the point biserial coefficient (rpbi) to measure the correlation between psychopathological dimensions and obsession subtypes. Results: We found significant correlations (p < 0.05) between the following: (1) anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; (2) apprehension/fear dimension and contamination, religious, and somatic obsessions; (3) sadness/demoralization dimension and contamination and somatic obsessions; (4) impulsivity dimension and aggressive and sexual obsessions, and (5) somatic concern/somatization dimension and contamination and somatic obsessions. We also found that OCD patients with comorbid obsessive-compulsive personality disorder - but not schizotypal or histrionic disorders - 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.

In addition to motor symptoms, patients with movement disorders often complain of psychiatric disturbances, including mood, anxiety, and impulse-control disorders and psychosis. These abnormalities are often misdiagnosed and left untreated, thus resulting in a worse prognosis and lower quality of life. Besides the use of standard pharmacological treatments, psychiatric abnormalities can be treated by means of nonpharmacological approaches. These approaches include various types of psychological therapies, the most widely used being cognitive behavioral therapy (CBT). We reviewed all articles, conducted until 2014, that contained primary data derived from clinical trials and case reports on the effect of CBT in the most common movement disorders. One randomized, controlled study and several uncontrolled studies on the efficacy of CBT in Parkinson's disease (PD) have shown a short-term benefit of depression and anxiety. In Tourette's syndrome (TS), CBT has been assessed in a number of large controlled clinical trials that have demonstrated an improvement in psychiatric disturbances and tics. There are no controlled studies on the efficacy of CBT in other types of movement disorders, such as dystonia, Huntington's disease, and essential tremor. Only a limited number of studies have evaluated the efficacy of CBT in the management of psychiatric disorders in movement disorders. The evidence available suggests that CBT is useful in TS and probably useful in PD. We recommend the planning of randomized, controlled clinical trials to investigate the effects of CBT and group CBT in the treatment of psychiatric disturbances in movement disorders.

Objectives To investigate the frequency and the different types of psychiatric disturbances in PSP patients using validated psychiatric instruments. Methods We conducted a case-control study using the Structured Clinical Interview (SCID-I) for DSM-IV to investigate psychiatric disorders in 28 PSP patients and 28 age and gender matched healthy controls. PSP severity was scored using the PSP rating scale; cognitive functions were assessed using the Montreal Cognitive Assessment scale and the Frontal Assessment Battery scale. Results SCID-I disclosed that psychiatric disturbances were more frequent in PSP patients (53%) than in healthy controls (17.8%) ( p = 0.005). Psychiatric disorders in PSP patients were characterized by mood disorders. Depression due to PSP was the most frequent diagnosis and was found in 8 of the 15 patients with depressive disorders. None of the PSP patients had a diagnosis of other SCID-I disorders. No clinical or demographic differences were found when comparing PSP patients with and without psychiatric disturbances. Conclusions Psychiatric disturbances, namely depressive disorders, were more frequent in PSP patients than in controls. A thorough evaluation of psychiatric disorders is important to insure appropriate treatment of PSP patients..

In the last decades, the potential association between antidepressants and cancer risk has been increasingly investigated. Fundamental researches, performed on animal models and cell tumoral lines, have highlighted several biological mechanisms possibly supporting this association. Nevertheless, the epidemiological studies investigating the risk of cancer in patients receiving selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have provided conflicting and inconclusive results. Therefore, the prescription of several antidepressants in oncologic patients still remains a matter of discussion. The aim of this review is to present and discuss available evidence concerning the association between the risk of breast and prostate cancer and the use of antidepressant medications. Thus, consistencies, differences, and contradictions of available data are reported. A special focus is addressed to amisulpiride, a widely prescribed drug still poorly investigated with regard to the risk of cancer occurrence and recurrence. Overall, there is no definitive evidence of increased risk of breast and prostate cancer among patients exposed to SSRIs and TCAs. The association between amisulpiride and cancer risk has been to date scarcely explored and considered in clinical settings. Nevertheless, the hyperprolactinemia frequently resulting from its adoption has been repeatedly associated, to increased cancer risk and poorer prognosis in cancer patients. Thus, the use of amisulpiride among cancer patients should be carefully considered.

IntroductionDespite 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/AimsWe aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes.MethodsWe 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 (rpbi) 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.ResultsWe 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.ConclusionsAnger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a largely unrecognized, heritable connective tissue disorder, mainly characterized by joint instability complications, widespread musculoskeletal pain, and minor skin features. In a case-control study, 47 consecutive JHS/EDS-HT patients were investigated for the prevalence of psychiatric disorders and compared to 45 healthy controls in a single center. The psychiatric evaluation consisted of structured clinical interview for DSM-IV criteria by using the SCID-I and the SCID-II. Symptom severity was assessed using the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), and the Brief Psychiatric Rating Scale (BPRS). The Global Assessment of Functioning Scale (GAF) was used to assess the overall severity of psychological, social, and occupational functions. JHS/EDS-HT patients had significantly higher mean scores for all questionnaires: HAM-A (6.7 vs. 3.8), HAM-D (6.4 vs. 2.7), GAF (75.0 vs. 86.1), and BPRS (27.5 vs. 25.6). The JHS/EDS-HT group had a 4.3 higher risk of being affected by any psychiatric disorder, and in particular, a 5.8 higher risk of having a personality disorder. In particular, 5 JHS/EDS-HT suffered from obsessive-compulsive personality disorder with an observed prevalence rate of 10.6 % (3.6-23.1). Psychiatric assessment of JHS/EDS-HT patients showed an extremely high prevalence of personality disorders (21 %), and of Axis-I disorders (38 %), mostly depressive. This study did not confirm the previously reported increased rate of panic disorders in JHS/EDS-HT.

Studies have shown that psychological hardiness is an important stress resilience resource for individuals. The 15-items Dispositional Resilience Scale (DRS-15) is a short, reliable and valid self-report instrument to measure hardiness that is not available in Italian. The present study was undertaken to create an Italian version of the DRS-15, and evaluate its psychometric properties and validity in the Italian context. An Italian version was produced using multiple independent bilingual translators. This version was administered to a non-clinical sample of adults (N=150), along with measure o psychological well-being (PWB-18) and health. A sub-sample (N = 66) completed the DRS-15 again one month later. Results showed good reliability in terms of internal consistency and test-retest stability. With regard to the subscale, stability was high for all three subscales, whereas two subscales (Commitment and Control) showed marginal internal consistency. DRS-15 total and subscales scores showed a theoretically meaningful pattern of correlations with PWB-18 subscales, supporting the validity of the Italian DRS. Also, multiple regression analysis revealed a correlation between DRS-15 scores and self-rated general health, even after controlling for age and sex. The new Italian DRS-15 provides a valid, reliable and easy to use tool fr assessing stress resilience in clinical and research settings.

Objective The aim was to investigate perioperative factors associated with the development of post-traumatic stress disorder (PTSD) in patients who underwent cardiac surgery. Design Prospective observational study. Setting Single academic center. Participants One hundred twenty-eight consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Interventions Patients were interviewed within the surgical unit 1 to 3 days before cardiac surgery. Measurements and Main Results Six months after surgery, participants were mailed the modified version of the Posttraumatic Stress Symptom Inventory 10. Of the 71 patients who completed the questionnaire and mailed it back at follow-up, 14 (19.7%) received a diagnosis of PTSD. Seven of 13 female patients who were not treated with β-blockers received a diagnosis of PTSD compared with 0 of 12 who were treated with β-blockers (p = 0.005, Fisher exact test). In a general linear model, including sex and β-blocker treatment as predictors, the Posttraumatic Stress Symptom Inventory 10 score was significantly predicted by β-blockade (F = 4.74, p = 0.033), with a significant interaction between sex and β-blockade (F = 9.72, p = 0.003). Conclusions These findings suggest that the use of β-blockers might be protective against the development of PTSD in women after cardiac surgery.

Introduction Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available. Aims To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT Methods We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning. Results Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported. Conclusions Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.

Introduction The vulnerability-stress model assumes that psychotic symptoms emerge from the interaction between stress, basic symptoms and information processing deficits. Despite the large amount of data on first episode psychosis, this particular topic has been investigated to a minor extent in patients readmitted to acute psychiatric wards. Objectives To assess the association between basic symptoms and subjective stress, life events, and executive functions. Aims To identify the factors associated to basic symptoms during relapses. Methods Patients affected by schizophrenia, schizoaffective and bipolar disorder according to DSM-IV TR were recruited from the acute psychiatric wards of two University Hospitals in Rome. They were evaluated through: a) Frankfurt Complaint Questionnaire (FCQ); b) Stress-related Vulnerability Scale (SVS); c) Paykel Interview for Recent Life Events (IRLE); d) Wisconsin Card Sorting Test (WCST). Results Forty-nine patients were enrolled (65% women; mean age 42.7 ± 10.5 years; education 12.4 ± 3.2 years; disease duration 17.6 ± 11.4; 63% affected by bipolar disorder). Basic symptoms were positively associated to SVS total score (rho = 0.66, p Conclusions Preliminary results of this study show that basic symptoms are positively associated to perceived stress and marital life events, while negatively associated to executive functions, during psychotic relapses.

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 Conclusions Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery.