Hospital malnutrition is becoming a clinical concern. Our aim was to determine the prevalence of hospital malnutrition through Nutritional Risk Screening 2002 (NRS) and to evaluate nutritional risk through a prospective study. Nutritional status was assessed collecting anthropometric parameters together with the data relating to the diseases in the medical records of patients admitted to the Department of Emergency Medicine of the "Sant'Eugenio" Hospital. One hundred and sixty patients were retrospectively enrolled during a 3-month observational period. The risk of malnutrition was detected in 52% of patients (of whom 38% at risk and 62% at serious risk). The NRS score was positively correlated with patient age, days between hospital admission and nutritional assessment, disease severity, length of hospital stay and catabolism (p<0.05); Basal Energy Expenditure (BEE) and mean arm circumference (MUAC) were negatively correlated with positive outcome (p<0.05). No correlations were found in the NRS score, gender, height, weight, Body Mass Index (BMI) and Total Energetic Expenditure (TEE) (p=n.s). A high prevalence of the risk of malnutrition may be detected in the emergency medicine setting, particularly in the geriatric population. The NRS score is not strictly related to BMI, but rather is an excellent tool for disease prognosis, as well as nutritional screening.

Objectives The Wellness Self-Management (WSM) is an adaptation and expansion of Illness Management and Recovery (IMR), an internationally recognized best practice. In order to validate the Italian version of WSM our goals included the translation from English to Italian of the WSM workbook and the implementation of an abbreviated WSM program in an Italian day hospital setting. Methods: In a randomized controlled trial 14 patients with a diagnosis of severe mental illness were recruited and randomly assigned to two groups. Seven individuals received an abbreviated version of WSM, while the controls received Treatment as Usual. Groups did not differ for age, education, cognitive functioning and symptomatology. All patients received weekly planned treatment in the day hospital setting. After treatment, group differences on change scores were tested using ANOVA. Results Compared to controls, at immediate post-intervention, WSM participants reported significant improvement in processing speed, psychopathology, neurocognitive and personal resources and real-life functioning. Conclusions These results offer promising preliminary evidence that the use of an abbreviated Italian translation of the WSM workbook provides an effective complement to current mental health treatment.

IntroductionWellness self-management is an adaptation and expansion of the illness management and recovery, an internationally recognized best practice. WSM is a recovery-oriented, curriculum-based practice designed to help adults with severe mental health problems make decisions and take action to manage symptoms and improve their quality of life.ObjectivesIn the present study, the Italian translation of the WSM was implemented and validated. Moreover, the impact of its application in a day hospital setting on cognitive functions, psychopathology, personal resources and real-life functioning with respect to treatment as usual (TAU) was investigated.AimsThe study was aimed at assessing the effectiveness of a semi-structured version of WSM in a day hospital setting in patients with severe mental illness.MethodsFourteen patients with a diagnosis of severe mental illness were recruited and randomly assigned to either WSM or TAU. WSM participants attended four 2-hour sessions per week for 1 month, including lessons selected on the basis of the goals of participants. Both groups received weekly planned treatment in the day-hospital setting and continued their pharmacotherapy.ResultsThe two groups of patients were comparable for age, education, cognitive functioning and psychopathological severity. WSM produced a significantly greater improvement in neurocognition, psychopathology, personal resources and real-life functioning with respect to TAU.ConclusionsOur results offer promising preliminary evidence that the use of WSM provides an effective complement to current mental health treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Authors must provide a brief abstract of 100-200 words. Focus Points Please provide three to six points that dictate the main focus of the manuscript and clearly illustrates what you are trying to convey in the article. Figures/Tables Please provide original figures and/or tables if content is amenable to it. References Please use American Medical Association style. References should be superscripted in text, then numbered, and comprehensive in list. See the following examples: 1. Jones J. Necrotizing Candida esophagitis. JAMA. 1980;244:2190-2191. 2. Stryer L. Biochemistry. 2nd ed. San Francisco, Calif: WH Freeman Co; 1980:559-596. 3. Alzheimer's Disease Cooperative Study. Valproate protocal. Available at: http://adcs.ucsd.edu/VP_Protocol.htm. Accessed October 15, 2003. Continuing Medical Education Authors must submit six multiple-choice questions (three Type A and three Type K), with answers. Copyright Materials are accepted for exclusive publication in CNS Spectrums and become the property of CNS Spectrums. Permission to reproduce material must be obtained from the publisher. Disclosure of Commercial and Non-Commercial Interests Authors must include a statement about all forms of support, including grant and pharmaceutical support, affiliations, and honoraria received for past and present material. Such information may, at the editor's discretion, be shared with reviewers. If the article is accepted for publication, the editors will consult with the authors as to whether this information should be included in the published paper. Submission Checklist • Original manuscript plus one copy, with cover letter on author's letterhead • Copies of permission letters to reproduce previously published and unpublished material • A brief abstract of the article D Six CME multiple-choice questions with answers • Three to six focus points • Disk labeled with the word processing program, title of paper, and lead author's name • Names and affiliations of three to five potential peer reviewers Volume 9 Number 7 496 CNS Spectrums July 2004 K F S U M i m i f DESCRIBING INFORMATION IE"! dtSTM S E R O Q U E L 9 (quet iapine tumarate ) Tablets S E R O Q U E L * (quet iapine lumara te ) Tablets efficacy of SEROOUEL , adjunct therapy trial of bipolar I patients initially hospitalized for up to 7 days tor acute mania, Effectiveness for more than 3 weeks has not been systematically evaluated in clinical trials. Therefore, the physician who elects to use SEROQUEL for extended periods should periodically re-evaluate the long-term risks and benefits of the drug for ""• ' " — i iS indicated for the treatment of schizophrenia. The efficacy of hart-term (6-week) controlled trials ot schizophrenic inpatients. __e, that is, lor more than 6 weeks, has not been systematically ore, the physician who elects to use SEROQUEL for extended periods should m usefulness of the drug for the individual patient. C0HTRAJHD4CAT10HS: SEROQUEL is contraindicated in individuals with a known hypersensitivity to this medication or any of its ingredients. WARNINGS: Nnirolaptlc Malignant Syndrome (NMS): A potentially fatal s p p t o m complex sometimes referred to as Neuralepte Malignant Syndrome (NMS has been reported in association with administration of antipsychotic drugs, including SEROQUEL. Rare cases of NMS have been reported with SEROQUEL. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability {irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrttythmia). Additional signs may include elevated creatine phosphokinase, myogtobinuria (rhabdomyolysis) and acute renal failure. The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology, The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for NMS. If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reproduction of drug therapy should be carefully considered. The patient should be carefully monitored since recurrences of NMS have been reported. Tardive Dyskinesia: A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rety upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop ttie syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown. The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome ana thereby may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown. Given these considerations, SEROQUEL should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Chronic antipsychotic treatment should generally be reserved for patients who appear to suffer from a chronic illness that (1) is known to respond to antipsychotic drugs, and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate, in patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically. If signs and symptoms ol tardive dyskinesia appear in a patient on SEROQUEL, drug discontinuation should be considered. However, some patients may require treatment with SEROQUEL despite the presence of the syndrome. Hnwnjtycsfflla and Dlabttes Metlitur Hyperglycerma, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including SEROQUEL. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is compfcated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hypergrycemia-related adverse events is not completely understood. However, epjdemiological studies suggest an increased risk of treatment-emergent nyperglycemia-related adverse events in patients treated with the atypical antipsychotics. Precise risk estimates for hyperglycemia-related adverse events in patients treated with atypical antipsychotics are not available. Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (eg, obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hypergfycemia including polydipsia, pofyuria, poryphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hypergrycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug. ntECAimONS: General: Orf lntt t lc Hypotension: SEROQUEL may induce orthostatic hypotension associated with dizziness, tachycardia and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its cx.-adreneratc antagonist properties. Syncope was reported in 1 % (23/2567) of the patients treated with SEROQUEL, compared with 0% (04307) on placebo and about 0.4% (2/527) on active control drugs. SEROQUEL should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemtc heart disease, heart failure or conduction abnormalities), cerebrovascuiar disease or conditions which would predispose patients to hypotension (dehydration, hypovolemia and treatment with anti~ ision and syncope may be minimized by limiting the iniDn to the target dose, a return to the previous dose in the in cardiac patients (see Orthostatic Hypotension). Information lor Patients: Physicians are advised to discuss the following issues with patients for whom they prescribe SEROQUEL. Orthos

Objective: Genes involved in 5HT transmission have been supposed to contribute to the biologic vulnerability for bulimia nervosa (BN). Because a long (L) and a short (S) variant of the promoter region of the 5HT transporter gene have been identified, we tested whether the 5HTT gene-linked polymorphic region (5HTTLPR) could represent a susceptibility factor for BN and/or could be related to nutritional parameters, harm avoidance personality dimension, and psychiatric comorbidity. Methods: A total of 219 white women (125 bulimics and 94 healthy control subjects) underwent a blood sample collection for 5HTTLPR genotyping and a clinical evaluation assessing comorbidity for axis I and II psychiatric disorders, harm avoidance personality dimension, and body composition (only patients). Results: The distribution of the 5HTTLPR genotypes did not significantly differ between patients and control subjects, although the L allele was significantly more frequent in the former. Bulimic individuals carrying at least one copy of the S allele had significantly lower mean body mass index and body fat mass values and significantly higher mean harm avoidance score than patients with the LL genotype. No significant association was found between the 5HTTLPR genotype and comorbid axis I and II psychiatric disorders. Conclusions: These findings support the view that polymorphic variants of the 5HTT promoter region do not play a part in predisposing to BN, whereas they seem to predispose bulimic individuals to nutritional impairment and increased harm avoidance. ANOVA = analysis of variance; BMI = body mass index; BW = body weight; BN = bulimia nervosa; MINI = Mini International Neuropsychiatric Interview; NS = not significant; 5HT = serotonin; 5HTT = serotonin transporter; 5HTTLPR = serotonin transporter length polymorphic region; SCID-IP = Structured Clinical Interview for DSM IV Axis I disorders–Patient Edition; SCID-II = Structured Clinical Interview for DSM IV Axis II personality disorders; TCI-R = Temperament and Character Inventory Revised.

The pathophysiological mechanisms underlying binge eating disorder (BED) are poorly understood. There is evidence that abnormalities in brain serotonin (5HT) play an important role in binge eating behavior, therefore genes involved in 5HT transmission, such as the 5HT transporter (5HTT) gene, may contribute to the biological vulnerability to BED. We examined whether the polymorphism of the promoter of the 5HTT gene, consisting of a long (L) and a short (S) variant, was associated with BED. Seventy-seven obese or non-obese women with BED, and 61 normal weight control women were genotyped at the 5HTT gene linked polymorphism (5HTTLPR). Statistical analysis showed that both the LL genotype and the L allele of the 5HTTLPR were significantly more frequent in BED subjects. Moreover, the L allele was associated with a moderate but significant risk to develop BED (OR = 2.01, CI = 1.33-3.57). Although these data should be regarded as preliminary because of the small size of our sample, they suggest that the 5HTTPRL may contribute to the genetic susceptibility to BED.

Tortorella, Alfonsoa; Monteleone, Palmieroa; del Giudice, Emanuele Miragliab; Cirillo, Graziab; Perrone, Laurab; Castaldo, Eloisaa; Maj, Marioa Author Information

Sir—Selective serotonin reuptake inhibitors (SSRIs), alone or in combination with different psychotherapies and/or nutritional counselling, have been proved to reduce binge eating and vomiting frequencies in patients with bulimia nervosa (BN). However, percent reductions in bingeing and purging range from 18 to 87%.1 It has been suggested that the initial capacity, affinity or genotype of proteins involved in the regulation of SSRI action could account for differences in treatment outcome.2 The 5-HT transporter (5-HTT) represents the prime target of SSRIs, and a long (L) and a short (S) variant of the promoter region of the 5-HTT gene, with different transcriptional efficiencies, have been identified.3 The S allele of the 5-HTT gene-linked polymorphic region (5-HTTLPR) has been associated with poorer SSRI response in major depression.2, 4, 5, 6, 7

Increased levels of cholesterol have been reported in patients with bulimia nervosa (BN), but all but one of the published studies were performed on non-fasting subjects, which limits the interpretation of this finding. Moreover, the relationships between serum lipids and comorbid psychiatric disorders or bulimic psychopathology have scarcely been investigated. We measured serum levels of total cholesterol, triglycerides, glucose, 17β-estradiol and thyroid hormones in 75 bulimic women and 64 age-matched healthy females after an overnight fast. Compared with healthy women, bulimic patients exhibited significantly enhanced serum levels of cholesterol and triglycerides, but similar values of glucose, 17β-estradiol, FT3 and FT4. No significant differences emerged in these variables between patients with or without comorbid depression, borderline personality disorder or lifetime anorexia nervosa. Circulating cholesterol was positively correlated to the patients' drive for thinness, ineffectiveness, enteroceptive awareness and impulse regulation sub-item scores of the Eating Disorder Inventory-2. These findings confirm that BN is associated with increased levels of serum lipids. This alteration may be involved in the pathophysiology of certain psychopathological characteristics of BN and cannot be explained by the co-occurrence of other psychiatric disorders.

Backgrounds: We designed a two-step prospective study aiming to detect cases with full and atypical eating disorders (EDs) in a population of female high-school students (first step) and to assess their natural outcome after a 4-year time period (second step).Methods: In the first step, we screened female students in their first year of high school by means of the EDI-2 and GHQ-28 questionnaires. Those students identified as being at risk for an ED underwent a psychiatric interview. In the second step, 4 years later, we tested schoolgirls in their last year of high school by adopting the same procedure as the first step.Results: 140 subjects participated in both steps. In the first step, we identified one subject with full-blown bulimia nervosa (BN), one with partial-syndrome BN, two with subclinical BN and eight with subclinical anorexia nervosa (AN). At the reassessment 4 years later, none of the girls had received any form of help. The full-blown BN case, the partial-syndrome BN case and one of the subclinical AN cases persisted unchanged; one of the subclinical BN cases shifted to subclinical AN; the remaining subclinical cases remitted spontaneously. Moreover, we identified 12 new cases of EDs.Conclusions: Present findings provide the first evidence that subclinical AN and subclinical BN represent unstable states that can spontaneously remit over time. Copyright (C) 2004 John Wiley & Sons, Ltd and Eating Disorders Association.