Aims. Aim of the current study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy). Methods. We collected data about daily admissions to psychiatric emergency services of two general hospitals, air pollutants' levels and meteorological data for the time period 1 January 2015 until 31 December 2016. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. Results. A total of 1860 emergency department admissions for mental disorders were identified. We observed a statistically significant impact of ozone levels on daily admissions. The estimated coefficient of O-3 is statistically significant at the 1% level. All other pollutants were not significantly associated with the number of daily admissions. Conclusions. Short-term exposure to ozone may be associated with increased psychiatric emergency services admissions. Findings add to previous literature on existing evidence for air pollution to have an impact on mental health. Ozone may be considered a potential environmental risk factor for impaired mental health.

Objectives Obsessive-compulsive symptoms (OCS) have often been described in schizophrenia spectrum disorders, contributing to the overall complexity of the clinical presentation, over and above the canonical symptom dimensions. The main aim of this study is to investigate the prevalence of OCS and its relationship with contextual psychopathology in a sample of acute psychotic inpatients within the schizophrenia spectrum. Methods 76 subjects consecutively admitted with a diagnosis of schizophrenia spectrum disorder underwent a systematic psychopathological assessment including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Positive and Negative Syndrome Scale (PANSS). Descriptive and bivariate analyses were performed in order to identify clinical and psychopathological correlates of the schizo-obsessive subgroup, defined as a Y-BOCS score >= 17. Results 44.7% of the participants revealed significant OCS. No significant differences were detected in terms of socio-demographic, diagnostic and treatment features. Subjects with clinically relevant OCS presented higher scores in the negative and general psychopathology subscales, as well as a higher PANSS total score (Tab. I). Conclusions High levels of OCS are relatively frequent in inpatients with schizophrenia and identify a subgroup with higher symptomatological severity. Screening for OCS in newly admitted subjects with schizophrenia might facilitate the timely identification of a subgroup with more intensive need of care.

Aims. To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients. Methods. 131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed. Results. Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p < 0.01) and reason (r = −0.27; p < 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r = −0.23; p < 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSD r = 0.37; p < 0.01; BD r = −0.01; p = 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BD r = −0.32; p < 0.05; SSD r = 0.03; p = 0.8). Twenty-two per cent (n = 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% of understanding, appreciating and reasoning MacCAT-T subscales maximum sores and 2 at expressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p < 0.001). Conclusions. Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.

IntroductionThe “schizophrenia spectrum” concept allowed better identifying the psychopathology underpinning disorders including schizophrenia, schizoaffective disorder (SZA) and cluster A personality disorders (PD).AimsTo compare the clinical portrait of the schizophrenia spectrum disorders, focusing on the impact of the affective dimension.MethodsInpatients at the acute psychiatric ward of Perugia (Umbria-Italy) were evaluated with the structured clinical interview for DSM-IV Axis I and Axis II disorders and diagnosed with a “schizophrenia spectrum” disorder according to DSM-IV-TR. The clinical evaluation was conducted using the positive and negative syndrome scale (PANSS). Pearson correlations of the different subscales in the three groups and between the negative scales with the affective symptom “depression” were conducted.ResultsThe sample consisted of 72 inpatients (schizophrenia 55.6%, SZA 20% and cluster A PD 19.4%). The negative and the general psychopathology scales directly correlated at different degrees in the three groups (schizophrenia: r = 0.750; P < 0.001; SZA: r = 0.625, P = 0.006; cluster A PD: r = 0.541, P = 0.046). The symptom “depression” directly correlated with 5 out of 7 negative symptoms: blunted affect (r = 0.616, P < 0.001), emotional withdrawal (r = 0.643, P < 0.001), poor rapport (r = 0.389, P = 0.001), passive/apathetic social withdrawal (r = 0.538, P < 0.001), lack of spontaneity & flow of conversation (r = 0.399, P = 0.001).ConclusionsOur study confirmed the existence of the “schizophrenia spectrum” with combined different disorders lying on a continuum in which negative symptoms mainly correlated with the psychopathological functioning. Noteworthy, the symptoms of the negative scale strongly correlated with the “depression” symptom, underlying the impact of the affective symptoms on the severity of the “schizophrenia spectrum” disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background: Deliberate self-harm (DSH) causes important concern in prison inmates as it worsens morbidity and increases the risk for suicide. The aim of the present study is to investigate the prevalence and correlates of DSH in a large sample of male prisoners.Methods: A cross-sectional study evaluated male prisoners aged 18+ years. Current and lifetime psychiatric diagnoses were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders -DSM-IV Axis I and Axis II Disorders and with the Addiction Severity Index-Expanded Version. DSH was assessed with The Deliberate Self-Harm Inventory. Multivariable logistic regression models were used to identify independent correlates of lifetime DSH.Results: Ninety-three of 526 inmates (17.7%) reported at least 1 lifetime DSH behavior, and 58/93 (62.4%) of those reported a DSH act while in prison. After multivariable adjustment (sensitivity 41.9%, specificity 96.1%, area under the curve = 0.854, 95% confidence interval CI = 0.811-0.897, P < 0.001), DSH was significantly associated with lifetime psychotic disorders (adjusted Odds Ratio aOR = 6.227, 95% CI = 2.183-17.762, P = 0.001), borderline personality disorder (aOR = 6.004, 95% CI = 3.305-10.907, P < 0.001), affective disorders (aOR = 2.856, 95% CI = 1.350-6.039, P = 0.006) and misuse of multiple substances (aOR = 2.024, 95% CI = 1.111-3.687, P = 0.021).Conclusions: Borderline personality disorder and misuse of multiple substances are established risk factors of DSH, but psychotic and affective disorders were also associated with DSH in male prison inmates. This points to possible DSH-related clinical sub-groups, that bear specific treatment needs. (C) 2017 Elsevier Masson SAS. All rights reserved.

Prognostic staging is one of the most important current psychiatrical challenges. Bipolar prognostic factors must be identified to assist in staging. To assess prognostic factors, to describe any correlation with the disease outcome and to recommend that psychiatrists assess bipolar patients, determining their stage of disease in order to identify possible high-risk groups of patients. We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors. The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; 60.9% reported anxiety, 71.7 % mixed state features and 72.7% rapid cycling. A comparison between 12 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use, current alcohol use/previous alcohol use, and current illicit drug use/anxiety were statistically significant; the correlation between previous illicit drug use/previous alcohol use, previous alcohol use/family history and mixed state features/anxiety were almost significant. 17 patients were assigned to a care coordinator; we found no statistically significant differences between the patients with or without a care coordinator on the basis of the presence of 12 possible prognostic factors. In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. Specific features of the disease (family history, age at onset, features of depressive episodes and mixed state, rapid cycling) may be highlighted.

Background . Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods . Participants (N=1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results . The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%,p<0.01; SF-12 MCS: 59.4% versus 74.3%,p<0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions . Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

AIMS:The role of type A behaviour in cardiovascular disease is controversial and most of the research is based on self-rating scales. The aim of this study was to assess the prevalence of type A behaviour in cardiology and in other medical settings using reliable interview methods that reflect its original description.METHODS:A sample of 1398 consecutive medical patients (198 with heart transplantation, 153 with a myocardial infarction, 190 with functional gastrointestinal disorders, 104 with cancer, 545 with skin disorders and 208 referred for psychiatric consultation) was administered the Structured Clinical Interview for the DSM-IV and the Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) which identifies 12 clusters, including type A behaviour.RESULTS:A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behaviour in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). Type A behaviour frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM-IV diagnoses. Among cardiac patients, those with type A behaviour were less depressed, demoralised and worried about their illness.CONCLUSIONS:Type A behaviour was found to occur in about a third of cases of patients with cardiovascular disease. Only in a limited number of cases was it associated with depression. It has a lifestyle connotation that may have important clinical consequences as to stress vulnerability and illness behaviour.

This paper describes the use of aripiprazole for the management of cognitive deficits and behavioral disorders in a young female patient suffering from systemic lupus erythematosus (SLE). Cognitive impairment, although often transient, is reported up to 75% of patients with SLE. The behavioral changes and, more generally, clear psychotic episodes have an incidence of 5% but they lead to considerable difficulties in clinical and therapeutic management. In cases with psychiatric manifestations of SLE, it is often necessary to introduce psychopharmacological therapy. The choice of aripiprazole has been made especially in light of low liability to cause weight gain and metabolic side effects. In fact aripiprazole is characterized by an original mechanism of action: it combines partial agonist activity on D(2), D(3) and 5-HT(1A) receptor with antagonistic activity on 5-HT(2A) and D(2). Aripiprazole has demonstrated efficacy in the management of behavioral disturbances and has improved some of impaired cognitive functions. Aripiprazole, therefore, could be a great tool in young patients with SLE.

BackgroundThe classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill.MethodA cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate.ResultsThree clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization.ConclusionsTwo-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.

Objective The European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW) and the Italian Consultation-Liaison Group advice that the aim of the Consultation-Liaison Psychiatry is to provide hospital treatment using valid and universal medical approaches, in full respect of personalized care. This study describes the Consultation-Liaison Service of the Perugia University and investigates the significant associations between a many variables of the assessed population.Methods We used a clinical report derived from the Patient Registration Form in order to collect demographic and clinical data of hospitalized patients; the t-test, the Mann-Whitney U-Test, and the chi2-test-Fischer's test were used for statistical assessment.Results During the time from July 2008 to June 2009, 722 consultations were performed at the general hospital in Perugia. First examinations were 605; 462 were in hospital ward and 143 were in emergency. These 143 were excluded from the study. Most consultations involved European patients (95,2%) of female gender (56.3%); mean age was 55.77 (SD +/- 21.27) (Table I). Emergencies were 22.5%; one fifth of patients were not informed of having been referred to our service and half of interventions were requested by departments of internal medicine. The primary reasons for the referral were depression (18.6%), unexplained physical symptoms (12.3%) and anxiety (10.4%); most patients were already taking psychotropic medication before our intervention (58.8%). The most frequent ICD-10 (International Classification of Disease) diagnoses were the neurotic, stress-related and somato-form syndromes (29.0%), affective syndromes (23.4%), mental syndromes related to an organic illness (11.0%), but 15.4% of the patients did not have any psychiatric diagnosis; the most common liaison interventions were aimed at the staff of department (46.6%); drug treatment was suggest in 58.9% of cases. At discharge, 22.9% of patients were referred to community psychiatric services, 19.5% to our service and 11.9% to their own general practitioner. The significant associations are the following: associations between gender and social status (p < 0.01), social condition (p < 0.01), work (p < 0.01) and advice about the need of the consultation (p < 0.05) (Table II). The area (medical, surgical and specialized area) are related with the advice (p < 0.05), the reason (p < 0.01) and the type of the consultation (p < 0.01), the diagnostic explanations (p < 0.01), the liaison investigations (p < 0.01) and, at last, with the longrange plan after discharge (p < 0.01) (Table III). The main ICD-10 psychiatric diagnoses (Schizophrenia, Affective Syndrome and Neurotic-Stress-Somatoform Syndrome) are associated with social status (p < 0.01), social condition (p < 0.01), work (p < 0.01), hospitalization length (p < 0.01), consultation type (p < 0.01), advice (p < 0.01), reason of the consultation (p < 0.01), liaison investigations (p < 0.05) and long-range plan after discharge (p < 0.05) (Table IV).Discussion The results agree with ISTAT (National Statistics Institute) data and with the international literature. The need for better physical and psychological investigation is confirmed. Clinicians must pay attention to bio-psycho-social status of hospitalized patients for promoting their wellbeing and not only illness remission.

ObjectivesThe present study investigates the differences in personality and perception and management of anger and impulsivity, between subjects that lost points on driving license and those did not, among members of the Automobile Club d'Italia.MethodsPamphlets, sent to 500 subjects, contained: a questionnaire investigating personal data and driving history, the Barratt Impulsiveness Scale-11 (BIS-11), the State and Trait Anger eXpression Inventory (STAXI) and the Temperament and Character Inventory (TCI). The BIS-11 investigates general impulsivity and other aspects like attentional, motor and nonplanning impulsivity. The STAXI gives information about experience, expression and control of anger. The TCI, informed on Cloninger's temperament and character theory of personality, consists of seven scales: Novelty Seeking, Harm Avoidance, Reward Dependence, Persistence, Self-Directness, Cooperativeness and Self-Transcendence. The differences between the two groups (subjects with/ without lost points in driving licence) were tested using t-Student test. To evaluate the association between the loss of points and the variables examined in the questionnaires, we calculated odds ratios using logistic regression models. We used simple Correlation to investigate the dependence between the several scales of different tests.Results112 pamphlets were sent back, 36 of which reported loss of points. No significant difference emerged between this two groups according to age, sex, education, loss of points, type of traffic violation, and years of driving. Simple correlation (Table I) demonstrates a wide dependence between the scales of different tests. The t-Student test indicated that the subjects that committed traffic offences has a lower mean in Harm Avoidance (13.83 vs. 16.72; p = 0.027), T-Anger (18.22 vs. 20.4; p = 0.062), and T-Anger/ T (6.22 vs. 7.19; p = 0.061) than those not reporting any offence. These results have been confirmed by logistic regression (Table III). HA turned out to be a protection factor for the loss of points (OR = 0.062; p = 0.031).ConclusionsNo psychopathological aspect emerged from our analysis, but some temperamental profiles turned-out to influence traffic behavior. Harm Avoidance proved to be a protection factor, in other words people with high HA are less predisposed to engage in risky driving. New findings of this study, compared to current literature, are both the choice to investigate traffic violations rather than accidents, and the sample, which is not selected on the basis of committing violations nor by education; higher mean age (45.96) ensured appropriate integration and modulation of impulsivity and aggressiveness.

This study aims to detect different psychopathological dimensions in first-episode psychoses with different underlying causes. We evaluated 22 subjects with first-episode psychosis, who differed in biological variables (HIV-positive versus HIV-negative) and who were compared by using the Structured Clinical Interview for DSM-III-Reviewer, the 18-item Brief Psychiatric Rating Scale (BPRS), the 17-item Hamilton Depression Rating Scale, the 14-item Hamilton Anxiety Rating Scale and the Mini-Mental State Examination. HIV-positive subjects had higher mean scores on the global BPRS and on the paranoid Positive and Negative Syndrome Scale subscale compared with HIV-negative subjects. Conversely, higher prevalence of affective and anxious symptoms was found in the HIV-negative patients in comparison to HIV-positives. HIV-positives had significantly greater attention/concentration impairment than HIV-negative persons. In conclusion, taking into account psychopathological dimensions may help psychiatrists in clinical decision-making regarding the differential diagnosis of psychotic symptoms. The psychopathological pattern of first-episode psychosis in HIV-positive patients may represent an 'elementary model' of acute psychosis characterized by paranoid delusions in the absence of the usual affective symptoms.

OBJECTIVE:To evaluate the incidence and effects of factors potentially influencing eating disordered patients' dropping out of outpatient cognitive-behavioural therapy (CBT).METHOD:Sixty-seven (64 female, 3 male) patients with eating disorders participated in the study. All patients followed a multidisciplinary team approach for a median period of 9 months. Several factors potentially affecting dropout were retrospectively assessed prior to treatment.RESULTS:The dropout rate was significantly higher in patients with purging anorexia nervosa (AN) compared to those with restrictive AN, bulimia nervosa and eating disorder not otherwise specified (33% vs. 27%, 25% or 21%, respectively, p<0.05). Among several factors influencing dropout, there was a significant association of patient low cooperativeness, purging episodes, restrictive eating, use of several weight control practices and psychiatric co-morbidity in patients who dropped out compared to completers (all p<0.05).CONCLUSIONS:In outpatient eating disorder treatment, non-compliance and premature interruption of therapy are affected primarily by factors which are related to patients' attitude and behaviour. These factors should be carefully addressed in patients with eating disorders to improve outcome.