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Preti A, Piras M, Cossu G, Pintus E, Pintus M, Kalcev G, Cabras F, Moro MF, Romano F, Balestrieri M, Caraci F, Dell'Osso L, Sciascio GD, Drago F, Hardoy MC, Roncone R, Faravelli C, Musu M, Finco G, Nardi AE, Carta MG. The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy. Psychiatry Investig 2021; 18:277-283. [PMID: 33849246 PMCID: PMC8103017 DOI: 10.30773/pi.2020.0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Antonio Preti
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Martina Piras
- PhD Programme Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mirra Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Goce Kalcev
- PhD Programme Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Federico Cabras
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | | | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | - Filippo Drago
- Department of Drug Sciences, University of Catania, Catania, Italy
| | | | | | | | - Mario Musu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Preti A, Demontis R, Cossu G, Kalcev G, Cabras F, Moro MF, Romano F, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Hardoy MC, Roncone R, Faravelli C, Gonzalez CIA, Angermayer M, Carta MG. The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews. BMC Psychiatry 2021; 21:48. [PMID: 33472585 PMCID: PMC7816458 DOI: 10.1186/s12888-021-03042-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Antonio Preti
- University of Cagliari, Cagliari, Italy.
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10126, Turin, Italy.
| | | | | | - Goce Kalcev
- Department of Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | | | | | | | | | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy
- Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | - Filippo Drago
- Department of Drug Sciences, University of Catania, Catania, Italy
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Carta MG, Fineberg N, Moro MF, Preti A, Romano F, Balestrieri M, Caraci F, Dell'Osso L, Disciascio G, Drago F, Hardoy MC, Roncone R, Minerba L, Faravelli C, Angst J. The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey. Front Psychiatry 2020; 11:188. [PMID: 32296351 PMCID: PMC7136520 DOI: 10.3389/fpsyt.2020.00188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Naomi Fineberg
- Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, United Kingdom.,Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ferdinando Romano
- Dipartimento di Sanità Pubblica e Malattie Infettive, University of Roma La Sapienza, Rome, Italy
| | | | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Disciascio
- Scuola di Specializzazione in Psichiatria, University of Bari, Bari, Italy
| | - Filippo Drago
- Department of Drug Sciences, University of Catania, Catania, Italy
| | | | - Rita Roncone
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, University of L'Aquila, L'Aquila, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Faravelli
- Dipartimento di Scienze Formazione e Psicologia, University of Florence, Florence, Italy
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Sancassiani F, Carmassi C, Romano F, Balestrieri M, Caraci F, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Moro MF, Roncone R, Preti A, Dell'Osso L. Impairment of Quality of Life Associated With Lifetime Diagnosis of Post-traumatic Stress Disorder in Women - A National Survey in Italy. Clin Pract Epidemiol Ment Health 2019; 15:38-43. [PMID: 30972141 PMCID: PMC6416466 DOI: 10.2174/1745017901915010038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | | | | | | | | | | | - Maria Carolina Hardoy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Mailman School of Public Health Columbia University, New York, NY 10027, USA
| | | | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Sancassiani F, Romano F, Balestrieri M, Caraci F, Di Sciascio G, Drago F, Hardoy MC, Moro MF, Roncone R, Piras M, Preti A, Dell’Osso L, Faravelli C, Carta MG. The Prevalence of Specific Phobia by Age in an Italian Nationwide Survey: How Much Does it Affect the Quality of Life? Clin Pract Epidemiol Ment Health 2019; 15:30-37. [PMID: 30972140 PMCID: PMC6407652 DOI: 10.2174/1745017901915010030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Filippo Caraci
- University of Catania,Catania,Italy
- I.R.C.C.S. Associazione Oasi Maria SS. ONLUS-Troina, Troina, Italy
| | | | | | | | - Maria Francesca Moro
- University of Cagliari,Cagliari,Italy
- Mailman School of Public Health Columbia University,Columbia, NY, US
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Carta MG, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Hardoy MC, D'Aloja E, Machado S, Roncone R, Faravelli C. The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy. Int J Soc Psychiatry 2015; 61:693-9. [PMID: 25770204 DOI: 10.1177/0020764015573848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sergio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Carta MG, Norcini-Pala A, Moro MF, Balestrieri M, Caraci F, Dell'Osso L, Sciascio GD, Faravelli C, Hardoy MC, Aguglia E, Roncone R, Nardi AE, Drago F. Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life. J Affect Disord 2015; 183:173-8. [PMID: 26021966 DOI: 10.1016/j.jad.2015.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
| | | | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Filippo Caraci
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Institute of Psychiatry, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carlo Faravelli
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Rita Roncone
- Department of Health, Life and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Antonio Egidio Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Drago
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
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Carta MG, Preti A, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, D'Aloja E, Cossu G, Calò S, Palumbo G, Bhugra D. Eating disorders as a public health issue: prevalence and attributable impairment of quality of life in an Italian community sample. Int Rev Psychiatry 2014; 26:486-92. [PMID: 25137115 DOI: 10.3109/09540261.2014.927753] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari , Italy
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Carta MG, Massidda D, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Calò S, Pollice R, Fortezzo A, Akiskal H. Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden. J Affect Disord 2014; 155:96-103. [PMID: 24238869 DOI: 10.1016/j.jad.2013.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Audrey Fortezzo
- International Mood Center, University of California, San Diego, USA
| | - Hagop Akiskal
- International Mood Center, University of California, San Diego, USA
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Carta MG, Angst J, Moro MF, Mura G, Hardoy MC, Balestrieri C, Chessa L, Serra G, Lai ME, Farci P. Association of chronic hepatitis C with recurrent brief depression. J Affect Disord 2012; 141:361-6. [PMID: 22609196 DOI: 10.1016/j.jad.2012.03.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Italy.
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Hardoy MC, Zamboni F, Mameli L, Calabrese JR. Self-injurious and aggressive behavior associated with a tacrolimus overdose. Psychosomatics 2012; 53:602-3. [PMID: 23157998 DOI: 10.1016/j.psym.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
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Carta MG, Aguglia E, Balestrieri M, Calabrese JR, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Lecca ME, Moro MF, Nardini M, Palumbo G, Hardoy MC. The lifetime prevalence of bipolar disorders and the use of antidepressant drugs in bipolar depression in Italy. J Affect Disord 2012; 136:775-80. [PMID: 22030133 DOI: 10.1016/j.jad.2011.09.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 09/04/2011] [Accepted: 09/28/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of bipolar spectrum disorders in the community is under debate and the prescription of antidepressant drugs (ADs) in bipolar depression appears to be an underestimated problem. OBJECTIVES To evaluate the prevalence of bipolar disorders by means of a screening instrument in seven communities within six regions of Italy and evaluate the appropriateness and number of prescriptions for ADs in bipolar depression. STUDY DESIGN community survey. STUDY POPULATION samples randomly drawn, after stratification from the adult population of municipal records. SAMPLE SIZE 4999 people from seven communities within six regions of Italy. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Mood Disorder Questionnaire (MDQ). Training: interviewers were trained psychologists or medical doctors. STUDY LIMITATIONS the population studied did not represent a nationally representative multistage clustered area probability sample of households. RESULTS 3398 subjects were interviewed (68% of recruited sample). Positivity at MDQ (MDQ+) was higher in males (3.4% vs. 2.8%) but the difference was not significant (OR=1.2, P=0.37). The association between MDQ+ and Major Depressive Disorder (MDD) was statistically significant for both males (OR=14.9, P<0.0001) and females (OR=8.3, P<0.001); 30% of subjects with MDQ+ and MDD lifetime diagnosis were taking ADs. CONCLUSIONS These overall rates of being MDQ+ are similar to community surveys conducted within USA and the use of ADs in people with MDQ+ and MDD diagnoses are.
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Abstract
SummaryAims - To present the results of an epidemiologic research about psychotropic drug use inSardinia. 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 byphysicians 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.Declaration of InterestMauro Giovanni Carta has received grants and research support from Regione Autonoma della Sardegna, Council of the European Union, European Union DGXII, GlaxoSmithKline, Pfizer, Lundbeck, Pharmacia, Recordati. Maria Carolina Hardoy has received grants and research support from University of Pisa, GlaxoSmithKline, Pfizer, Farmades. Bernardo Carpiniello has received grants and research support from GlaxoSmithKline, Pfizer, Recordati, Janssen Cilag, EliLilly, Astra Zeneca.
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Affiliation(s)
- Mauro Giovanni Carta
- Dipartimento di Sanità Pubblica, Sezione di Psichiatria, Università degli Studi di Cagliari, Via Liguria 13, 09123 Cagliari.
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Carta MG, Tondo L, Balestrieri M, Caraci F, dell'Osso L, Di Sciascio G, Faravelli C, Hardoy MC, Lecca ME, Moro MF, Bhat KM, Casacchia M, Drago F. Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder. BMC Psychiatry 2011; 11:164. [PMID: 21985128 PMCID: PMC3206417 DOI: 10.1186/1471-244x-11-164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Cagliari, Italy.
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matteo Balestrieri
- Inter-University Center for Behavioural Neurosciences, DPMSC, University of Udine, Udine, Italy
| | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Italy
| | - Liliana dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Guido Di Sciascio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Carlo Faravelli
- Department of Neurology and Psychiatry, Florence University, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, University of Cagliari, Cagliari, Italy,Department of Psychiatry, Reald University, Vlore, Albania
| | - Maria E Lecca
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | | | - Krishna M Bhat
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Massimo Casacchia
- Department of Science of Health, University of L'Aquila, L'Aquila, Italy
| | - Filippo Drago
- Department of Drug Sciences, University of Catania, Italy
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Hardoy MC, Seruis ML, Floris F, Sancassiani F, Moro MF, Mellino G, Lecca ME, Adamo S, Carta MG. Benefits of exercise with mini tennis in intellectual disabilities: effects on body image and psychopathology. Clin Pract Epidemiol Ment Health 2011; 7:157-60. [PMID: 22016751 PMCID: PMC3195809 DOI: 10.2174/1745017901107010157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Maria Carolina Hardoy
- Reald University Vlore, Albania, University of Cagliari, Italy
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
| | - Maria Luisa Seruis
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
| | - Francesca Floris
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
| | | | | | - Gisa Mellino
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
| | - Maria Efisia Lecca
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
| | - Siria Adamo
- Center for Liaison Psychiatry and Psychosomatics, University of Cagliari, Italy
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Hardoy MC, Cadeddu M, Serra A, Moro MF, Mura G, Mellino G, Bhat KM, Altoé G, Usai P, Piga M, Carta MG. A pattern of cerebral perfusion anomalies between major depressive disorder and Hashimoto thyroiditis. BMC Psychiatry 2011; 11:148. [PMID: 21910915 PMCID: PMC3184264 DOI: 10.1186/1471-244x-11-148] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/13/2011] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Alessandra Serra
- Department of Internal Medicine, University of Cagliari, Cagliari, Italy
| | | | - Gioia Mura
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Gisa Mellino
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Krishna M Bhat
- Department of Neuroscience & Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Gianmarco Altoé
- Department of Psychology, University of Cagliari, Cagliari, Italy
| | - Paolo Usai
- Department of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Mario Piga
- Department of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Mauro G Carta
- Department of Public Health, University of Cagliari, Cagliari, Italy
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Carta MG, Aguglia E, Bocchetta A, Balestrieri M, Caraci F, Casacchia M, Dell'osso L, Sciascio GD, Drago F, Faravelli C, Lecca ME, Moro MF, Morosini PL, Nardini M, Palumbo G, Hardoy MC. The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy. Clin Pract Epidemiol Ment Health 2010; 6:94-100. [PMID: 21253459 PMCID: PMC3023943 DOI: 10.2174/1745017901006010094] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/03/2010] [Accepted: 03/03/2010] [Indexed: 11/22/2022]
Abstract
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. Methods: 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.
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Hardoy MC, Carta MG. Strategy to Accelerate or Augment the Antidepressant Response and for An Early Onset of SSRI Activity. Adjunctive Amisulpride to Fluvoxamine in Major Depressive Disorder. Clin Pract Epidemiol Ment Health 2010; 6:1-3. [PMID: 20498696 PMCID: PMC2858520 DOI: 10.2174/1745017901006010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/01/2009] [Accepted: 11/01/2009] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Maria Carolina Hardoy
- Department of Public Health, Centre for Research and Clinical Practice in Mental Health, Iglesias, University of Cagliari, Italy
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Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health 2009; 5:15. [PMID: 19558652 PMCID: PMC2710332 DOI: 10.1186/1745-0179-5-15] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 06/26/2009] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
| | - Matteo Balestrieri
- Clinica di Psichiatria e PMD, Dipartimento di Patologia e Medicina Sperimentale, University of Udine, Udine, Italy
| | - Andrea Murru
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
| | - Maria Carolina Hardoy
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
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Carta MG, Hardoy MC, Fryers T. Are structured interviews truly able to detect and diagnose Bipolar II disorders in epidemiological studies? The king is still nude! Clin Pract Epidemiol Ment Health 2008; 4:28. [PMID: 19025594 PMCID: PMC2642514 DOI: 10.1186/1745-0179-4-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 11/21/2008] [Indexed: 11/29/2022]
Abstract
Introduction A research commentary published in 2005 pointed out that the apparently low prevalence of Bipolar Disorder diagnosis as reported by epidemiological studies may be related to the under-estimate of bipolar disorder cases generally yielded by methodological instruments that are applied in such investigations. New data apparently challenge this notion More recent publications have presented new results that apparently contradict the issues raised by the commentary, stating that the CIDI interview, which is used in the most important epidemiological studies is not only valid but highly reliable in identifying bipolar disorders. Commentary This paper analyzes the new data and concludes that they do not give a clear indication as to how reliably the CIDI can recognize undiagnosed bipolar disorder cases. Further research studies are needed on larger "negative" (to the CIDI) samples before the field will be persuaded that CIDI really does what it is supposed to do.
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Affiliation(s)
- Mauro Giovanni Carta
- Centro per la Terapia e la Ricerca in Salute Mentale, Dipartimento di Sanità Pubblica, Università di Cagliari, Cagliari, Italy.
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Hardoy MC, Sardu C, Dell'Osso L, Carta MG. The link between neurosteroids and syndromic/syndromal components of the mood spectrum disorders in women during the premenstrual phase. Clin Pract Epidemiol Ment Health 2008; 4:3. [PMID: 18302757 PMCID: PMC2311299 DOI: 10.1186/1745-0179-4-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 02/26/2008] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- Maria Carolina Hardoy
- Department of Public Health, Centre for Research and Clinical Practice in Mental Health, Iglesisas, University of Cagliari, Italy
| | - Claudia Sardu
- Department of Public Health, Centre for Research and Clinical Practice in Mental Health, Iglesisas, University of Cagliari, Italy
| | - Liliana Dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
| | - Mauro Giovanni Carta
- Department of Public Health, Centre for Research and Clinical Practice in Mental Health, Iglesisas, University of Cagliari, Italy
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Carta MG, Hardoy MC, Pilu A, Sorba M, Floris AL, Mannu FA, Baum A, Cappai A, Velluti C, Salvi M. Improving physical quality of life with group physical activity in the adjunctive treatment of major depressive disorder. Clin Pract Epidemiol Ment Health 2008; 4:1. [PMID: 18221549 PMCID: PMC2266746 DOI: 10.1186/1745-0179-4-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 01/26/2008] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health, University of Cagliari, Cagliari, Italy and University Center for Research and Clinical Practice in Mental Health, University of Cagliari (Cagliari) and ASL 7 Iglesias (Iglesias), Italy.
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Carta MG, Zairo F, Mellino G, Hardoy MC. Add-on quetiapine in the treatment of major depressive disorder in elderly patients with cerebrovascular damage. Clin Pract Epidemiol Ment Health 2007; 3:28. [PMID: 18039392 PMCID: PMC2228281 DOI: 10.1186/1745-0179-3-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 11/26/2007] [Indexed: 11/20/2022]
Abstract
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.
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Carta MG, Hardoy MC, Garofalo A, Pisano E, Nonnoi V, Intilla G, Serra G, Balestrieri C, Chessa L, Cauli C, Lai ME, Farci P. Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy. Clin Pract Epidemiol Ment Health 2007; 3:22. [PMID: 17956625 PMCID: PMC2203967 DOI: 10.1186/1745-0179-3-22] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Accepted: 10/23/2007] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Italy.
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Hardoy MC, Garofalo A, Mellino G, Tuligi F, Cadeddu M, Carta MG. Quetiapine as add-on treatment for bipolar I disorder: efficacy in preventing relapse of depressive episodes. Clin Pract Epidemiol Ment Health 2007; 3:17. [PMID: 17892548 PMCID: PMC2078585 DOI: 10.1186/1745-0179-3-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 09/24/2007] [Indexed: 11/14/2022]
Abstract
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 (χ2 = 24.8, P < 0.001), 6.7 for depressive episodes (χ2 = 24.7, P < 0.001), and 2.5 for manic or mixed episodes (χ2 = 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.
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Affiliation(s)
- Maria Carolina Hardoy
- Center for Epidemiology and Clinical Practice in Mental Health ASL 7 Iglesias, Italy and Department of Public Health, University of Cagliari, Italy
| | - Alessandra Garofalo
- Center for Epidemiology and Clinical Practice in Mental Health ASL 7 Iglesias, Italy and Department of Public Health, University of Cagliari, Italy
| | - Gisa Mellino
- Center for Epidemiology and Clinical Practice in Mental Health ASL 7 Iglesias, Italy and Department of Public Health, University of Cagliari, Italy
| | | | - Mariangela Cadeddu
- Center for Epidemiology and Clinical Practice in Mental Health ASL 7 Iglesias, Italy and Department of Public Health, University of Cagliari, Italy
- AUSL, Lanusei, Italy
| | - Mauro Giovanni Carta
- Center for Epidemiology and Clinical Practice in Mental Health ASL 7 Iglesias, Italy and Department of Public Health, University of Cagliari, Italy
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Pilu A, Sorba M, Hardoy MC, Floris AL, Mannu F, Seruis ML, Velluti C, Carpiniello B, Salvi M, Carta MG. Efficacy of physical activity in the adjunctive treatment of major depressive disorders: preliminary results. Clin Pract Epidemiol Ment Health 2007; 3:8. [PMID: 17620123 PMCID: PMC1976311 DOI: 10.1186/1745-0179-3-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/09/2007] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Alessandra Pilu
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Manlio Sorba
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
- Italian Society of Sport Psychiatry, Viale Merello 22, 09100, Cagliari, Italy
| | - Anna Laura Floris
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Francesca Mannu
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Maria Luisa Seruis
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Claudio Velluti
- Orthopedic Clinic, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
| | - Massimiliano Salvi
- Orthopedic Clinic, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Public Health, University of Cagliari, Via Porcell 4, 09100 Cagliari, Italy
- Italian Society of Sport Psychiatry, Viale Merello 22, 09100, Cagliari, Italy
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Carta MG, Cardia C, Mannu F, Intilla G, Hardoy MC, Anedda C, Ruggero V, Fornasier D, Cacace E. The high frequency of manic symptoms in fibromyalgia does influence the choice of treatment? Clin Pract Epidemiol Ment Health 2006; 2:36. [PMID: 17177985 PMCID: PMC1779782 DOI: 10.1186/1745-0179-2-36] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 12/19/2006] [Indexed: 11/10/2022]
Abstract
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. METHODS 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.
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Affiliation(s)
| | - Claudia Cardia
- Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Francesca Mannu
- Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Gesuina Intilla
- Psychiatry, Department of Public Health, University of Cagliari, Italy
| | | | - C Anedda
- Rheumatology, Department of Internal Medicine, University of Cagliari, Italy
| | - V Ruggero
- Rheumatology, Department of Internal Medicine, University of Cagliari, Italy
| | - D Fornasier
- Rheumatology, Department of Internal Medicine, University of Cagliari, Italy
| | - Enrico Cacace
- Rheumatology, Department of Internal Medicine, University of Cagliari, Italy
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Carta MG, Zairo F, Mellino G, Hardoy MC, Vieta E. An open label follow-up study on amisulpride in the add-on treatment of bipolar I patients. Clin Pract Epidemiol Ment Health 2006; 2:19. [PMID: 16930471 PMCID: PMC1560121 DOI: 10.1186/1745-0179-2-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 08/24/2006] [Indexed: 11/13/2022]
Abstract
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 (χ2 = 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, χ2 = 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.
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Affiliation(s)
| | - Fausta Zairo
- Department of Public Health, University of Cagliari, Italy
| | - Gisa Mellino
- Department of Public Health, University of Cagliari, Italy
| | | | - Eduard Vieta
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain
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Abstract
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.
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Carta MG, Reda MA, Consul ME, Brasesco V, Cetkovich-Bakmans M, Hardoy MC. Depressive episodes in Sardinian emigrants to Argentina: why are females at risk? Soc Psychiatry Psychiatr Epidemiol 2006; 41:452-6. [PMID: 16604272 DOI: 10.1007/s00127-006-0052-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2006] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Dept. of Public Health, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
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Carta MG, Hardoy MC, Cadeddu M, Murru A, Campus A, Morosini PL, Gamma A, Angst J. The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample. Clin Pract Epidemiol Ment Health 2006; 2:2. [PMID: 16524481 PMCID: PMC1420280 DOI: 10.1186/1745-0179-2-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 03/08/2006] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Carolina Hardoy
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Mariangela Cadeddu
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Andrea Murru
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Andrea Campus
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy
| | | | - Alex Gamma
- Zurich University Psychiatric Hospital, Psychiat. Uni. Klinik, PO Box 68, Lenggstrasse 31, CH-8029, Zurich, Switzerland
| | - Jules Angst
- Zurich University Psychiatric Hospital, Psychiat. Uni. Klinik, PO Box 68, Lenggstrasse 31, CH-8029, Zurich, Switzerland
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Carta MG, Hardoy MC, Carpiniello B, Murru A, Marci AR, Carbone F, Deiana L, Cadeddu M, Mariotti S. A case control study on psychiatric disorders in Hashimoto disease and Euthyroid Goitre: not only depressive but also anxiety disorders are associated with thyroid autoimmunity. Clin Pract Epidemiol Ment Health 2005; 1:23. [PMID: 16285879 PMCID: PMC1308833 DOI: 10.1186/1745-0179-1-23] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Accepted: 11/10/2005] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | | | - Bernardo Carpiniello
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Andrea Murru
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Anna Rita Marci
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Fiora Carbone
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Luca Deiana
- Department of Internal Medicine, University of Cagliari, Italy
| | - Mariangela Cadeddu
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
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Carta MG, Bernal M, Hardoy MC, Haro-Abad JM. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Health 2005; 1:13. [PMID: 16135246 PMCID: PMC1236945 DOI: 10.1186/1745-0179-1-13] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2005] [Accepted: 08/31/2005] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
| | - Mariola Bernal
- Unitat de Recerca i Desenvolupament, Hospital Sant Joan de Deu-SSM, Barcelona, Spain
| | | | - Josep Maria Haro-Abad
- Unitat de Recerca i Desenvolupament, Hospital Sant Joan de Deu-SSM, Barcelona, Spain
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Hardoy MC, Cadeddu M, Murru A, Dell'Osso B, Carpiniello B, Morosini PL, Calabrese JR, Carta MG. Validation of the Italian version of the "Mood Disorder Questionnaire" for the screening of bipolar disorders. Clin Pract Epidemiol Ment Health 2005; 1:8. [PMID: 16042762 PMCID: PMC1199611 DOI: 10.1186/1745-0179-1-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 07/21/2005] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Maria Carolina Hardoy
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
| | - Mariangela Cadeddu
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Andrea Murru
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
| | - Bernardo Carpiniello
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | | | - Joseph R Calabrese
- Case University School of Medicine Director, Mood Disorders Program, University Hospitals of Cleveland, USA
| | - Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
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Hardoy MC, Garofalo A, Carpiniello B, Calabrese JR, Carta MG. Combination quetiapine therapy in the long-term treatment of patients with bipolar I disorder. Clin Pract Epidemiol Ment Health 2005; 1:7. [PMID: 16026618 PMCID: PMC1188063 DOI: 10.1186/1745-0179-1-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Accepted: 07/18/2005] [Indexed: 11/10/2022]
Abstract
Objective Determine the long-term effectiveness of quetiapine in combination with standard treatments in preventing relapses for patients with bipolar I disorders Method Twenty-one outpatients with type I bipolar disorder who had inadequate responses to ongoing standard therapies were treated with add-on quetiapine in an open-label study. The quetiapine dose was increased until clinical response occurred. Illness response was assessed using the Clinical Global Impression (CGI) scale. Relapse rates before and during quetiapine treatment were compared by calculating incidence risk ratios. Results Quetiapine was added to ongoing standard therapy for 26 to 78 weeks. Thirteen patients received combination therapy for at least 52 weeks. The mean quetiapine dose received was 518 ± 244 mg/day. There were highly significant improvements in overall relapse rate, manic/mixed relapse rate, and depression relapse rate in the period during quetiapine treatment compared with the period before quetiapine was initiated. The calculated relative risk of relapse in the absence of quetiapine treatment was 2.9 overall (95% confidence interval, 1.5~5.6), 3.3 for manic/mixed relapse (95% confidence interval, 1.5~7.1), and 2.4 for depressive relapse (95% confidence interval, 1.3~4.4). The mean Clinical Global Impression scores improved significantly from baseline during 26 weeks of quetiapine treatment in 21 patients (p = 0.002) and remained significantly better during a 52-week treatment period in 13 patients (p = 0.036). Conclusion Long-term treatment with quetiapine combination therapy reduced the probability of manic/mixed and depressive relapses and improved symptoms in patients with bipolar I disorder who had inadequate responses to ongoing standard treatment.
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Affiliation(s)
- MC Hardoy
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Alessandra Garofalo
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Bernardo Carpiniello
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - JR Calabrese
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - MG Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
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Carta MG, Hardoy MC. Why a new online open access journal in the field of clinical and epidemiological research in mental health? Clin Pract Epidemiol Ment Health 2005; 1:1. [PMID: 15967051 PMCID: PMC1151593 DOI: 10.1186/1745-0179-1-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/27/2005] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
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Hardoy MC, Carta MG, Marci AR, Carbone F, Cadeddu M, Kovess V, Dell'Osso L, Carpiniello B. Exposure to aircraft noise and risk of psychiatric disorders: the Elmas survey--aircraft noise and psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 2005; 40:24-6. [PMID: 15624071 DOI: 10.1007/s00127-005-0837-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2004] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Maria Carolina Hardoy
- Division of Psychiatry, Dept. of Public Health, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
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Carta MG, Kovess V, Hardoy MC, Brugha T, Fryers T, Lehtinen V, Xavier M. Psychosocial wellbeing and psychiatric care in the European Communities: analysis of macro indicators. Soc Psychiatry Psychiatr Epidemiol 2004; 39:883-92. [PMID: 15549240 DOI: 10.1007/s00127-004-0871-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2004] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Mauro G Carta
- Psychiatric Unit, Dept. of Public Health, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
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Carta MG, Hardoy MC, Cadeddu M, Carpiniello B, Dell'Osso L, Reda MA, Wittchen HU. Social Phobia in an Italian region: do Italian studies show lower frequencies than community surveys conducted in other European countries? BMC Psychiatry 2004; 4:31. [PMID: 15488146 PMCID: PMC535931 DOI: 10.1186/1471-244x-4-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Accepted: 10/15/2004] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Maria Carolina Hardoy
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
| | - Mariangela Cadeddu
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Bernardo Carpiniello
- Division of Psychiatry, Department of Public Health, University of Cagliari, Italy
| | - Liliana Dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
| | - Mario Antonio Reda
- Division of Behavioural Sciences, Department of Neurological and Behavioural Sciences, University of Siena, Italy
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Carta MG, Loviselli A, Hardoy MC, Massa S, Cadeddu M, Sardu C, Carpiniello B, Dell'Osso L, Mariotti S. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry 2004; 4:25. [PMID: 15317653 PMCID: PMC516779 DOI: 10.1186/1471-244x-4-25] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 08/18/2004] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health, Division of Psychiatry, University of Cagliari, Italy
| | | | - Maria Carolina Hardoy
- Department of Public Health, Division of Psychiatry, University of Cagliari, Italy
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
| | - Sergio Massa
- Department of Public Health, Division of Psychiatry, University of Cagliari, Italy
| | - Mariangela Cadeddu
- Department of Public Health, Division of Psychiatry, University of Cagliari, Italy
| | - Claudia Sardu
- Department of Public Health, University of Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Division of Psychiatry, University of Cagliari, Italy
| | - Liliana Dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Italy
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Hardoy MC, Carta MG, Catena M, Hardoy MJ, Cadeddu M, Dell'Osso L, Hugdahl K, Carpiniello B. Impairment in visual and spatial perception in schizophrenia and delusional disorder. Psychiatry Res 2004; 127:163-6. [PMID: 15261715 DOI: 10.1016/j.psychres.2004.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 03/09/2004] [Accepted: 03/15/2004] [Indexed: 10/26/2022]
Abstract
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.
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Carta MG, Hardoy MC, Dell'Osso L, Carpiniello B. [Tardive dyskinesia: review of the literature]. Clin Ter 2004; 155:127-33. [PMID: 15354761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
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.
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Affiliation(s)
- M G Carta
- Divisione di Psichiatria, Dipartimento di Igiene e Sanità Pubblica, Università di Cagliari, Italia.
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Carta MG, Hardoy MC, Ducci F, Catena M, Dell'Osso L, Carpiniello B. Gabapentin in the treatment of bipolar depression in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2004; 22:266. [PMID: 15083900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Via Liguria 1309127, Cagliari, Italy.
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Carta MG, Hardoy MC, Kovess V, Dell'Osso L, Carpiniello B. Could health care costs for depression be decreased if the disorder were correctly diagnosed and treated? Soc Psychiatry Psychiatr Epidemiol 2003; 38:490-2. [PMID: 14504731 DOI: 10.1007/s00127-003-0662-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to assess the general population from two Sardinian areas to ascertain the direct health care costs involved in a diagnosis of major depression, and to verify the hypothesis of an increased expenditure for untreated depressed subjects. DESIGN A case-control study was carried out using the database of an epidemiological community survey. Cases were subjects with a diagnosis of Major Depressive Episode (ICD-10, WHO 1992) in the last year, and controls comprised two groups matched to cases for sex and age, made up of healthy subjects and subjects affected by chronic somatic disorders, respectively. RESULTS Depressed subjects use more health care resources than those affected by chronic somatic disorders or healthy subjects. An increase in health care costs is observed for drugs and hospitalisations in depressed subjects for whom no adequate antidepressive treatment has been prescribed. CONCLUSIONS In spite of the limitations of the small sample size, the results seem to confirm an increase of direct health care costs in untreated depressed subjects. In view of the availability of efficient forms of treatment for depression, the findings obtained indicate that depression should be considered a priority question for public health and assigning of resources. Further confirmation should be sought in larger population-based studies representing the entire national context.
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Affiliation(s)
- M G Carta
- Psychiatric Unit, Dept. of Public Health, University of Cagliari, Via Liguria 13, 09127, Cagliari, Italy.
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Hardoy MC, Carta MG, Carpiniello B, Cianchetti C, Congia S, D'Errico I, Emanuelli G, Garonna F, Hardoy MJ, Nardini M. Gabapentin in antipsychotic-induced tardive dyskinesia: results of 1-year follow-up. J Affect Disord 2003; 75:125-30. [PMID: 12798252 DOI: 10.1016/s0165-0327(02)00043-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In a previous study, improvement of antipsychotic-induced blefarospasm and involuntary oral-mandibulo movements were observed with the use of the anticonvulsant drug gabapentin among affectively ill patients who had been exposed to maintenance neuroleptics. The results reported in the present paper represent the sequel to the previous study. METHODS The purported efficacy of gabapentin in the treatment of tardive dyskinesia has been assessed in an open design 1-year follow-up study, in which 30 schizoaffective, bipolar I and schizophrenic patients from seven Italian centres were evaluated by means of AIMS. The results showed a statistically significant time-related decrease in AIMS scores. The mean percentage of improvement at AIMS was 47.5+/-18.2%. An improvement of more than 35% after 1 year in 76% of the subjects who completed the trial (n=25) and in 63.3% of the entire sample admitted to the study was revealed. LIMITATION Open trial. CONCLUSION The introduction of new antipsychotic drugs has probably already limited the problems related to tardive dyskinesia. However, this type of side-effect is also observed during the course of treatment with atypical neuroleptics albeit with a lesser frequency. The fact that gabapentin treatment may have further improved clinical conditions of patients in whom therapeutic protocols had already been modified, appears to suggest exertion of a possible synergic action by the new neuroleptics on tardive dyskinesia.
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Affiliation(s)
- Maria Carolina Hardoy
- Division of Psychiatry, Department of Public Health, University of Cagliari, Via Liguria 13, 09127, Cagliari, Italy
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Abstract
BACKGROUND with increasing awareness of lithium's limitations, several new anticonvulsants had been tested for their mood stabilisation during recent years. Among the innovative third generation mood stabilizing anticonvulsants, gabapentin (GBP) seems to have a broad spectrum of efficacy, although no certain data are available as to its efficacy and use in clinical practice. Accordingly, an extensive review on this subject has been carried out. METHODS A computer-generated search of the biomedical literature and abstract books of the more important scientific psychiatric congresses until June 2000 was undertaken to identify all pertinent case reports, case series and studies of GBP as monotherapy or adjunctive therapy in mood disorders. We identified 40 open-label studies on the use of GBP in at least 600 patients with bipolar disorder (BP), manic, depressed, or mixed episodes and unipolar depression and four controlled studies. RESULTS The 40 open-label studies and two of the controlled trials suggested that GBP may have a role as adjunctive agent in the treatment of patients with bipolar disorders particularly when complicated by co-morbid anxiety disorder or substance abuse. GBP is usually very well tolerated and has no pharmacological interference with other mood stabilisers. However, in the other two double-blind studies GBP has not been found to be efficacious in the treatment of refractory mania or refractory bipolar depression. CONCLUSIONS Although failing to show clear antimanic efficacy in randomized trials, gabapentin still remains a clinically useful agent when it comes to combination treatment in refractory and co-morbid patients.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
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Carta MG, Altamura AC, Hardoy MC, Pinna F, Medda S, Dell'Osso L, Carpiniello B, Angst J. Is recurrent brief depression an expression of mood spectrum disorders in young people? Results of a large community sample. Eur Arch Psychiatry Clin Neurosci 2003; 253:149-53. [PMID: 12904979 DOI: 10.1007/s00406-003-0418-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2002] [Accepted: 03/31/2003] [Indexed: 10/26/2022]
Abstract
The clinical relevance of Recurrent Brief Depression (RBD) has not received sufficient attention to date and continues to represent a controversial issue. The present study was carried out in a community sample to evaluate the lifetime prevalence of RDB, the degree of comorbidity, as well as possible risk factors. Subjects from a community survey in Sardinia (Italy) were randomly selected from registers of a rural, an urban and a mining area (n=1040, 461 males, 579 females). Interviews were carried out by physicians using the Italian version of the Composite International Diagnostic Interview Simplified which had been modified for the purpose of this study. Lifetime prevalence of RBD was 7.6%; 5.8% in males, 9% in females. Subjects aged 18 to 24 years presented higher frequencies (13.8%, OR 2.2) than those aged 25 or over. Comorbidity with Major Depression was particularly frequent. RBD was furthermore associated with suicide attempts and substance abuse, thereby constituting an effective health problem. Further epidemiological and clinical studies of RBD are warranted in order to develop specific treatments and prevention strategies.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health University of Cagliari, Via Liguria 13, 09127, Cagliari, Italy.
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Carta MG, Hardoy MC, Boi MF, Mariotti S, Carpiniello B, Usai P. Association between panic disorder, major depressive disorder and celiac disease: a possible role of thyroid autoimmunity. J Psychosom Res 2002; 53:789-93. [PMID: 12217453 DOI: 10.1016/s0022-3999(02)00328-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the association between celiac disease and specific anxiety and depressive disorders and to identify potential common pathogenetic links, with particular regard to thyroid function and autoimmunity. METHODS Cases included 36 adult celiac patients, 25 females and 11 males, aged 18-64 years. Controls comprised 144 healthy subjects matched by sex and age with no clinical evidence or family history of celiac disease. Diagnosis of celiac disease was made on the basis of clinical history and serological criteria. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview, according to DSM-IV criteria. Thyroid was evaluated by palpation, echography and measurement of serum-free thyroid hormones (FT4, FT3), thyroid-stimulating hormone (TSH) and antithyroid autoantibodies (anti-TPO). RESULTS Compared to controls, a significantly higher number of celiac patients met criteria for lifetime [15 (41.7%) versus 30 (29.8%), P < .01] and 6-month [7 (19.4%) versus 9 (6.2%), OR = 3.2, chi(2) = 5.2, P < .05] major depressive disorder (MDD) and lifetime [5 (13.9%) versus 3 (2.1%), P < .001] and 6-month [3 (8.1%) versus 2 (1.4%), P < .05] panic disorder (PD). Anti-TPO prevalence was significantly higher in celiac patients than in the control group (11/36 = 30.5% versus 14/144 = 9.7%, P < .001). A higher frequency of PD and MDD was found in celiac patients with positive anti-TPO when compared to negative anti-TPO patients (4/11 = 36.4% PD in TPO+ versus 1/25 = 4% PD in TPO-, P < .01; 9/11 = 81.8% MD in TPO+ versus 6/25 = 9.5% MD in TPO-, P < .01). CONCLUSION Patients affected by celiac disease tend to show a high prevalence of PD and MDD and association with subclinical thyroid disease appears to represent a significant risk factor for these psychiatric disorders.
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Affiliation(s)
- Mauro Giovanni Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
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Carta MG, Serra P, Ghiani A, Manca E, Hardoy MC, Del Giacco GS, Diaz G, Carpiniello B, Manconi PE. Chemokines and pro-inflammatory cytokines in Down's syndrome: an early marker for Alzheimer-type dementia? Psychother Psychosom 2002; 71:233-6. [PMID: 12097789 DOI: 10.1159/000063649] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND People with Down's syndrome (DS) show early Alzheimer-like dementia. It has been suggested that the pro-inflammatory cytokine class plays a role in Alzheimer's disease (AD). The study aims at verifying whether pro-inflammatory cytokines in DS are correlated with age, affective symptoms and intellectual decline to a different degree than in subjects with non-DS learning disabilities. CASES 19 subjects with DS; controls: sex- and age-matched individuals with learning disabilities caused by perinatal ischaemic damage. The level of mental retardation was assessed according to DSM-IV; psychopathological symptoms were measured by the Assessment and Information Rating Profile. Serum levels of cytokines were determined with ELISA. RESULTS DS patients showed higher levels of cytokines and chemokines, with the exception of RANTES; but the only significant difference detected was for MIP-1alpha. A correlation between the degree of mental retardation and IL-6, and between MIP-lalpha and age was found in patients with DS, but not in controls. CONCLUSIONS The data obtained suggest a possible involvement of chemokines in the inflammatory and degenerative processes similar to AD in DS. Further longitudinal research is required to confirm these findings.
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Affiliation(s)
- Mauro G Carta
- Division of Psychiatry, Department of Public Health, University of Cagliari, Cagliari, Italy.
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