Exploring depression in adolescents: How depression changes in early onset psychosis (EOP), clinical high risk (UHR) and clinical control (CC) patients

Introduction

Depression is very common in adolescent patients and impacts on their quality of life and functioning. Indeed, depression is an important clinical aspect for treatment, outcome, and prognosis.

Objectives

This pilot study investigated the factorial structure of the Calgary depression scale for schizophrenia (CDSS) in a sample of help seeking adolescent patients, stratified in three clinical diagnostic subgroups: early onset psychosis (EOP), clinical high risk (UHR) and clinical control (CC). The relationships between these factors and SIPS domains and subjective experiences were also explored.

Methods

Sixty-nine subjects were examined to assess the severity of depressive symptoms and the degree of subjectively felt cognitive-affective vulnerability (i.e. basic symptoms)

Results

Principal component analysis revealed CDSS to include two main factors, namely: “guilty idea of reference-pathological guilt” (factor I), “depression-hopelessness” (factor II). Two factors revealed multiple correlations with SIPS domains and subjective experiences.

Conclusions

The results confirm the dual factorial structure of CDSS previously reported in the literature in adult samples, further increase our knowledge of the psychopathological components of depression in adolescents, and strongly suggest that CDSS can also be used in early diagnostic settings

Disclosure

No significant relationships.

Demographic and Clinical Characteristics, Including Subsyndromal Symptoms Across Bipolar-Spectrum Disorders in Adolescents

Objectives: Bipolar disorder (BD) is a debilitating illness that often starts at an early age. Prevention of first and subsequent mood episodes, which are usually preceded by a period characterized by subthreshold symptoms is important. We compared demographic and clinical characteristics including severity and duration of subsyndromal symptoms across adolescents with three different bipolar-spectrum disorders. Methods: Syndromal and subsyndromal psychopathology were assessed in adolescent inpatients (age = 12-18 years) with a clinical mood disorder diagnosis. Assessments included the validated Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P). We compared phenomenology across patients with a research consensus conference-confirmed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnoses of BD-I, BD-not otherwise specified (NOS), or mood disorder (MD) NOS. Results: Seventy-six adolescents (age = 15.6 ± 1.4 years, females = 59.2%) were included (BD-I = 24; BD-NOS = 29; MD-NOS = 23) in this study. Median baseline global assessment of functioning scale score was 21 (interquartile range = 17-40; between-group p = 0.31). Comorbidity was frequent, and similar across groups, including disruptive behavior disorders (55.5%, p = 0.27), anxiety disorders (40.8%, p = 0.98), and personality disorder traits (25.0%, p = 0.21). Mania symptoms (most frequent: irritability = 93.4%, p = 0.82) and depressive symptoms (most frequent: depressed mood = 81.6%, p = 0.14) were common in all three BD-spectrum groups. Manic and depressive symptoms were more severe in both BD-I and BD-NOS versus MD-NOS (p < 0.0001). Median duration of subthreshold manic symptoms was shorter in MD-NOS versus BD-NOS (11.7 vs. 20.4 weeks, p = 0.002) and substantial in both groups. The most used psychotropics upon discharge were antipsychotics (65.8%; BD-I = 79.2%; BD-NOS = 62.1%; MD-NOS = 56.5%, p = 0.227), followed by mood stabilizers (43.4%; BD-I = 66.7%; BD-NOS = 31.0%; MD-NOS = 34.8%, p = 0.02) and antidepressants (19.7%; BD-I = 20.8%; BD-NOS = 10.3%; MD-NOS = 30.4%). Conclusions: Youth with BD-I, BD-NOS, and MD-NOS experience considerable symptomatology and are functionally impaired, with few differences observed in psychiatric comorbidity and clinical severity. Moreover, youth with BD-NOS and MD-NOS undergo a period with subthreshold manic symptoms, enabling identification and, possibly, preventive intervention of those at risk for developing BD or other affective episodes requiring hospitalization.

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = -0.17 to -0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r ² = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults

AIM

The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization.

METHODS

The study sample consisted of 147 help-seeking adolescents (mean age 17 years) selected after a screening phase (Prodromal Questionnaire) and evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). All participants were specifically asked if they had experienced either psychological bullying or physical bullying, and they completed the Interpersonal Sensitivity Measure (IPSM).

RESULTS

Of the whole sample, 30 (20%) participants had experienced psychological bullying or physical bullying at least once in their life. Performing a multiple regression, bullying victimization was found to be an independent predictor of subtle paranoid ideation and suspiciousness. Interpersonal sensitivity was also found to be an independent predictor of subtle paranoid ideation; in particular, two IPSM subscales, fragile inner-self and separation anxiety, showed a significant correlation with subtle paranoid ideation.

CONCLUSIONS

Our results confirmed that bullying victimization is a negative interpersonal experience associated with paranoid ideation and suspiciousness. However, being overly sensitive and having negative beliefs about the self as fragile and vulnerable to threat also lead to a tendency to attribute experiences as externally caused and, in turn, facilitate the formation and maintenance of paranoid ideation.

Youth mental health services in Italy: An achievable dream?

AIM

"Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology.

METHOD

All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline.

RESULTS

A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline.

CONCLUSIONS

LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged.

Interpersonal sensitivity and persistent attenuated psychotic symptoms in adolescence

Interpersonal sensitivity defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. Interpersonal sensitivity was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of interpersonal sensitivity at baseline are associated with the persistence of attenuated positive psychotic symptoms and general psychopathology at 18-month follow-up. A sample of 85 help-seeking individuals (mean age = 16.6, SD = 5.05) referred an Italian early detection project, completed the interpersonal sensitivity measure and the structured interview for prodromal symptoms (SIPS) at baseline and were assessed at 18-month follow-up using the SIPS. Results showed that individuals with high level of interpersonal sensitivity at baseline reported high level of attenuated positive psychotic symptoms (i.e., unusual thought content) and general symptoms (i.e., depression, irritability and low tolerance to daily stress) at follow-up. This study suggests that being "hypersensitive" to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms and general symptoms, such as depression and irritability, at 18-month follow-up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms.

Impairment in Social Functioning differentiates youth meeting Ultra-High Risk for psychosis criteria from other mental health help-seekers: A validation of the Italian version of the Global Functioning: Social and Global Functioning: Role scales

Social and occupational impairments are present in the schizophrenia prodrome, and poor social functioning predicts transition to psychosis in Ultra-High Risk (UHR) individuals. We aimed to: 1) validate the Italian version of the Global Functioning: Social (GF: S) and Global Functioning: Role (GF: S) scales; 2) evaluate their association with UHR criteria. Participants were 12-21-years-old (age, mean=15.2, standard deviation=2.1, male/female ratio=117/120) nonpsychotic help-seekers, meeting (N=39) or not (N=198) UHR criteria. Inter-rater reliability was excellent for both scales, which also showed good to excellent concurrent validity, as measured by correlation with Global Assessment of Functioning (GAF) scores. Furthermore, GF:S and GF: R were able to discriminate between UHRs and non-UHRs, with UHRs having lower current scores. After adjusting for current GAF scores, only current GF:S scores independently differentiated UHR from non-UHR (OR=1.33, 95%CI: 1.02-1.75, p=0.033). Finally, UHR participants showed a steeper decrease from highest GF:S and GF: R scores in the past year to their respective current scores, but not from highest past year GAF scores to current scores. GF:S/GS: R scores were not affected by age or sex. GF:S/GF: R are useful functional level and outcome measures, having the advantage over the GAF to not confound functioning with symptom severity. Additionally, the GF:S may be helpful in identifying UHR individuals.

Prevalence and implications of Truman symptoms in subjects at ultra high risk for psychosis

Preliminary qualitative research has suggested that patients with early stages of psychosis and those at Ultra High Risk (UHR) may experience "Truman symptoms" (TS). This study is an exploratory investigation of TS in a sample of 26 UHR subjects and 14 matched controls (HC) recruited from three prodromal and early intervention clinics and its relation with clinical features, depersonalization and basic self-disturbances. The UHR were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS), Social and Occupational Functioning Assessment Scale (SOFAS), the Positive and Negative Syndrome Scale (PANSS), the Cambridge Depersonalization Scale (CDS) and the Examination of Anomalous Self Experiences (EASE) checklist. In our sample, TS were specific (TS absent in HC) and highly prevalent (50%) in UHR subjects. We found a significant difference in EASE total scores across HC, UHR with TS and without TS but post-hoc analyses showed similar scores in the two latter groups. The presence of TS in our UHR sample was associated with significant higher PANSS general psychopathology but with non-significant difference in the CAARMS, CDS and SOFAS scores. This study of TS in UHR subjects suggested that they might be prevalent and specific of this population.

Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis

BACKGROUND

The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment.

AIMS

To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.

METHOD

Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).

RESULTS

People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.

CONCLUSIONS

Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.

Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up

BACKGROUND

The long-term functional status of subjects at ultra high risk for psychosis (HR) is relatively under investigated. This study explores baseline predictors of long-term functional outcome in HR subjects who did not convert to psychosis during a 6 years follow-up period.

METHODS

A total of 154 HR were followed up for an average of 6 years. The primary outcome variable was global assessment of functioning at the last follow-up visit as assessed with the Global Assessment of Functioning tool. A multinomial logistic regression was performed to identify potential predictors of functional outcome.

RESULTS

Baseline and follow-up data on functioning was available for 92 HR. Twenty-four (43%) individuals who did not convert to psychosis reported poor functioning at follow-up. Baseline scores in the GAF (Exp(b) = 0.857; 95% CIs: 0.75/0.97), employment status (Exp(b) = 0.029; 95% CIs: 0.00/0.268), and CAARMS total scores (Exp(b) = 1.976; 95% CIs: 1.00/1.14) predicted functional outcome in HR subjects at 6 years.

CONCLUSIONS

Despite the preventive treatments received, many individuals who did not convert to full-blown psychosis in the longer term do not functionally remit. These individuals are lower functioning, unemployed and have higher symptom loading at the time of their presentation to the prodromal clinic. Our study suggests the need for innovative treatments targeting long term functional status beyond the prevention of psychosis onset in the HR population.

Self-reported attenuated psychotic-like experiences in help-seeking adolescents and their association with age, functioning and psychopathology

OBJECTIVE

Self-rated attenuated psychotic-like experiences (APLEs) are increasingly used to screen for ultra-high-risk (UHR) across all ages. However, self-rated psychotic-like experiences (PLEs), in particular perception-related ones, were more frequent in children and adolescents, in which they possessed less clinical significance. We therefore explored the prevalence of different factors of APLEs in help-seeking adolescents, and their relationship with age, functioning and psychopathology.

METHOD

As a part of the "Liberiamo il Futuro" project, help-seeking adolescents (N=171; 11-18 years, 53% male) were screened with the 92-item Prodromal Questionnaire (PQ-92). A factor analysis was performed on the PQ-92 positive items (i.e., APLEs) to identify different APLE-factors. These were assessed for their association with age, functioning and psychopathology using regression analyses.

RESULTS

APLEs were very common in help-seeking adolescents, and formed four factors: "Conceptual Disorganization and Suspiciousness", "Perceptual Abnormalities", "Bizarre Experiences", and "Magical Ideation". Associations with age and functioning but not psychopathology were found for "Perceptual Abnormalities" that was significantly more severe in 11-12-year-olds, while "Conceptual Disorganization and Suspiciousness" was significantly related to psychopathology.

CONCLUSION

In line with findings on PLEs, prevalence and clinical significance of APLEs, especially perception-related ones, might depend on age and thus neurodevelopmental stage, and may fall within the normal spectrum of experience during childhood. This should be considered when screening for UHR status in younger age groups.

Validation of the Italian version of interpersonal sensitivity measure (IPSM) in adolescents and young adults

BACKGROUND

Interpersonal sensitivity is a personality trait that describes as excessive awareness of both the behaviour and feelings of others. High interpersonal sensitivity has been associated with the development and maintenance of mental health problems. This study aimed to examine whether the Italian version of the interpersonal sensitivity measure (IPSM) has good internal consistence and convergent validity.

METHODS

Validity was established on a sample of 153 Italian adolescents and young adult help seekers for several psychological problems. These subjects were divided in two groups - depressive spectrum disorder group (n=42) and other diagnosis group (n=111) - according to Structured Clinical Interview (SCID-I) for DSM-IV and Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). For convergent validity, we studied the correlation between total and each subscale IPSM scores and the General Symptoms (included depressive and dysphoric symptoms) of Prodromal Questionnaire.

RESULTS

The internal consistency were adequate and comparable to the original Boyce and Parker study. The validity was good, as indicated by both the convergent validity analysis and the depressive spectrum disorder group and other diagnosis group comparison.

LIMITATIONS

The absence of another scale measuring interpersonal sensitivity to assess the construct validity of IPSM; the clinical heterogeneity of the sample; the absence of test re-test reliability of the instrument.

CONCLUSIONS

Analysis of the results of internal consistency and convergent validity of the IPSM indicates that this version translated into Italian is valid and reliable.

[Subtypes of psychotic-like experiences in a community sample of young adults: socio-demographic correlates and substance use]

AIM

This study aimed to investigate if particular psychotic-like experiences (PLEs) subtypes were more likely to be associated with a series of socio-demographic variables, with alcohol abuse and with cannabis or illicit drug use. The idea is to further characterize different PLEs subtypes in order to discloud their individual nature.

METHODS

A cross-sectional design was conducted on a sample of 997 university students aged between 19 and 26 years, which belonged to 4 faculties of 2 different universities. Alcohol abuse and cannabis or illicit drug use were assessed using a self-report questionnaire; PLEs were assessed using the Community Assessment of Psychic Experiences. Cases were randomized in order to obtain equipotent groups; then, an analysis of the probable dependence relations between PLEs subtypes and other variables was conducted using analysis of variance models.

RESULTS

Persecutory ideas (PI) and bizarre experiences were more frequent within females and non-resident students, moreover PI were more frequent within younger subjects (<20 years). Magical thinking was significantly associated to a more frequent cannabis use in the last year (>1/month).

CONCLUSIONS

These results confirm usefulness and validity of a "subtype approach" to PLEs. In fact PLEs subtypes may have, not only a different clinical presentation, but even different epidemiological and psychopathological ones.

[Drop-out risk factors in mood disorder: a clinical study]

INTRODUCTION

The aims of this study are (i) to assess the drop-out rate in an outpatient sample with mood disorder diagnosis in a psychotherapy unit; (ii) to focus clinical and sociodemographic variables related with drop-out; (iii) to delineate a psychopathological profile of the dropping-out patient through the SCL-90-R and OPD scores.

METHOD

The sample of this study includes 90 depressive patients, which came to our service for a psychotherapy. The outcome is classified as drop-out and non drop-out. Each patient is submitted to the multidimensional scale SCL-90-R in the course of the first interview. At the end of the first visit each patient has been evaluated through the first and the fourth OPD axis. A descriptive analysis of all the data collected was made and the principal links between clinical and sociodemographic variables and dropout, between SCL-90-R score and drop-out, and between OPD scores and drop-out were detected.

RESULTS

About 42% of the patients were drop-out, of which 89% by the third session. The variables associated with drop-out are: pathological score in the paranoic and interpersonal sensibility scale of SCL-90-R, low compliance scores, low integration of defences, self perception, object's perception and link.

DISCUSSION

The drop-out rate in depressive patients turned out to be frequent. The patient's resources in terms of relationship, self-perception and object's perception are strongly related to the drop-out risk. These results are suggestive for the idea that the evaluation of drop-out risk in psychiatric patients must considerate the subjective aspects of the patient besides the clinical features.

[Diagnostic interpretation of depressive symptoms from a psychodynamic point of view]

AIMS

The principal aim of this study is: (i) to assess the rate of depressive disorders in a sample of patient in a psychotherapy service of the Department of Psychiatric Sciences and Psychological Medicine at the Sapienza University, Roma; (ii) to focus the psychopathological features of depressive patient through the SCL-90R scale; (iii) to evaluate the correlation between SCL-90R score and categorical diagnosis.

MATERIALS AND METHODS

The sample of this study includes 178 patients, who came to our service for a psychotherapy. The anamnestic and clinical information were collected for each patient. Each patient is submitted to the multidimensional scale SCL-90R in the curse of the first interview. A descriptive analysis of all the data collected was made and the principal links between SCL-90 R score and categorical diagnosis were detected.

RESULTS

About 46% of the patients were depressive disorders following the DSM-IVTR diagnostic criteria. About 70% of depressive patients have psychoticism pathological scores, 60% have paranoic pathological scores, 70% anxiety pathological scores and 60% interpersonal sensibility pathological scores. The depressive dimension was pathological in about 77% of anxious patient and in 87% of patient with personality disorders.

CONCLUSIONS

The DSM.IVTR categorical psychiatric diagnosis might underestimate important psychopathological dimensions which are underline through a dimensional scale as the SCL-90R and through a psychodynamic diagnostic instrument.

[Characteristics in a sample of criminal mental hospital (Castiglione delle Stiviere) inmates discharged in the Lazio region]

AIM. The aim of this study was: (i) To identify socio-demographic and clinical data in a sample of inmates in the Criminal Mental Hospital (CMH) at Castiglione delle Stiviere; (ii) to assess the presence of characteristics which could foresee the commission of a crime of psychiatric interest; (iii) to assess the frequency of crime repetition.

MATERIALS AND METHODS

This study was carried out on a sample of 38 patients. A descriptive analysis of the sample was carried out and the associations among several variables were analyzed.

RESULTS

The sample is characterized by a high frequency of schizophrenia diagnosis (73.0%), the presence of hospitalization before the commission of the crime (68.4%) and the absence of criminal precedents (71.1%). For men the age of the commission of the crime is equal to 33.72 +/- 10.6 years and for women to 45.18 +/- 11.4 years (p = 0.011). The time between the onset and the commission of the crime is longer in patients who have received therapy (treatment) than in those ones with no treatment (p = 0.012). About 12% of the sample committed new crimes.

CONCLUSIONS

The results showed previous criminal acts are not predictive for the commission of new crimes of psychiatric interest. However many patients had previous contacts with community facilities before their first admission to hospital and the treatment extended the interval between the onset of the disease and the commission of the crime. The relapse rate after the discharge was very low if compared with samples coming from other services that offered more custodial rather than rehabilitative facilities.

[Management of combined psychotherapy and pharmacological treatment. A 'cross sectional' study on a selected sample of psychiatrists]

AIMS

The association between pharmacological treatment and psychotherapy is frequent. However doesn't exist any agreement or guide-line about the management of this combined therapy. Therefore we considered useful to evaluate which were the most frequent way of management of the combined therapy in a sample of 120 psychiatrists.

MATERIALS AND METHODS

A 10-items questionnaire finalized to explore the management way of the combined therapy was administered to a sample of 120 psychiatrists. A descriptive analysis of the data was made and the association between different variables was explored. The statistical analysis was performed using SPSS 13.0.

RESULTS

35% of the sample work as a private practitioner, 19.17% is involved in public health (CMHT'S). More than 50% of the sample consider the combined therapy as a effective. In the public field the combined treatment turn out to be the most utilized, opposite than in private practice. 75% of the sample manage alone the combined therapy, while 25% work in team with a colleague. 85% of the pharmacotherapy is utilized in psychosis with positive symptoms, followed by the mood disorder with psychotic symptoms. Neuroleptics are the most frequently prescribed drug.

CONCLUSIONS

The combined therapy seems to be useful when coherently with the psychotherapy theory model. The pharmacological treatment should be utilized when strictly necessary and, if is possible, the combined therapy should be managed by one psychiatrist.