Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study.

OBJECTIVES: To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial. DESIGN: Single-group, blinded trial. SETTING: Rehabilitation Center of São Camilo University, Brazil. PARTICIPANTS: Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). INTERVENTIONS: Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures! MAIN OUTCOME MEASURES: The feasibility and safety outcomes were patients' game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39). RESULTS: Patients' scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training. CONCLUSION: Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life).

PANSS factors and scores in schizophrenic and bipolar disorders during an index acute episode: a further analysis of the cognitive component.

To investigate the factor structure of psychotic symptoms, we compared the clinical characteristics of manic patients with those of schizophrenic patients evaluated with positive and negative syndrome scale (PANSS). The clinical symptoms of 148 bipolar patients and 86 schizophrenic patients hospitalized for an index psychotic episode were assessed. Schizophrenic patients showed more positive and cognitive symptoms than bipolars. The factor analysis of the two PANSS scores showed a three-factor solution with 'positive', 'negative' and 'mixed' depressive-activated factors for bipolars and 'positive', 'negative' and 'depressive' factors for schizophrenics. In both groups, the 'cognitive cluster' loaded on the first 'positive' factor while the 'lack of insight' (LOI) has a different meaning in the two groups, more related to the positive symptoms in the bipolar patients and more related to the negative symptoms in the schizophrenic patients. This finding suggests that LOI could be a non-unitary phenomenon in psychoses and it should be further explored to better elucidate differences in symptom structures between schizophrenic and bipolar disorders.

[Subjective response to neuroleptic medication: a validation study of the Italian version of the Drug Attitude Inventory (DAI)]. / Gli aspetti soggettivi del trattamento con farmaci antipsicotici: studio di validazione della versione italiana della Drug Attitude Inventory (DAI).

OBJECTIVE: Aim of the study was to investigate the psychometric properties of the Italian version of the Drug Attitude Inventory (DAI) by exploring its construct validity. SETTING: 90 voluntary admitted patients with DSM III-R Schizophrenic (n.72) and Schizoaffective (n.18) disorders, age range between 18 and 50 years, treated with typical antipsychotics, able to participate in the study, were selected. DESIGN: Exploratory factor analyses with alpha factoring and maximum-likelihood methods with Varimax Rotation were used to analyse DAI scores. RESULTS: Extraction methods found 7 factors which explained 62.5% of the total variance. The first 2 factors could be labelled as "subjective response to treatment" construct and factors 3 to 7 as "attitude to medication" construct. CONCLUSION: Although preliminarily, the Italian version of the DAI seems to maintain the original psychometric properties and it can be used easily to get a valid measurement of the patients' attitude to neuroleptic medication.

A factor analysis of signs and symptoms of the manic episode with Bech-Rafaelsen Mania and Melancholia Scales.

BACKGROUND: Several factor analyses of signs and symptoms of mania have been reported using different rating scales. We propose here that the use of two instruments well known in the European literature may be useful in detecting the structure of manic episodes. METHOD: We investigated the pattern of symptoms in a group of 124 bipolar inpatients hospitalised for a manic episode. We conducted a factor analysis of the broad range of psychiatric symptoms covered by the Bech-Rafaelsen Mania Scale (BRMaS) and Melancholia Scale (BRMeS). RESULTS: Five eigen values were greater than unity, which determined the number of factors computed. The five factors captured 66.7% of the total variance. Following rotation, five factors were clinically relevant. CONCLUSION: This suggests that both euphoric activation and depression are prominent in this sample.

Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls.

Studies on cognitive function in bipolar disorder have led to contrasting results and few data are available on affected subjects during the euthymic phase. In the present study we investigated the cognitive function of a cohort of bipolar (n=40) and schizophrenic (n=66) patients compared to healthy controls (n=64). Patients were evaluated in the outpatient setting over at least 3 months using a computerized version of Wisconsin Card Sorting Test. Schizophrenic patients showed the worst performance while that of the bipolar patients was somewhere between schizophrenic and controls. A discriminant analysis was able to classify correctly 60.59% of the subjects (schizophrenics 48.5%, bipolars 40%; healthy controls 85. 9%). The scores of the Wisconsin Card Sorting Test were entered into a principal component analysis, which yielded a 2-factor solution. Even in that analysis bipolar patients showed intermediate features in comparison with the other groups. These data indicate that bipolar patients have subtle neurocognitive deficits even after the resolution of an affective disorder. As well as observing quantitative differences between groups, the results show different dimensions of cognitive performance within groups suggesting that the deficit of euthymic bipolars could be a dishomogeneous entity, probably more heterogeneous than that in schizophrenia. Studies administering a more complete neuropsychological battery could further clarify the nature and meaning of the cognitive deficits in schizophrenia and bipolar disorder.

Cognitive symptoms of mania in pure and mixed episodes evaluated with the Positive and Negative Syndrome Scale.

To investigate the clinical specificity of mixed affective patients, we compared the clinical characteristics of pure manic patients with those of mixed manic patients. The clinical symptoms of 146 bipolar inpatients hospitalized for a manic episode were assessed by means of the Positive and Negative Syndrome Scale. Mixed patients showed more positive and cognitive symptoms and among these the lack of judgement and insight was prominent. Further studies are needed to clarify the specificity of lack of insight of the mixed bipolar patients.

Subjective experience and subjective response to neuroleptics in schizophrenia.

Although several studies have addressed the issue of the relationship between the subjective response to neuroleptics and drug compliance, very little attention has been given to the study of the subjective experience of psychosis and drug attitudes. The present study was therefore undertaken to examine the relationship between the subjective experience of psychosis as assessed by the Frankfurter Beschwerde-Fragebogen (FBF) and subjective response (SR) to neuroleptics as assessed by the Drug Attitude Inventory (DAI) in a group of schizophrenic patients. Significant correlations were found between the total scores on the FBF and DAI (r= .46, P< .01). The DAI total score also correlated with all four factors (central cognitive disturbances, perception and motility, depressivity, and internal and external overstimulation) on the FBF. This finding suggests that the SR neuroleptics is partly explained by a "positive" subjective experience of psychosis.

Awareness of illness and outcome in schizophrenia.

The purpose of the present study was to investigate whether awareness of illness affects specific measures of outcome in schizophrenia. Patient awareness was evaluated using a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD). Patient outcome was assessed by means of the Strauss-Carpenter scale. Our findings indicate that lack of awareness of "negative symptoms" has a considerable impact on outcome: in fact "Social Contacts" highly correlated with Blunt Affect, Anhedonia and Asociality items on the SUMD. Lack of awareness seems then to be a powerful predictor of poor outcome.

The effects of psychotherapies: a study on patients' perception of results in an Italian public setting.

Enquiries centred on the perspective of users of psychiatric treatments and their families, has become an increasingly widespread method to improve the quality of treatments administered by health services. In this study, in particular, we examine the users' perception of the quality and variability of the effects of psychotherapies, the difficulties met, and the perceived help factors. The sample consists of 216 users of psychotherapy and 223 patients in psychiatric treatment with psychological support. They are outpatients, managed by the public health service. The questionnaires included closed ended, open-ended questions and scales that were previously tested on a sample of patients. The questionnaire for patients was anonymous and administered by researchers external to the medical staff. Irrespective of the diagnosis or of a concurrent pharmacological therapy, a high percentage of patients (75%), in both groups, feel improved. Improvement consist of the decrease of symptoms, a sense of feeling better, but also feeling grown up, more mature, having higher self-esteem and feeling more adequate in interpersonal relationships. This last type of result is significantly more frequent in the group of patients in psychotherapy. Besides these patients are faced with more difficulties and play more active a role while they are in treatment. The main difference between patients in psychotherapy and those in psychiatric management with psychological support is not indeed the identification of different perceived therapeutic factors, but rather the different evaluation of their relative importance. On the whole, the study seems to show that the effects of real psychotherapies include, beside an improvement of symptoms, the achievement of goals of personal growth and maturity, self-satisfaction and an increase in self-esteem, all in accordance with a conception of health as well-being and self-satisfaction rather than as absence of illness.

[Psychotherapies in psychosocial centers in Lombardia: a point of view of psychiatrists and psychologists]. / Le psicoterapie nei centri psicosociali della Lombardia: il punto di vista di psichiatri e psicologi.

OBJECTIVE: The purpose of this study is the systematic analysis of operators' points of view about psychotherapies concretely performed in the Public Psychiatric Public Services and inside the global operating mode of the assistance. SETTING: The study has involved 26 CPS selected randomly in Lombardia. The sample has been built with 73 psychiatrists and 42 psychologists. MAIN OUTCOME MEASURES: All the therapeutists involved in this research have been submitted to a question-form querying socio-anagraphic data, professional training, orientations, operating modes in their CPS, rules and objectives of their psycotherapies, observations and evaluations about psychoterapic treatments and their effects. RESULTS AND CONCLUSIONS: Psychiatrists and psycologists working in CPS, mostly the younger ones (less than 45 years old), followed a personal training in over the 70% of the cases. The prevalent orientation is the psycoanalityc one in both the categories. The most part of therapeutists deems that there has been an evolution in their way of conceiving psychiatry inside the public service. The lines at these evolutions have been mentioned explicitly in the article. Psychiatrists and psycologists, even with some concrete differences; seems to have mostly homogeneous points of view: psychiatrists have a more flexible vision of which practices can be considered as a psychotherapy, whereas psycologists are more rigorously linked to theoric reference models and to rules learnt during their training. They are both slightly favourable to the use of psychotherapies in their services, even if, as a matter of fact, they are used by just a few patients. No contrast between psycotherapy and psycopharmacology has been detected from operators' answers. These practices seem to be both considered useful and integrable.

[The report on a divisional plan as an evaluation of results]. / Il rapporto su un piano di comparto come valutazione di risultato.

The adoption of norms of recommended practice (NRP) by industrial management (a fundamental step in ensuring a safer and healthier work environment, is in our opinion a suitable approach for evaluating primary prevention programmes. We tested this hypothesis in the shoe and leather goods manufacturing industry (55 facilities). An ordinal scale was defined for each variable taken into account by NRP and for other variables related to employers' actions. A score was assigned to every facility with reference to the starting and ending points of the programme. In this way we estimated the degree of variation, in time and among facilities, in adopting NRP.

[A sampling study in 6 Lombardy hospitals on the knowledge possessed by nurses on the risks associated with accidental exposure to patient blood]. / Indagine campionaria in sei ospedali lombardi sulle conoscenze possedute dagli infermieri sui rischi associati all'esposizione accidentale al sangue dei pazienti.

In six hospitals of the Lombardy Region 3.000 questionnaires have been circulated to evaluate the degree of awareness and information of the personnel with respect to the behavior to be adopted at the occasion of an accidental exposure to the blood of patients. Up to 63% (1896) of the original questionnaires were available for the analysis. The mean of the responses which can be considered correct for the professional level involved, does not seem to be an area-dependent variable. The number of correct answers declines proportionally as the age increases. A drastic difference in the degree of knowledge is documented to exist between general and professional nurses, who however are exposed to the same risk. The ignorance on the role and choice of disinfectants and on the way of disposing of used needles is particularly striking. The results of the questionnaire, mainly when they are referred to each hospital, are easily utilizable to finalize and support information and training programs.