[Diagnosis of major depression in HIV-infected patients]. / Diagnosi psichiatrica di depressione maggiore in soggetti con infezione HIV.

A survey of current mood disorders (and especially major depression) is performed after considering quoted literature over the last five years. The sample includes all the HIV-infected-patients continuously referred to the Outpatient Service of the Infectious Diseases dept. of Bologna's "Ospedale Maggiore" General Hospital during some five days (19-23rd, July 1993). Each of the 53 recruited subjects was seen by a psychiatrist in the same morning of his/her medical visit; then also BPRS, STAI, CGI, BDI and MADRS were administered. A psychiatric diagnosis has been found in the 45% of the sample. The results being discriminated on the basis of absence-presence and diagnostic category, they point out a significant prevalence of ARC among subjects with psychiatric diagnosis and prevalence of asymptomatic HIV-infection among those ones with absent psychiatric diagnosis. Drug dependence (72%) and personality disorder are markedly prominent among ARC patients. But the surprising outcome (lower than references data) is that the diagnosis of current major depression is found only in 1.9% of cases (mood disorder in 9.4%).

[Increased suicide risk in cancer patients]. / Cancro e suicidio: aumento del rischio dei suicidio nei pazienti neoplastici.

It is a much debated question whether suicide risk is higher for cancer patients in comparison to general population. We analyse this problem by a literature review and focus on specific risk groups. We have identified two different research topics: (1) The study of cancer prevalence among suicides. (2) The study of suicide incidence among cancer patients. Mainly on a basis of the latter and more homogeneous researches, we have outlined that cancer diagnosis involves an increased suicide risk. It is difficult on the contrary to explain the sources of suicidal behaviour by means of the heterogeneous literature data. Most of authors agree that suicide risk is highest during the first to second year since diagnosis. The risk can be attributed to the information on cancer diagnosis, but mainly to the seriousness of neoplastic disease, because of negative short-term outcome of most serious patients. Furthermore the risk can be attributed to the period immediately following discharge from oncologic and surgical wards, especially for long-term patients who suffer from distress given by the treatment itself. Then it is at risk the relapse after symptom remission. The high-risk patients are those suffering from the most severe and rapidly progressive neoplasms, treated by chemotherapy or affected by terminal illness with intractable pain. Patients with previous psychiatric history (particularly including alcohol dependence and depression) are likely to kill themselves in the remission phase of illness. In conclusion cancer patients who commit suicide, are not a homogeneous group. The relationships between cancer, depression and suicide are crucial, because severe depression is particularly frequent among cancer patients but is sometimes misdiagnosed and lacking in treatment.