Personality disorders in addiction outpatients: prevalence and effects on psychosocial functioning.

AIM: To evaluate the prevalence of personality disorders (PDs) in the outpatients attending an addiction service, with particular attention to the effects of PDs on social and occupational functioning and on the intensity of treatment required. DESIGN: A cross-sectional epidemiological study with the assessment of 320 outpatients, through SCID-II (Structured Clinical Interview for DSM-IV Axis II PDs), SOGS (South Oaks Gambling Screen), and questionnaire extracted from EuropASI. RESULTS: The percentage prevalence of PDs was 62.2% (confidence interval at 95% (95% CI): 57-68). PDs were positively associated with placement in an addiction treatment community (odds ratio (OR) = 2.98, CI = 1.77-5.03), having received lifetime treatment at the mental health center (MHC) (OR = 3.67, CI = 1.67-8.07) or having attempted suicide (OR = 2.30, CI = 1.05-5.02). Furthermore, PDs were related to a reduced probability of keeping a job (OR = 0.54, CI = 0.31-0.95) or starting a family (OR = 0.51, CI = 0.30-0.87). CONCLUSION: Axis II comorbidity occurs in 62% of addiction outpatients and has substantial effects on social and occupational functioning as well as on treatment programs.

Cannabis use in young people: the risk for schizophrenia.

Cannabis is one of the most commonly used illicit drugs, and despite the widely held belief that it is a safe drug, its long-term use has potentially harmful consequences. To date, the research on the impact of its use has largely been epidemiological in nature and has consistently found that cannabis use is associated with schizophrenia outcomes later in life, even after controlling for several confounding factors. While the majority of users can continue their use without adverse effects, it is clear from studies of psychosis that some individuals are more vulnerable to its effects than others. In addiction, evidence from both epidemiological and animal studies indicates that cannabis use during adolescence carries particular risk. Further studies are warranted given the increase in the concentration of the main active ingredient (Δ(9)-tetrahydrocannabinol) in street preparations of cannabis and a decreasing age of first-time exposure to cannabis.

Cognitive impairment after age 60: clinical and social correlates in the Faenza Project.

A total of 7,389 dementia-free elderly (60-102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ≤ 2 standard deviations than the age- and education-corrected mean score obtained by the nondemented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI = 1.6, 1.2-2.2), stroke (OR, 95%CI = 1.9, 1.4-2.6), and depressive symptoms (OR, 95%CI = 1.9, 1.4-2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI = 1.8, 1.1-2.9), low Socio Economic Status (SES) (OR, 95%CI = 1.5, 1.1-2.1), and unmarried status (OR, 95%CI = 1.7, 1.2-2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9-12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND.

Prospective and retrospective components in the memory for actions to be performed in patients with severe closed-head injury.

This study investigated the basic mechanisms of the impairment of memory for actions to be performed in a group of 16 chronic survivors of severe closed-head injury (CHI). The experimental paradigm allowed discrimination between the deficit in spontaneously remembering the intention at the appropriate moment (prospective component of the task) and the deficit in remembering the specific actions to perform (retrospective component). The experimental procedure also contrasted a condition in which the time expiration was marked by the ringing of a timer (event-based condition) and one in which the time expiration was not marked by any event and the patient had to monitor the passing of time and completely self-activate the recall of the intention (time-based condition). Two other experimental manipulations were concerned with the duration of the delay interval from the examiner's instructions to the time expiration (10 vs. 45 min) and the fact that the three actions to be performed could be functionally related or not. With respect to a group of 16 normal controls, the patients with CHI were impaired in both the prospective and retrospective components of the memory for actions. Although an impairment of episodic memory is a plausible explanation for the poor retrieval of specific actions to perform, it is unlikely that this deficit played a major role in the CHI patient's reduced accuracy in spontaneously recalling the intention when the event occurred or the time expired. Instead, reduced frequency and less strategic utilization of time monitoring and/or self-reminding likely played a significant role in this sense.