Maternal stress, prenatal medical illnesses and obstetric complications: Risk factors for schizophrenia spectrum disorder, bipolar disorder and major depressive disorder.

Maternal stress and medical illnesses during early life are well-documented environmental indicators of an increased risk of schizophrenia. Few studies, conversely, have confirmed an association with major affective disorders. The present study examined the impact of maternal stress, medical illnesses and obstetric complications on the development of severe mental disorder in 240 patients with a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder and matched with 85 controls. Mothers of participants were asked about stressful events during pregnancy using the Social Readjustment Scale; information on prenatal/perinatal illnesses were acquired from medical records. Schizophrenia spectrum disorder was positively associated with maternal stress (OR = 2.16), infections (OR = 7.67), inadequate weight gain (OR = 9.52) during pregnancy, and peripartum asphyxia (OR = 4.00). An increased risk of bipolar disorder was associated with head circumference < 32 cm at birth (OR = 5.40) and inversely with inadequate weight gain (OR = 0.29). Major depressive disorder diagnosis was inversely related to inadequate weight gain (OR = 0.22). These results support a role for maternal stress, medical illnesses and obstetric complications as risk factors for subsequent severe mental illness in adulthood. Further research is needed, especially with regard to affective disorders.

Childhood adversities are different in Schizophrenic Spectrum Disorders, Bipolar Disorder and Major Depressive Disorder.

BACKGROUND: Research has shown that a history of childhood adversities is common in patients with psychiatric disorders but few studies have investigated links between specific types of adversity and specific psychiatric disorders. METHODS: We investigated the frequency of early childhood adversities in a sample consisting of 91 patients with diagnosis of schizophrenic spectrum disorders (SSD), 74 patients with bipolar disorder (BD), 83 patients with major depressive disorder (MDD) and 85 healthy controls and sought to identify adverse early childhood life events that predict the development of major psychiatric disorders. The Childhood Experiences of Care and Abuse questionnaire was used to collect data on traumatic experiences occurring before the age of 17 years and comprehensive demographic data were also collected. The data were analyzed with chi-squared tests, t-tests, post-hoc and logistic regression. RESULTS: Maternal absence/loss and economic difficulties in the early life were more prevalent in the BD group than other groups. Escape from home, cannabis abuse, psychological abuse, physical abuse and loneliness were more frequent in the SSD group than in other groups. Paternal absence, neglect of core needs, serious familial tension and absence of adult and peer confidants were all less common in the HC group than in the other groups. The regression model confirmed that different types of adversities play a crucial role in the development of the three investigated disorders. CONCLUSIONS: Our results support that SSD, BD and MDD are associated to different childhood adversities. This suggests that psychosocial interventions that reduce the incidence of these early life adversities might reduce the incidence of severe and disabling psychiatric disorders.

First World War and Mental Health: a retrospective comparative study of veterans admitted to a psychiatric hospital between 1915 and 1918.

AIM: The association between mental illness and war has been repeatedly investigated. Higher levels of depressive symptoms and an increased suicidal risk have been found in veterans. In this study we investigated the mental health conditions among Italian soldiers during the "Great War", who were hospitalized in a mental health hospital in Italy. METHODS: The study sample consists of 498 soldiers who were admitted during the World War I between 1915 and 1918, and 498 civilian patients admitted in two different periods (1898-1914, 1919- 1932). Psychiatric diagnoses have been recorded retrospectively by a detailed examination of clinical records. Socio-demographic informations, diagnosis at first admission, number of admissions, and deployment in war zones were collected. A logistic regression analysis was performed, the diagnosis of depression was considered as dependent variable while clinical and demographic variables as independent predictors. RESULTS: Soldiers deployed in war zones were more likely to have a diagnosis of depression compared to those not serving on the frontline. The logistic regression analysis showed that the diagnosis of depression is predicted by being a soldier and being deployed in a war area. DISCUSSION AND CONCLUSIONS: Our data confirm that soldiers engaged in war are at higher risk of developing depression compared to non-deployed soldiers.

Hospitalization and other risk factors for depressive and anxious symptoms in oncological and non-oncological patients.

OBJECTIVE: Depression and anxiety are common in hospitalized patients. In particular, oncological patients might be vulnerable to depression and anxiety. The aim of this study is to assess and compare different variables and the prevalence of anxiety and depression symptoms between oncological and medically ill inpatients and to identify variables that can influence depressive and anxious symptoms during hospitalization of patients. METHODS: A total of 360 consecutive hospitalized patients completed the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Patients Health Questionnaire-9, General Health Questionnaire (GHQ-12), 12-Item Short-Form Survey: physical component summary (PCS), and mental component summary (MCS). Patients were divided into oncological patients and non-oncological patients: groups 1 and 2. RESULTS: Only two significant differences were evident between the groups: the PCS of 12-item Short-form Survey was higher in non-oncological patient (p < 0.000), and the GHQ total score was higher in oncological patients. Variables significantly associated with HADS-D ≥ 8 were lower MCS, higher GHQ-12 score, lower PCS, more numerous previous hospitalizations, longer duration of hospitalization, and positive psychiatric family history. Variables significantly associated with HADS-A ≥ 8 were lower MCS, higher GHQ-12 score, positive psychiatric family history, longer duration of hospitalization, and younger age. CONCLUSIONS: Anxiety and depression symptoms in concurrent general medical conditions were associated with a specific sociodemographic profile, and this association has implications for clinical care. Copyright © 2016 John Wiley & Sons, Ltd.

Rare and very rare adverse effects of clozapine.

Clozapine (CLZ) is the drug of choice for the treatment of resistant schizophrenia; however, its suitable use is limited by the complex adverse effects' profile. The best-described adverse effects in the literature are represented by agranulocytosis, myocarditis, sedation, weight gain, hypotension, and drooling; nevertheless, there are other known adverse effects that psychiatrists should readily recognize and manage. This review covers the "rare" and "very rare" known adverse effects of CLZ, which have been accurately described in literature. An extensive search on the basis of predefined criteria was made using CLZ and its combination with adverse effects as keywords in electronic databases. Data show the association between the use of CLZ and uncommon adverse effects, including ischemic colitis, paralytic ileus, hematemesis, gastroesophageal reflux disease, priapism, urinary incontinence, pityriasis rosea, intertriginous erythema, pulmonary thromboembolism, pseudo-pheochromocytoma, periorbital edema, and parotitis, which are influenced by other variables including age, early diagnosis, and previous/current pharmacological therapies. Some of these adverse effects, although unpredictable, are often manageable if promptly recognized and treated. Others are serious and potentially life-threatening. However, an adequate knowledge of the drug, clinical vigilance, and rapid intervention can drastically reduce the morbidity and mortality related to CLZ treatment.

Depressive symptoms in caregivers of patients with dementia: demographic variables and burden.

OBJECTIVE: Individuals suffering from dementia are affected by a progressive and significant global deterioration and, consequently, might require longer assistance in the advanced stage of the illness. The illness is a great burden on the person who takes care of a patient, namely, the caregiver. This study aims to analyze the presence and relationship of specific sociodemographic variables, subjective burden, and depressive symptoms among caregivers of patients with dementia. METHODS: The participants of this study were caregivers at a health care unit for the elderly in southern Italy. An evaluation of the burden of patients with dementia on caregivers was carried out using the Caregiver Burden Inventory (CBI) and depressive symptoms using the Self-Rating Depression Scale (SDS). RESULTS: A total of 150 caregivers completed the study. In all, 83 (55%) caregivers showed a total CBI score ≥36, of whom 70% showed pathological depression scores in SDS. According to SDS, 28 (19%) caregivers showed a total CBI score from 24 to 36, of whom 32% were depressed. Depression was present in 5% of the caregivers whose CBI score was <24. Hence, an association between burden and depression was evident (χ(2)=47.446, P<0.001). A multiple linear regression analysis showed that depression (adjusted R(2)=0.622, F=50.123, P<0.001) was associated with higher physical (ß=0.666, P=0.001) and developmental (ß=0.712, P<0.001) burdens, lower socioeconomic status (ß=-4.282; P=0.002), higher level of urbanicity (ß=3.070; P=0.012), and advanced age (ß=2.132; P=0.08). CONCLUSION: Our study confirms the presence of depressive symptoms in a large number of caregivers with high burden. Nevertheless, this study demonstrates that depressive symptoms are mainly associated with sociodemographic variables and, to a lesser degree, physical and developmental burdens.

Unemployment, perceived health status and coping: A study in Southern Italy.

BACKGROUND: Unemployment is a very stressful experience that significantly impairs an individual's perception of their overall wellbeing. Interaction between unemployment and physical health is complex. OBJECTIVE: To analyze how specific coping strategies and socio-demographic variables may influence the level of physical and mental health perceived by those searching for work at an employment centre in Catanzaro, Italy. METHODS: Participants completed a set of self-administrated questionnaires including a socio-demographic questionnaire, the Coping Inventory for Stressful Situations (CISS) and the SF-12 Health Survey (SF-12). A forward stepwise multiple regression analysis was used to ascertain those coping strategies significantly associated with participants' perceived health status. RESULTS: Complete documentation was received from 113 registered unemployed participants, (61 men and 52 women) giving a response rate of 45% .Physical health status was significantly and positively associated with age and task-oriented coping, while the perception of mental health was associated not only with age, but also by lower emotion-oriented coping and a low number of previous job losses. CONCLUSION: The perception of health status is reduced among unemployed. Age is the only socio demographic variable that influences the perception of health status. Adaptive Task-oriented coping strategies are related to better physical health perception, whereas Emotion-oriented coping makes people prone to poorer mental health perception.

Religiousness and spirituality in patients with bipolar disorder.

BACKGROUND: Religiousness and spirituality (R/S) are often neglected features among psychiatric patients but important both for quality of life and coping strategies for mental disorders. In patients affected by bipolar disorder (BD), R/S can sometimes be confused with symptoms related to the psychiatric disorder. This study aimed to perform a clinical review of the relationship between R/S and BD. METHODS: Data sources included Medline (OvidSP), CINAHL (Ebsco), EMBASE (Ovid), PsychINFO (Ebsco), Angeline, Cochrane Database of Systematic Reviews and Database of Abstract of Reviews of Effects, searching for pertinent Keywords: 'religiousness', 'spirituality' and 'bipolar disorder'. RESULTS: Nine works were found but only five used homogeneous samples with BD patients. R/S were important when facing symptoms and relapses in the lifeworld. These beliefs influenced the relationship with psychiatrists and spiritual figures of reference. CONCLUSIONS: R/S play a role as a psychosocial variable in the course of BD. However, the hypothesis that the R/S factor can be relevant both in terms of providing a protective effect as well as a provocative element in depressive or hypomanic phases was not fully supported at the moment.

Use of atypical antipsychotics in the elderly: a clinical review.

The use of atypical antipsychotic drugs in the elderly has become wider and wider in recent years; in fact, these agents have novel receptor binding profiles, good efficacy with regard to negative symptoms, and reduced extrapyramidal symptoms. However, in recent years, the use of both conventional and atypical antipsychotics has been widely debated for concerns about their safety in elderly patients affected with dementia and the possible risks for stroke and sudden death. A MEDLINE search was made using the words elderly, atypical antipsychotics, use, schizophrenia, psychosis, mood disorders, dementia, behavioral disorders, and adverse events. Some personal studies were also considered. This paper reports the receptor binding profiles and the main mechanism of action of these drugs, together with their main use in psychiatry and the possible adverse events in elderly people.

Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives.

Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.

Specific personality traits and coping styles predict affective symptoms in early post acute coronary syndrome inpatients.

OBJECTIVE: Affective symptoms have adverse effects in hospital and long-term cardiac outcomes of post Acute Coronary Syndrome (ACS) patients. This study aims to identify personality traits and maladaptive coping strategies that could predict affective symptoms in early post-ACS patients. METHODS: Seventy patients undergoing revascularization procedures were examined within a week after their admission by means of the Hospital Anxiety-Depression Scale. Personality was analyzed through the Type D Personality Scale and the Coping Inventory for Stressful Situation. Multiple logistic regression analysis was used to determine independent predictors of anxiety and depressed mood. RESULTS: A high rate of depressive and anxious symptoms was found and 76% of patients resulted Type D personality. Depression was associated with b-blocker therapy, Type D personality, and specific coping strategies. Unmarried status, low education, unstable angina, Type D personality, emotion, and avoidance oriented coping independently predicted anxiety. CONCLUSION: These findings underlie the importance of assessment for Type D personality and coping strategies that could be useful to identify post-ACS patients at higher risk for affective symptoms. Using these brief instruments, as sensitive screening measures, we investigated the prevalence of depressive and anxiety symptoms in patients with ACS, we identified personality traits and coping strategies used to manage stress and estimated independent predictors of affectivity disorders after ACS.