Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability.

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

Vertigo "in the pink": The impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients.

BACKGROUND: Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). OBJECTIVE: The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. METHODS: Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. RESULTS: BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. CONCLUSIONS: Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.

Stigma and discrimination toward mental illness: translation and validation of the Italian version of the Attribution Questionnaire-27 (AQ-27-I).

PURPOSE: The aim of this study was to translate the Attribution Questionnaire-27 (AQ-27) to the Italian language (AQ-27-I), and to examine the reliability and validity of this new Italian version. METHODS: The questionnaire was translated using the standard translation/back-translation method. Cronbach's alpha and intraclass coefficients were used to estimate instrument reliability. Confirmatory factor analysis was conducted to corroborate the original English version factor structure in the new measure, and to establish validity. Path analyses were meant to validate relationships found in the English version among Italian-speaking participants. RESULTS: The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.82 for the total scale and ranging between 0.52 and 0.91 for the subscales. The test-retest reliability was also satisfactory, with intraclass correlation coefficients of 0.72 for the total scale and ranging between 0.51 and 0.89 for the subscales. Fit indices of the model supported the factor structure and paths. CONCLUSIONS: The AQ-27-I is a reliable measure to assess stigmatizing attitudes in Italian.

The different psychological profiles of subjects attending melanoma screening campaigns and those delaying diagnosis: an aid for designing preventive campaigns?

Patient delay in seeking medical attention for melanoma (MM) constitutes one of the main challenges in designing prevention campaigns. No conclusive studies exploring psychological aspects of those patients, using standardized psychometric instruments, are currently available. We hypothesized that the attitude toward illness of subjects attending the melanoma screening day (EMD) would differ from patients diagnosed with MM following the usual clinical pathways. Five psychometric tests, assessing attitude toward illness, were administered both to EMD and MM groups, this latter further divided into two subgroups (good and bad detectors, GD and BD) considering the histo-clinical characteristics of the lesion. The Mann-Whitney U Test and Pearson Chi Square test were used to compare EMD patients with the other groups and to compare psychometric scores between GD and BD. BD and GD groups showed significant differences. Interestingly, the BD group was characterized by higher scores in Temperament and Character Inventory Fearful subscale, Multidimensional Health Locus of Control Powerful Others scale and Illness Behaviour Questionnaire General Hypochondriasis, Affective Disturbance and Irritability subscales. BD patients tend to react in a phobic manner to medical recommendations and they appear to favour external and more assertive help, which would suggest choosing a more direct approach in proposing a prevention campaign. Although this is a pilot study and further studies are needed, it gives new insight to build up more effective prevention campaigns for those patients.

Suicide intervention skills in health professionals: a multidisciplinary comparison.

Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian professionals. Two hundred and thirty two professionals (38 psychiatrists, 50 general practitioners, 34 psychiatric nurses, 60 doctors and nurses working in accident and emergency services, and 50 medical students) completed the Suicide Intervention Response Inventory (SIRI-2) (Neimeyer & Bonelle, 1997) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups and psychiatric nurses scored significantly higher than general practitioners in identifying appropriate responses to suicidal patients. Taken together, our findings suggest the necessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.

Aripiprazole: effectiveness and safety under naturalistic conditions.

A retrospective study was conducted to examine aripiprazole's effectiveness and safety in a naturalistic treatment setting in both inpatients and outpatients affected by schizophrenia and other psychotic disorders. All patients with schizophrenia, schizoaffective and delusional disorders, and schizoid and schizotypal personality disorders treated with aripiprazole from March 1, 2005, to March 1, 2006, in the authors' community mental health service were divided into outpatient (n=26) and inpatient (n=17) groups; the average treatment periods were 204 days and 25 days, respectively. Effectiveness was evaluated by improvement of symptoms (a 25% reduction of Brief Psychiatric Rating Scale [BPRS] score from baseline) and functioning level (a 50% increase of Global Assessment of Functioning [GAF] scale score from baseline), as well as dropout rate. Adverse effects and their impact on treatment course were also evaluated. The final scores of the 2 scales showed a statistically significant difference from baseline (BPRS: p<.001 in the 2 groups; GAF: p<.005 in inpatients, p<.001 in outpatients). The average improvements in BPRS and GAF were 54% and 35%, respectively, in outpatients and 71% and 71% in inpatients. Side effects included anxiety, psychomotor agitation, insomnia, and psychotic symptom worsening. The dropout rate was 24% in inpatients and 23% in outpatients, largely because of the aforementioned side effects. The data, though limited by the small sample and naturalistic methodology, suggest that aripiprazole may be effective for both long- and short-term treatment, with a greater improvement among inpatients and a similar dropout rate between groups.

Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres.

BACKGROUND: The disturbed behaviour of acute in-patients can have serious consequences, and methods of management are contentious and vary between countries. Little is known about this variation and its relationship to the characteristics of in-patient populations. AIM: The aim of this study was to compare rates and patterns of disturbed behaviours and containment methods in acute psychiatric wards in three centres in the United Kingdom, Italy and Greece. METHOD: A retrospective survey of medical and nursing records (n=838) at seven hospitals for the first 2 weeks of patients' admissions was done using a structured data collection tool. RESULTS: Nearly all types of disruptive behaviour varied by centre, with rates being generally higher in the UK and lowest in Italy. Specific relationships between different behaviours were replicated across all three centres. Ethnic minority patients were more likely to be subject to containment measures in all centres, even when their behaviours did not differ from the majority. Rates of containment method use were only partially related to the frequency of disturbed behaviour. CONCLUSIONS: More research is required to discover the efficacy of varying containment methods, with a view to minimising their use. Gross international and inter-hospital variation demands large samples rather than single site studies. Clinicians need to reflect upon containment rates that may be, in some places, excessive and incorrectly targeted.

[Cardiovascular risk factors in severely ill psychiatric patients]. / Fattori di rischio cardiovascolari in pazienti psichiatrici gravemente malati.

The most recent European guidelines for coronary heart disease (CHD) prevention acknowledges that stress/anxiety and depression are independent risk factors for CHD. The Psychiatric Patients Health Status Study is a transversal study on the health condition of 1.590 serious psychiatric patients. We've built a database containing historical, clinical and laboratory data of the 1.374 subjects aged > 30 years. 25% of them has a family history of CHD and 7% of cerebrovascular disease. 1.4% has clinical history of CHD, while 5.7% has a clinical history of cerebrovascular disease. The 37.3% is cigarette smoker. Moreover, in this population there is a high prevalence of overweighting (M: 25.30%; F: 11.30%) and obese (M: 13.25%; F: 5.82%) subjects. Furthermore, we observed a 40% of hypertensive patients among that only one half with controlled blood pressure level and 6.5% of diabetics or glucose intolerant among that 78% with uncontrolled basal glucose level. Finally, 40% of these subjects is affected by dyslipidaemia and 98% of them has uncontrolled plasma lipid levels. 16% of patients accounts more than one pharmacologically treatable CHD risk factor. A non-lethal CHD event in these patients could really increases the risk of non-compliance and of drug-drug interactions because of the high number of drugs needed to treat both kind of disease. Thus, we find unethical do not treat hypertension, dyslipidemia and diabetes in severe psychiatric patients.