Metacognitive training for young subjects (MCT young version) in the early stages of psychosis: Is the duration of untreated psychosis a limiting factor?

OBJECTIVES: The treatment program 'Metacognitive training for patients with schizophrenia' (MCT) addresses cognitive biases assumed to play a crucial role in the pathogenesis of delusions (e.g., jumping to conclusions, theory of mind deficits). The aim of our study was to examine the effectiveness and the feasibility of this intervention targeted to early phases of psychosis (MCT young version). DESIGN: An experimental design included two groups of subjects on the basis of their duration of untreated psychosis (DUP) 'short' (less or equal than 12 months) and 'long' DUP (longer than 12 months), assessed at baseline and after the 4-month intervention. METHODS: Fifty-six young subjects affected by early psychosis were assessed on psychopathology, social functioning, neurocognitive, and metacognitive measures. The primary outcome was the reduction of psychopathology. Secondary outcomes included reduction of cognitive and emotional dysfunction and improvement of social functioning. RESULTS: At the end of the 4-month MCT, both groups showed significant improvements in many variables: positive symptoms, cognitive functions, as verbal memory, attention and mental flexibility, and metacognitive functions, as cognitive insight. Significant and positive changes were found in theory of mind abilities and social perception. CONCLUSIONS: The difference in DUP between the two groups of young subjects of our sample did not seem to influence the intervention outcomes, still taking into account that the average difference between the two groups in terms of DUP is 12.6 months. PRACTITIONER POINTS: Metacognition refers to the general ability 'to think about thinking,' that is, the ability to think about one's mental state and the mental states of others. Persons with schizophrenia experience different metacognitive impairments. The metacognitive training for patients with schizophrenia - young version can be applied to young people affected by psychosis and seems to improve symptomatology, social functioning, cognitive, and metacognitive abilities, independently by their Duration of Untreated Psychosis over a 2-year period.

[The onset of affective disorder: impact of duration of untreated psychosis on global functioning]. / L'esordio del disturbo affettivo: impatto della durata di psicosi non trattata sul funzionamento globale.

AIM: Observational study on a young sample at the onset of affective disorder seeking help to a dedicated service, with the aim to evaluate the age of onset, the duration of untreated psychosis (DUP), and the functional outcome at 2-year follow-up. METHODS: For 57 young people at First Episode Psychosis (FEP) of Affective Disorder, consecutively recruited to SMILE service, were collected socio-demographic and clinical (DUP, psychiatric history, age of onset) data and psychopathological (BPRS e SCL-90), perceived distress (GHQ-12) and functioning (VGF) evaluations. RESULTS: Two years after the access to SMILE service, the sample showed a functional improvement, with a duration of untreated psychosis (DUP) of 120,9 weeks and a mean age of onset of 21 years. More than 50% of the sample reported a family psychiatric history; this subgroup showed a higher substance use and a longer DUP compared to young people with a negative family psychiatric history. DISCUSSION AND CONCLUSIONS: This study confirms the problem of the diagnostic delay of young people at FEP of Affective Disorder and underlines the role of family psychiatric history. Our results support the need of a specialized service to improve the early detection, identification and treatment of mental disorders.

Prevalence and clinical features associated to bipolar disorder-migraine comorbidity: a systematic review.

BACKGROUND: The prevalence and clinical features associated with bipolar disorders (BDs)-migraine comorbidity have been reported inconsistently across different studies, therefore warranting a systematic review on the matter. METHODS: A systematic review was conducted in accordance with the PRISMA statement searching major electronic databases for documents indexed between January, 2000 and July, 2014. Eligible studies were those including quantitative data on prevalence rates and clinical features associated to BD-migraine comorbidity; case reports excluded. Three authors independently conducted searches, quality assessment of the studies and data extraction. RESULTS: Several cross-sectional studies, and a handful of retrospective follow-up studies or non-systematic reviews assessed the prevalence and/or the clinical correlates of migraine-BD comorbidity. High prevalence rates and a significant burden of BD-migraine comorbidity were common findings, particularly in case of BD-II women (point-prevalence rates up to 77%), migraine with aura (up to 53%) and/or cyclothymic temperament (up to 45% of the cases). LIMITATIONS: Some of the biases encountered in a few studies accounted by the present review may nonetheless have hampered the generalizability of the overall conclusions drawn herein. CONCLUSIONS: BD-migraine comorbidity may comprise of a sub-phenotype of BDs requiring patient-tailored therapeutic interventions to achieve an optimal outcome. Specifically, additional studies including longitudinal follow-up studies are aimed in order to shed further light on the actual prevalence rates and clinical features associated to BD-migraine comorbidity, with a special emphasis towards the clinically suggestive potential connection between mixed features, bipolar depression, migraine, and increased risk for suicidality. PROSPERO registration number: CRD42014009335.

Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden.

BACKGROUND: The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied. METHODS: The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model. RESULTS: The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability. LIMITATIONS: Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations. CONCLUSIONS: Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences.

Cognitive behavioral therapy for young people after l'aquila earthquake.

OBJECTIVE: Cognitive behavior therapy (CBT) emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly associated with anxiety or mood disorders. The aim of this study was to evaluate the CBT efficacy among young people exposed to L'Aquila earthquake, in 2009. METHODS: one year after the disaster, 39 young subjects as a case group (CBT treated) and 24 as a comparison group (no CBT treated) were evaluated with the Impact of Event Scale Revised (IES-R), the General Health Questionnaire-12 items (GHQ-12) and the Brief Cope. CBT was conducted in 12 sessions (once per week for 3 months). After CBT intervention, both groups were evaluated again with the same psychometric instruments. RESULTS: our results show a significantly decrease in post traumatic symptoms and psychological distress severity in CBT group. It was attributable to an improvement in each of three PTSD dimensions (intrusion, avoidance, and arousal) and in the total score of IES-R (p< 0.04). Among CBT treated group, subjects that adopted "planning/problem solving" coping strategies (p < .02) and "religiosity" (p < .045) show higher improvement in psychological distress. CONCLUSIONS: our findings show the efficacy of CBT and the influence of individual coping strategies in the improvement of posttraumatic stress symptoms and psychological distress among young people seeking help from an outpatients service for young people with psychiatric problems (the SMILE) after the catastrophic disaster in L'Aquila.

Persistent fear of aftershocks, impairment of working memory, and acute stress disorder predict post-traumatic stress disorder: 6-month follow-up of help seekers following the L'Aquila earthquake.

The aim of our 6-month follow-up study was to assess predictors of post-traumatic stress disorder (PTSD) among individuals seeking treatment at the General Hospital Psychiatric Unit within the first month following the L'Aquila earthquake. Clinical, trauma-related and neurocognitive variables were considered. At the 6-month follow-up, 91 (74.5%) out of 122 subjects were re-assessed and administered the Impact of Events Scale-revised (IES-R) for the detection of PTSD according to DSM-IV criteria. Within 4 weeks following the earthquake, patients were assessed with a checklist of traumatic-event-related variables, along with the Stanford Acute Stress Disorder Questionnaire (SASDQ) for the detection of ASD, with a short battery on working (Wechler Memory Scale-R, Digit Forward and Backward) and verbal memory (subtest of Milan Overall Dementia Assessment, MODA). A statistically significant higher proportion of subjects affected by 'partial' ASD showed a PTSD diagnosis (80.6%, N = 29) compared to not diagnosed subjects (40%, N = 22) and a PTSD diagnosis was shown by all the 4 subjects (4.4%) affected by 'full' ASD at the entry in the study. At the 6-month follow-up 56% of the sample could be considered affected by PTSD on the IES-R scale. The results of the logistic regression analysis on our selected predictors indicated that the persistent fear of aftershocks seemed to increase by over 57 times the likelihood of positive estimate of PTSD, followed by impairment of working memory backward (OR 48.2), and having being diagnosed as ASD case in the first 4 week after the earthquake (OR 17.4). This study underlines the importance of identifying PTSD predictors, in order to planning early treatment interventions after natural disasters.

Dysfunctional neural networks associated with impaired social interactions in early psychosis: an ICA analysis.

The "default mode", or baseline of brain function is a topic of great interest in schizophrenia research. Recent neuroimaging studies report that the symptoms of chronic schizophrenia subjects are associated with temporal frequency alterations as well as with the disruption of local spatial patterns in the default mode network (DMN). Previous studies both on chronic and medicated subjects with psychosis suffered from limitations; on this basis, it was hypothesized that the default mode network showed abnormal activation and connectivity in young and neuroleptic-naïve patients with first-episode psychosis. This study investigated emotional responses to pleasant and unpleasant/disgusting visual stimuli by a resting-state analysis of fMRI-data from 12 untreated first-episode psychosis patients with prevalently negative symptomatology versus 12 healthy subjects. We chose this experimental task to explore the functional link between default mode network and hedonic processing which has been proposed as a marker of cerebral dysfunction in psychotic disorder and implicated in its pathophysiology. Independent Component Analysis (ICA) was used to identify the default mode component. Both healthy and first-episode subjects showed significant spatial differences in the default mode network. In first-episode subjects, medial frontal hypoactivity and cerebellar hyperactivity were correlated with the severity of negative symptoms.

Acute stress reactions and associated factors in the help-seekers after the L'Aquila earthquake.

BACKGROUND: The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L'Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed. METHODS: For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies. RESULTS: Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by 'full' ASD, whereas 48 subjects (39.3%) could be considered affected by 'partial' ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting 'behavioural disengagement' or 'requesting emotional support from others' were found to increase the likelihood of a positive estimate of being an 'ASD case', while the adoption of an 'acceptance' coping style seemed to reduce the likelihood of the positive estimate of being an 'ASD case'. CONCLUSIONS: This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.

New evidence in theory of mind deficits in subjects with chronic schizophrenia and first episode: correlation with symptoms, neurocognition and social function.

AIM: Currently substantial evidence exists about Theory of Mind (ToM) impairment in subjects affected by chronic and first episode schizophrenia. In particular, in order to enhance the validity of our construct, we used in this study classical false beliefs tasks and advanced theory of mind tasks, together with the application of structural equation model, in order to ex-amine whether we are using ToM tasks with good psychometric properties. The main goal of the present study was to examine ToM deficits in a large sample including subjects suffering from chronic schizophrenia, first episode of schizophrenia and nor-mal controls, by observing in the same task the relationship with symptomatological gravity, neurocognition and social function.Materials and methods. A sample of 178 patients with chronic schizophrenia, a sample of 49 subjects with a first episode of psychosis and 484 healthy controls participated to this study. Measures of social cognition included task of false belief and advanced theory of mind task. RESULTS: No significant differences were found on ToM tasks between subjects affected by chronic and first episode schizophrenia. Social cognition showed in both groups a strong correlation with negative symptoms and social function, but did not evidence any relationship with neurocognition. CONCLUSION; ToM deficits exist in subjects suffering from chronic and first episode schizophrenia. These impairments do not seem to be a consequence of illness condition, they are likely to be state-independent and appear to be the most important cognitive mediator of social functioning in both groups.

[Use of cannabis and psychopathological risk in onset psychosis]. / Uso di cannabis e rischio psicopatologico negli esordi psicotici.

AIM: The aim of the study is to assess the correlations between cannabis use and psychopathological features, disorder severity and global functioning in subjects with onset psychosis (schizophrenic and bipolar psychosis) and at risk mental state. MATERIALS AND METHODS: Sixty-seven consecutive subjects with diagnosis of bipolar spectrum disorder (N=49), schizophrenic spectrum disorder (N=5) and at risk mental state (N=13) were recruited from the SMILE (Service for Monitoring and early Intervention Looking at the fight against the onset of mental Even psychological youths' suffering). All subjects were assessed with the Self Report Symptom Inventory-90 (SCL-90), the Global Assessment of Functioning scale (GAF) and Clinical Global Impressions-Severity (CGI-S). Moreover, they were assessed for the cannabis use in the last month. RESULTS: The total sample was splitted in two groups: Group 1 of cannabis use subjects (N=30) and Group 2 of no cannabis use subjects (N=37). Group 1 subjects showed significant higher scores at psychoticism SCL-90 dimension and at CGI-S than Group 2 subjects. The higher scores at anger/hostility and psychoticism SCL-90 dimensions and at CGI-S seem to be discriminant features of Group 1 cannabis use subjects. CONCLUSIONS: The data reported suggest that cannabis use assessment in onset psychosis (bipolar and schizophrenic onset) and at risk mental state could add clinical information to the psychopathological and diagnostic description. Such information should be ''incorporated'' in the treatment choice model and outcome prediction assessment.

[Psychological distress and post-traumatic stress disorder (PTSD) in young survivors of L'Aquila earthquake]. / Distress psicologico e disturbo post-traumatico da stress (DPTS) in una popolazione di giovani sopravvissuti al terremoto dell'Aquila.

AIM: The aim of the study is to evaluate the presence of PTSD diagnosis, psychological distress and post-traumatic symptoms in a population of young earthquake survivors after L'Aquila earthquake. METHODS: Between April 2009 and January 2010, 187 young people seeking help consecutively at the Service for Monitoring and early Intervention against psychoLogical and mEntal suffering in young people (SMILE) of L'Aquila University Psychiatric Department, underwent clinical interview with the Semi-Structured Clinical Interview DSM-IV-I and-II (SCID-I and SCID-II) and psychometric evaluation with Impact Event Scale-Revised (IES-R) and General Health Questionnaire-12 items (GHQ-12). RESULTS: 44.2% and 37.4% respectively, showed high and moderate levels of psychological distress. 66.7% reported the presence of a significant post-traumatic symptoms (Post-traumatic Syndrome) with an IES-R>28, while a diagnosis of PTSD was made in 13.8% of the sample. The obsessive-compulsive trait, female sex and high level of distress (GHQ ≥20) appear to be the main risk factors for the development of PTSD than those who had a post-traumatic syndrome for which the displacement and social disruption, appear to be more associated with post-traumatic aftermaths. DISCUSSION: Our findings, in line with recent literature, confirm that a natural disaster produces an high psychological distress with long-term aftermaths. Early intervention for survivors of collective or individual trauma, regardless of the presence of a PTSD diagnosis should be a primary goal in a program of Public Health.

Cognitive function and clinical symptoms in first-episode psychosis and chronic schizophrenia before and after the 2009 L'Aquila earthquake.

AIM: On 6 April 2009, at 3:32 GMT, central Italy was struck by a 6.3-magnitude earthquake with its epicentre near L'Aquila, the capital city of the Abruzzo region. Earthquakes may precipitate psychiatric symptoms. The aim of this study was to investigate cognitive functioning and positive and negative symptoms before and after the 2009 L'Aquila earthquake in patients with first-episode psychosis (FEP) and chronic schizophrenia (CS). METHODS: A total of 54 FEP patients (34 males and 20 females) and 63 CS patients (39 males and 24 females) were investigated. Psychometric scores were submitted to a 2 × 2 mixed analysis of variance, with group (FEP and CS) as the between-subjects variable and time (pre- and post-earthquake) as the within-subjects variable. RESULTS: Positive symptoms increased significantly from the pre- to the post-earthquake assessment in FEP patients but not in those with CS. There were no significant differences between the pre- and post-earthquake period in terms of negative symptoms in both groups. Compared with the pre-earthquake assessment, FEP patients scored significantly worse at the post-earthquake evaluation in terms of Wisconsin Card Sorting Test categories achieved, immediate verbal memory and delayed verbal memory. However, there were no significant differences in cognitive scores between the pre- and post-earthquake periods in patients with CS. CONCLUSIONS: Our findings suggest that a disastrous earthquake has a negative impact on cognitive functioning and positive symptoms in FEP patients, but not in those with CS.

[Body image disorders and other psychiatric symptoms in aesthetic plastic surgery]. / Disturbi dell'immagine corporea e sintomatologia psichiatrica in pazienti candidati ad interventi di chirurgia estetica.

OBJECT: The aim of our study has been to investigate the presence of alterations of body image and psychiatric symptoms in a sample of patients candidates to participate in cosmetic surgery. MATERIAL: It has been recruited 56 outpatients (M=12; F=44) of mean age of 37, 55 years (ds 13.31) consecutively afferent to the Plastic Surgery Ward at the University of L'Aquila. All patients were Plastic Surgery candidates. They have been evaluated by administration of the following instruments: Self-Report Symptom Inventory-Revised (SCL-90) and the Body Uneasiness Test (BUT). RESULTS: The sample was divided into two groups in order to BUT positivity (33.92% positive versus 66.02% negative). Both groups have showed statistically significant differences (p < 0.01) in all SCL-90 dimensions moreover the BUT positive patients have showed greater scores in all SCL-90 dimensions than BUT negative patients. DISCUSSION: Our data indicate the high prevalence of body image disorders and the presence of other psychiatric symptoms in Plastic Surgery patients. CONCLUSIONS: Our study confirm the importance of psychiatric evaluation in those patients. Therefore, a liaison between Psychiatric Service and Plastic Surgery is needed and the consequent psychiatric evaluation results essential to give indications for complete surgical cosmetic procedures.

Pragmatic language and theory of mind deficits in people with schizophrenia and their relatives.

BACKGROUND: Deficits in theory of mind have frequently been observed in people affected by illnesses characterized by disrupted social behaviour like autism and psychoses. In schizophrenia, a pragmatic deficit in expressive language can also be observed. The present study was designed in order to assess the suitability of theory of mind and pragmatic conversation abilities as possible cognitive endophenotypes of schizophrenia. METHODS: First- and second-order false belief tasks and pragmatic deficits in expressive language were examined in 38 patients with schizophrenia, in 34 non-psychotic relatives and in 44 healthy controls. An extensive clinical and neuropsychological assessment was also conducted. RESULTS: Schizophrenic people and their first-degree relatives performedworse than the normal control subjects in false belief and pragmatic conversation tasks. General cognitive ability and neuropsychological measures of executive functions were not related to social cognition tasks. CONCLUSIONS: Theory of mind disorders and failing to understand the gricean conversational maxims are associated with schizophrenia liability.

Epileptic EEG discharges and short non-convulsive crisis: Influence on cognitive and psychobehavioural functions in youths.

PURPOSE: Learning and behavioural difficulties often occur in benign childhood epilepsy. In recent years, several electroencephalogram (EEG) characteristics have been related to the occurrence of learning and behavioral problems. We determined if the cognitive characteristics of epileptic children depend exclusively on illness factors, or if epileptic electroencephalogram discharges during the crisis contribute to these changes. METHODS: We studied a randomly selected group of 150 youths with short non-convulsive crises, who completed cognitive testing and electroencephalographic studies. The inclusion criteria were: undefined crisis, variations in cognitive function and/or frequent epileptiform discharges on the electroencephalogram. RESULTS: Previous research indicates that the type of epilepsy and the patient's educational level can influence cognitive functioning. The electroencephalographic epileptic discharges during the crisis has been found to influence cognitive transitory functions such as vigilance or swiftness of mental functions. The type of epilepsy is correlated statistically with impairment of learning ability tests: reading (F, 5.487, P = 0.005) and mathematics (F, 3.007, P < or = 0.05). In addition, 40% of the epileptic patients had behavioural disordered versus 16% for the control group (P < 0.02). CONCLUSIONS: Our results show dissociation between the characteristic directly dependent on epilepsy, particularly the type of epilepsy, on stable cognitive functions, such as the progress in school, and the effect of parosystic anomalies or the immediate effect of crisis and EEG dischargeson cognitive processes.

The questionnaire of family functioning: a preliminary validation of a standardized instrument to evaluate psychoeducational family treatments.

The aim of the study was to develop and preliminarily validate a self-completed questionnaire that could help in the assessment of families before and during psycho-educational interventions. The questionnaire was developed according to the cognitive-behavioural psycho-educational model. From an initial 38-item version of the questionnaire, a final shorter 24-item version was derived. The validation study of the final version was conducted on relatives of schizophrenic and schizoaffective patients: 31 for the test-retest reliability study and 92 for the confirmation of the subscales and convergent validity study vs. SF-36 and the questionnaire on Family Problems, PF. The final questionnaire showed good psychometric properties. The three-core dimensions of Problem-Solving, Communication Skills, and Personal Goals were clearly outlined in the items correlation analysis. The association with family burden and health-related quality of life was as expected. The FF provides a promising assessment of the family functioning pattern that is the object of psychoeducational family interventions. Further studies are needed to confirm the validity of the instrument, that could be helpful both in planning and in monitoring psycho-educational interventions and in mental health promotion projects.

Deficit of social cognition in subjects with surgically treated frontal lobe lesions and in subjects affected by schizophrenia.

The ability of humans to predict and explain other people's behaviour by attributing independent mental states such as desires and beliefs to them, is considered to be due to our ability to construct a "Theory of Mind". Recently, several neuroimaging studies have implicated the medial frontal lobes as playing a critical role in a dedicated "mentalizing" or "Theory of Mind" network in the human brain. In this study we compare the performance of patients with right and left medial prefrontal lobe lesions in theory of mind and in social cognition tasks, with the performance of people with schizophrenia. We report a similar social cognitive profile between patients with prefrontal lobe lesions and schizophrenic subjects in terms of understanding of false beliefs, in understanding social situations and in using tactical strategies. These findings are relevant for the functional anatomy of "Theory of Mind".

The Supportive Care Task Force at the University of L'Aquila: 2-years experience.

The Supportive Care Task Force (SCTF) was established within the Medical Oncology Department at the University of L'Aquila in May 2002. The missions of the SCTF were to allow systematic evaluation and treatment of symptoms, to warrant continuity of care in all phases of disease and to provide medical oncology residents with training in the treatment of symptoms. A medical oncologist, two senior residents in medical oncology and a registered nurse comprised the SCTF. A psychiatrist, two neurologists, a dietician, and two physiotherapists served as consultants or on a part-time basis. Four beds in two-bedded rooms inside the Medical Oncology Department were reserved to SCTF. A close integration with the physicians of the Medical Oncology Department was realised. The only criterion to admission was the presence of uncontrolled symptoms. Patients were evaluated and monitored with the visual analogue scale for pain and with the Edmonton Symptom Assessment Scale (ESAS). The Palliative Prognostic Score (PaP Score) was employed to assess the prognosis. Non-clinical needs were evaluated with the Need Evaluation Questionnaire (NEQ). Protocols for the treatment of common symptoms were available in written form for consultation by physicians, residents and nurses. From 1 May 2002 to 31 May 2004, we observed 208 patients: 111 women and 97 men. The median age was 64.7 (range 28-90) years. Fifty-four patients (25.9%) were admitted more than once, for a total of 285 admissions. One hundred ninety-nine admissions (69.5%) were for supportive care while 86 admissions (30.5%) were for supportive care and active treatment. The most frequent symptoms were asthenia and anorexia. We registered excellent results regarding the treatment of pain, nausea and dyspnea while psychological symptoms, anorexia and asthenia proved more difficult to treat. Two hundred twenty patients were discharged: 142 (49.8%) home; 76 (26.7%) to the Home Care Service and two (0.7%) to others units of the hospital. Sixty-five (22.8%) died in our unit.

Is theory of mind in schizophrenia more strongly associated with clinical and social functioning than with neurocognitive deficits?

This paper examines the correlations between 'Theory of Mind' (ToM) and neurocognitive performance, together with clinical and social functioning, in out-patients with schizophrenic disorders. It was hypothesised that, since the ability to make inferences about the environment and about other peoples' mental states is a key ingredient of social competence, the assessment of ToM would correlate more strongly with current social functioning than with more traditional neurocognitive measures. 'Independent raters' assessed Theory of Mind, neurocognitive and clinical variables as well as community functioning in 44 subjects with schizophrenia. The neuropsychological measures were more closely associated with community functioning than with psychiatric symptoms. These associations remained evident when the effects of intelligence were controlled. Patients with a higher level of competence in making social inferences had better overall community functioning than those who showed less ability in this aspect of social cognition. In a regression model, the capacity to comprehend other people's mental states (ToM-2) was among the best predictors of global social functioning, together with recent onset of illness, good verbal fluency and low levels of negative and positive symptoms. These results are consistent with other recent findings. ToM measures of social cognition may be a useful addition to neuropsychological assessment when developing programmes for reducing clinical impairments and improving the community functioning of subjects with schizophrenic disorders. Further studies are needed to verify the value of these measures as predictors of the successful application of specific psychosocial rehabilitation strategies.