Dental health and treatment needs in institutionalized psychiatric patients in Italy.

The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.001), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (t = 2.78; P = 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment; 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OHI-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.001) and with the length of institutionalization (t = 3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6% and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P<0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.

Seasonality of mood in Italy: role of latitude and sociocultural factors.

A mail survey of degree of seasonal suffering was conducted in Italy using the SPAQ (Seasonal Pattern Assessment Questionnaire). Experiencing seasonal changes as a problem was reported by more than half of the 543 responders. Both mean GSS (Global Seasonality Score) and circannual profile of 'feeling worst' yielded results similar to those reported in the USA at comparable latitudes. Global prevalences of SAD, Reverse-SAD and Sub-SAD were 4.4, 2.1 and 4.8%, respectively. Female sex and young age were associated with a higher degree of seasonal sensitivity. No clear evidence was found of higher sensitivity at higher latitudes or of a significant influence of sociocultural factors.

[Anticipatory anxiety and interpersonal relations with the radiologist of patients undergoing diagnostic imaging]. / Ansia anticipatoria e rapporto interpersonale con il medico radiologo nei pazienti sottoposti a diagnostica per immagini.

A pilot study has been carried out with the aim of evaluating the impact of updated imaging techniques (CT and MRI) versus "simple" examinations (tomography, X-rays, US, and nuclear medicine) on the anticipatory anxiety of the patients, as well as on the radiologist-patient relationship. Ninety consecutive patients undergoing diagnostic imaging modalities were examined according to the following schedule: 1) preliminary interview and anxiety assessment according to HRSA; 2) diagnostic imaging investigation, and 3) filling out an "ad hoc" questionnaire. The collected data have been divided into two groups: the "simple" group (52 patients submitted to X-rays, tomography, US, and nuclear medicine), and the "complex" group (38 patients submitted to CT and MRI). Anticipatory anxiety was observed in all subjects and attained psychopathological rates in more than half of them. Anxiety proved to be related to the completion of the examination rather than to its complexity. The questionnaire has pointed out the need for a more interactive relationship between radiologist and patient during diagnostic imaging examinations.

Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of the 1978 psychiatric reform.

A survey to analyse patients' characteristics and the care delivered to them was conducted in several psychiatric facilities, covering the whole range of care offered in the public sector in two regions of Southern Italy. A case-control method of analysis was chosen, and the relative risk estimates (RR), together with their 95% confidence intervals (CI), of being in custodial facilities were computed, comparing patients treated in custodial institutions ('cases') with those in community-based services ('controls') in respect of social and clinical variables. Factors more strongly associated with custodial treatment were: illiteracy (RR = 2.4), unmarried status (RR = 2.4), a history of prolonged illness (RR = 7.6), organic diagnosis (RR = 2.6), previous custodial treatment (RR = 3.9), and expected poor social functioning (RR = 2.4). The suitability and advantages of the case-control method of analysis in the field of psychiatric care evaluation are discussed.