[Temperament and attachment in alcohol addicted patients of type 1 and 2]. / Temperamento e attaccamento in pazienti con dipendenza da alcol di tipo 1 e 2.

OBJECTIVES: Our study first objective is the evaluation of the attachment to partner and affective temperamental traits in alcohol addicted patients; the second objective is the evaluation of differences between alcohol addicted patients of type 1 and 2 according to Cloninger and Sullivan. METHODS: The sample is composed of 40 adult patients with a alcohol addiction diagnosis enrolled at the Alcoholic Service of the Viterbo "Villa Rosa" Nursing Home. Patients have been submitted the semistructured interviews SCID I and SCID II and the self submitted TCI-R test. Furthermore they have completed the TEMPS-A (Temperament Evaluation Memphis, Pisa, Paris and San Diego) and the ECR (Experiences in Close Relationships). RESULTS: The attachment profile shows that 50% of patients have an insecure type of attachment so distributed: 25.5% of patients show a preoccupied type of attachment, 17.5% appear dismissing and 7.5% fearful. As for the affective temperament we observed a major frequency of elevated scores of Hyperthymic TEMPS-A (OR = 1.68; p < 0.01) compared to controls. At last type 2 compared to type 1 is characterized by a more elevated mid scores presence at the Avoiding dimension of Scale ECR. CONCLUSIONS: The alcohol addicted patients sample mainly show an attachment of insecure type and, with major frequency, a hyperthymic temperament. Moreover in type 2 patients there is a prevalence of the avoiding dimension in intimate relationships.

Bipolar disorder preceded by substance abuse: a different phenotype with not so poor outcome?

BACKGROUND: The co-occurrence of bipolar disorder and substance use is frequent. The question whether substance use precedes, induces or follows bipolar disorder is still unresolved. Substance use has been typically represented as a negative prognostic factor for the clinical course of bipolar illness and it has been associated with decreased compliance and treatment resistance. To extend these previous findings we examined the clinical course and outcome of patients with bipolar disorder I or II whose bipolar onset was preceded by substance/alcohol use. METHODS: The impact of substance use as a predisposing or precipitating factor of a bipolar episode was evaluated by comparing a group of bipolar subjects whose mood symptomatology onset was preceded by substance/alcohol use (N=145) (SUBP) with a similar sized representative sample of bipolar patients (either substance users/abusers or not using substances) whose first mood episode was unrelated to substance use (N=144) (NSUBP). RESULTS; The analysis of clinical and socio-demographic variables revealed that patients in the SUBP group showed less severe psychopathology, as indicated by fewer total hypomanic and depressive episodes during the course of their illness. Depressive onset was less frequent amongst the SUBP group. SUBP patients, compared to NSUBP, were poorly compliant to treatment. CONCLUSIONS: Bipolar disorder preceded by substance misuse may represent a clinically milder subtype of bipolar illness. This subtype would be less "primary" and might be more early targeted by primary prevention with programmes focused on substance misuse.

Suicide in the Italian military environment (1986-1998).

OBJECTIVE: The aim of our study was to provide data about suicide and attempted suicide in the Italian military environment from 1986 to 1998. METHODS: Italian data were gathered from the clinical documentation archived by the Epidemiological Observatory. These data were collected in a Case Report Form and subsequently sorted into the statistical program database, SPSS, and then processed. RESULTS: From 1986 to 1998, there were 122 suicides and 136 attempted suicides. The most frequently involved ranks were military troops. Subject age range varied from 17 to 60 years. The most frequent ages for both suicides and attempted suicides were 19, 20, 21, and 22 years old. DISCUSSION: The authors assume that the lower predominance of suicide in the military population is mainly attributable to the following factors: screening procedures of military personnel aim to exclude mentally disturbed and the military service provides a young individual with the possibility to belong and to identify himself with a group.