Exploration of experiences in therapeutic groups for patients with severe mental illness: development of the Ferrara group experiences scale (FE- GES).

BACKGROUND: Group therapies are routinely provided for patients with severe mental illness. The factors important to the group experience of patients are still poorly understood and are rarely measured. To support further research and practice, we aimed to develop a questionnaire that captures how patients experience groups within a community mental health context. METHODS: An initial pool of 39 items was conceptually generated to assess different aspects of group experiences. Items were completed by 166 patients with severe mental illness attending group therapies in community mental health services in Italy. Patients with different psychiatric diagnoses who attended at least 5 group sessions were included. An exploratory factor analysis was used to identify different dimensions of group experiences and to reduce the number of items for each dimension. RESULTS: The resulting questionnaire has five subscales: 1) sharing of emotions and experiences, 2) cognitive improvement, 3) group learning, 4) difficulties in open expression and 5) relationships. Each subscale has 4 items. The scale and sub-scales have good internal consistency. CONCLUSIONS: The Ferrara Group Experiences Scale is conceptually derived and assesses dimensions of group experience that are theoretically and practically relevant. It is brief, easy to use and has good psychometric properties. After further validation, the scale may be used for research into patient experiences across different group therapy modalities and for evaluation in routine care.

Working with the 'difficult' patient: the use of a contextual cognitive-analytic therapy based training in improving team function in a routine psychiatry service setting.

The clinical management of 'difficult' patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with 'difficult' patients reduced professional burnout symptoms, improved patients' service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ) before (T0) and after (T1) CAT training, and at 1-month follow-up (T2). A significant decrease were found, at T2, on the MBI Emotional Exhaustion scores, the SES Availability subscale, the GEQ Attraction to Group-Social and Group Integration-Social, while the MBI-Personal Accomplishment scores increased from baseline.The results of this study suggest that a CAT-based training can facilitate team cohesion and patient engagement with a service and reduce burnout levels among mental health team members dealing with 'difficult' patients.

Patient opinions on the helpfulness of external rehabilitative activities in residential psychiatric care: a pilot study.

INTRODUCTION: This study explores the patient opinions about the helpfulness of the External Rehabilitative Activities (ERA) delivered in two residential facilities for psychiatric rehabilitation. METHODS: We administered a Questionnaire developed to assess general helpfulness, helpfulness of specific therapeutic processes and satisfaction with the ERA to a sample of 46 psychiatric patients participating in at least three external activities. RESULTS: The External Rehabilitative Activities, tested by the ERA-Questionnaire, were considered helpful or very helpful by most of the patients. The therapeutic process with the highest score was "relaxation", followed by "general helpfulness", "socialization", "knowledge of social context", "community integration". The least-valued process was "autonomy". CONCLUSION: This pilot study has shown that psychiatric patients consider ERA helpful and rate more helpful the specific therapeutic processes, such as relaxation and socialization, that assure symptomatic relief and interaction with the outside world.

Hopelessness and related variables among cancer patients in the Southern European Psycho-Oncology Study (SEPOS).

BACKGROUND: Although hopelessness has been studied in cancer, no data are available in non-English-speaking countries. OBJECTIVE: The authors sought to amass data from Southern European countries (Italy, Portugal, Spain, and Switzerland) in order to fill this void. METHOD: A group of 312 cancer patients completed the Mini-MAC Hopelessness subscale, the Hospital Anxiety and Depression Scale (HADS), the Cancer Worry Inventory (CWI), and a six-item Visual Analog scale (VAS) to measure intensity of physical symptoms, general well-being, difficulty in coping with cancer, intensity of social support from close relationships, leisure activity, and support from religious beliefs. RESULTS: Regression analysis indicated that HADS-Depression, VAS Maladaptive Coping and Well-Being, and the CWI explained 42% of the variance. CONCLUSION: Hopelessness in cancer patients seems not exclusively to correspond to depression, but is related to various other psychosocial factors, such as maladaptive coping, as well.

Factor structure of the Brief Psychiatric Rating Scale in unipolar depression.

BACKGROUND: In clinical practice patients with unipolar depression present with a variety of symptom clusters that may combine together in many different ways. However, only few factor analytic studies used general psychopathology scales to investigate the symptom structure of unipolar depression. METHODS: The study included 163 consecutive inpatients with an ICD-10 diagnosis of depressive disorder (ICD-10 codes F32 to F33). All patients were assessed with the 18-item version of the Brief Psychiatric Rating Scale (BPRS) within 3days from admission. Exploratory factor analysis with Varimax rotation was performed on BPRS items. RESULTS: Four factors were extracted, explaining 52% of total variance. They were interpreted as Apathy, Dysphoria, Depression and Psychoticism. The distribution of factor scores was approximately normal for Apathy, while it displayed a slight negative skewness for Depression, a slight positive skewness for Dysphoria, and a marked positive skewness for Psychoticism. Patient sex, family history of depression, lifetime history of suicide attempt, and recent serious family conflict were not associated with any factor. Occupational status, age, and age at onset displayed a positive correlation with Apathy. Duration of illness and number of previous admissions were positively correlated with Dysphoria. LIMITATIONS: Patients were not administered a structured diagnostic interview, and no detailed assessment of personality disorders was performed; also, patients were recruited only at a single site, which reduces the generalizability of the results. CONCLUSIONS: Our findings suggest that in depressive disorders there are psychopathological dimensions other than depressed mood that are worthy of greater clinical attention and research. Dimensions such as apathy and dysphoria may play an important part in the clinical phenomenology of unipolar depression and deserve systematic and careful assessment in order to provide patients with the best possible treatment and improve clinical outcomes.

Effects of supportive-expressive group therapy in breast cancer patients with affective disorders: a pilot study.

BACKGROUND: So far, no study has tested supportive-expressive group therapy (SEGT) in cancer patients with an established psychiatric diagnosis. The aim of this 6-month follow-up study was to evaluate breast cancer patients with an ICD-10 diagnosis of affective syndromes participating in SEGT and a group of breast cancer patients with no ICD-10 diagnosis. METHODS: A total of 214 patients were examined in the screening phase (T0) using the ICD-10, the Brief Symptom Inventory (BSI), the Mini-Mental Adjustment-to-Cancer Scale (Mini-MAC), the Multidimensional Scale of Perceived Social Support, the Openness Scale and the Cancer Worries Inventory (CWI). Those with an ICD-10 diagnosis of affective syndromes received 16-24 sessions of SEGT (90-min sessions, once a week), while those with no ICD-10 diagnosis were followed up. A second assessment for both sam- ples took place 6 months later (T1). RESULTS: Seventy-eight (36.4%) patients were positive for an ICD-10 diagnosis of affective syndromes at T0, while 127 (59.4%) did not meet any ICD-10 diagnosis. Among the former, 54 patients participated in the SEGT. At T1, significant differences were observed in all the dimensions of the BSI, hopelessness and anxious preoccupation subscales of the Mini-MAC, the Openness Scale and the CWI. No variable at T0 was a predictor of BSI distress as measured at T1. Among those with no ICD-10 diagnosis at T0, 8.2% were positive for affective disorders at the 6-month follow-up. CONCLUSIONS: This study suggested that SEGT is effective for breast cancer patients with affective disorders, and indicates the need for prospective evaluations in order to identify those who may develop psychopathology over time.

Factors related to admission of psychiatric patients to medical wards from the general hospital emergency department: a 3-year study of urgent psychiatric consultations.

OBJECTIVE: Emergency Rooms (ER) of Emergency Departments (ED) in General Hospitals (GH) have a role in providing for psychiatric evaluation. The aims of the present study were to examine the decision-making process of consultation psychiatry at the GH-ER and to analyze the differences between psychiatric patients admitted to a medical ward with those admitted to the psychiatry unit and those who are discharged from the ER. METHOD: Over a period of 3 years, psychiatric consultations requested by ER of ED physicians to the GH Psychiatric service were recorded by using a form to describe epidemiological and clinical data on the consultation process. RESULTS: Of 1,962 psychiatric consultations, most regarded subjects who had had previous psychiatric contacts (76.2%) and at least one psychiatric admission (53.6%), and were currently cared for by the Mental Health Services (51.1%). Neurotic/stress-related syndromes (27.98%), schizophrenia (27.67%), and personality disorders (21.81%) were the most frequent ICD-10 diagnoses. The psychiatrist's disposal was to discharge the patient in 49.9% cases, to admit him/her to medical wards of the GH (MGH; 26.9%) or to the acute inpatient psychiatric ward (AIP; 23.1%). MGH group statistically differed from AIP group for being female (p < 0.01), older (p < 0.01), more likely having an ICD-10 diagnosis of neurosis/stress-related syndromes (p < 0.01) or organic mental disorder (p < 0.01), and less likely having a diagnosis of schizophrenia (p < 0.01), being in charge of the Mental Health Services (p < 0.01), and having had previous psychiatric admissions (p < 0.01). These results were confirmed by logistic regression analysis. CONCLUSIONS: The study shows that the medical wards of the General Hospital are a significant entry-point for providing psychiatric care of patients with ICD-10 neurotic and stress-related syndromes, even if without specific medical problems.

Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD-10 data and performance of the Distress Thermometer from the Southern European Psycho-Oncology Study (SEPOS).

BACKGROUND: The assessment of mood and anxiety disorders secondary to cancer by using easy-to-administer instruments has been the object of recent research. METHODS: The aim of this study was to examine the accuracy of the short screening tool developed by the National Comprehensive Cancer Network Clinical Practice Guidelines for Distress Management, (0-10 point-scale Distress Thermometer) (DT) in detecting affective syndrome disorders in Italian cancer patients. The sample consisted of 109 cancer outpatients who were administered the ICD-10 psychiatric interview (CIDI), the DT and the Hospital Anxiety Depression Scale (HADS). RESULTS: Forty-four patients (40.4%) met the criteria for an ICD-10 diagnosis of affective syndromes. The DT was significantly associated with HADS-Total score (r=0.66, p=0.001). A cut-off > or = 4 on the DT showed a sensitivity of 79.5% and a specificity of 75.4% (positive predictive value--PPV = 68.6%; negative predictive value--NPV = 84.5%). The cut-off score > or = 10 on the HADS was associated with a sensitivity of 86% and a specificity of 81.5% (PPV = 76%; NPV = 89.9%). A cut-off score > or = 5 on DT and > or = 15 on HADS maximized sensitivity (78.6% and 85%, respectively) and specificity (83.1% and 96%, respectively) for patients with more severe affective syndromes (major depression, persistent depressive disorders). CONCLUSIONS: The results suggest that simple instruments can be used as feasible tools in the screening of mood and anxiety disorders among cancer patients.

[Patient opinions on the experiences of psychiatric hospitalization: a qualitative study]. / Il punto di vista dei pazienti riguardo all'esperienza del ricovero psichiatrico: uno studio qualitativo.

INTRODUCTION: The evaluation of the patients' perspective of psychiatric admission is useful to define what is the therapeutic milieu and important to improve treatment quality. AIM: This study aimed to explore the patients' perspective of psychiatric admission to a residential unit for intensive rehabilitation treatment. METHODS: A questionnaire, assessing the patients' experiences of psychiatric admission developed from previous studies, has been administered to a series of inpatients at the rehabilitation unit "La Luna", University of Ferrara, Department of Mental Health. RESULTS: 40 patients (20 depressed and 20 schizophrenic) participated in the study. Some dimensions, such as protection from the external world (85% of depressed and 65% of schizophrenic) and opportunity to recover their own existence (75% of depressed and 65% of schizophrenic) emerged as the main experiences. The subjects (85% of depressed and 70% of schizophrenic) also reported to have a good relationship (caring and empathic) with the staff and other patients and to perceive a sense of universality, without the anxiety of living with other severe patients (65% of depressed and 55% of schizophrenic). Schizophrenic patients felt to be limited by the experience of admission more than the depressed (20% of depressed and 60% of schizophrenic, p<0.05). The most influential factor of negative or positive experience was the quality of relationship with the staff and other patients. CONCLUSIONS: This study outlines the importance of therapeutic relationship in patients' perspective of psychiatric admission and suggests broader attention to human quality on therapeutic approach.

Psychological factors affecting oncology conditions.

The area of psychological factors affecting cancer has been the object of research starting from the early 1950s and consolidating from the 1970s with the development of psychooncology. A series of problems in the DSM and ICD nosological systems, such as the difficult application of the criteria for psychiatric diagnoses (i.e. major depression, adjustment disorders) and the scarce space dedicated to the rubric of psychosocial implications of medical illness (i.e. Psychological Factors Affecting a Medical Condition under 'Other Conditions That May Be a Focus of Clinical Attention' in the DSM-IV) represent a major challenge in psycho-oncology. The application of the Diagnostic Criteria for Psychosomatic Research (DCPR) has been shown to be useful in a more precise identification of several psychological domains in patients with cancer. The DCPR dimensions of health anxiety, demoralization and alexithymia have been shown to be quite frequent in cancer patient (37.7, 28.8 and 26%, respectively). The overlap between a formal DSM-IV diagnosis and the DCPR is low, with 58% of patients being categorized as non-cases on the DSM-IV having at least one DCPR syndrome. The specific quality of the DCPR in characterizing psychosocial aspects secondary to cancer is also confirmed by the fact that some dimensions of coping (e.g. Mini-Mental Adjustment to Cancer subscale hopelessness) correlate with the DCPR dimension of demoralization, while a quantitative approach on symptom assessment (e.g. stress symptoms on the Brief Symptom Inventory) is not useful in discriminating the patients with and without DCPR syndromes. More research is needed in order to understand the relationship between DCPR constructs (e.g. alexithymia) and psychosocial factors which have been shown to be significant in oncology (e.g. emotional repression and avoidance). The role of specific DCPR constructs in influencing the course of illness is also an area that should be investigated.

Relationship between self-reported and observer-reported ratings for psychopathology in psychiatric inpatients.

OBJECTIVE: Psychopathology can be measured adopting the perspective of clinicians or the perspective of patients themselves. In the present study, we investigated the degree of coherence between these two viewpoints. METHODS: During an 8-month recruitment period, all consecutive patients admitted to two Italian residential facilities were screened for inclusion. The 24-item version of the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E) and the Brief Symptom Inventory (BSI) were administered within the first 3 days since admission and immediately before discharge. RESULTS: During the study period, 71 patients with psychosis (code F20-F29) and 80 patients without psychosis (code F30-F39 and code F60-F69) were included. In patients with psychosis, no correlation was observed between the BPRS-E total score and the General Severity Index (GSI) score at admission and before discharge. However, statistically significant correlations were found between the BPRS depression and anxiety subscale and the BSI subscales investigating affective and neurotic dimensions. In patients without psychosis, no correlation was observed between the BPRS-E total score and the GSI score at admission; conversely, at discharge, a statistically significant correlation was found between the BPRS-E total score and the GSI score, and between the BPRS-E depression and anxiety subscale and the BSI subscales investigating affective and neurotic dimensions. CONCLUSIONS: Self-reported and observer-reported ratings hold different meanings and cannot be considered equivalent. In terms of symptom dimensions, data showed that individuals tend to preserve the ability of measuring/assessing their own affective disturbances, even in the presence of psychotic symptoms, but not the ability of measuring/assessing loss of contact with reality.

Factors associated with antipsychotic dosing in psychiatric inpatients: a prospective study.

The persistent use of doses in excess of recommended levels is associated with increased risks of adverse reactions without evidence of additional benefits. Such treatment modality was evaluated in hospitalized psychiatric patients. During a 6-year recruitment period, a consecutive series of psychiatric inpatients receiving antipsychotic therapy were included. At admission, sociodemographic and clinical data, including antipsychotic drug use, were collected, and the 18-item version of the Brief Psychiatric Rating Scale was administered. At discharge, data on antipsychotic drug therapy were collected. Prescribed daily doses were converted into multiples of the defined daily doses. Using a cut-off score of a prescribed daily dose/defined daily dose as a ratio of more than 1.5 both at admission and at discharge assessments, a total of 62 (15.4%) patients persistently received high antipsychotic dose. With less stringent criteria (prescribed daily dose/defined daily dose as a ratio of more than 2), however, only 4.4% of the entire sample was persistently exposed to high antipsychotic doses. Bootstrapped linear regression analysis revealed that positive symptoms were positively associated with high antipsychotic dose, whereas negative symptoms were negatively associated with high antipsychotic dose. Antipsychotic polypharmacy at admission was the strongest predictor of persistently receiving antipsychotic doses in excess of recommended levels. This study showed that the use of high antipsychotic dosing is not an occasional event. Clinicians should consider that concurrent prescribing of two or more antipsychotic agents increases the probability of administering excessive dosing in the long-term.

Violence in psychiatric units: a 7-year Italian study of persistently assaultive patients.

BACKGROUND: The problem of violence and aggressive behaviour among patients with psychiatric disorders need careful assessment to improve the quality of psychiatric care. The aim of this paper is to describe the characteristics of repeated episodes of violence among patients admitted to an Italian psychiatric ward. METHODS: All violent behaviours, which occurred in a 15-bed psychiatric inpatient unit over a 7-year period, were assessed by using the Staff Observation Aggression scale (SOAS). RESULTS: Of a total of 3.507 admissions, 409 aggressive episodes were recorded by 160 patients (rate per admission 11.6%). A total of 65 patients exhibited two or more episodes and 95 patients showed a single episode. Repeatedly violent patients had a higher length of stay in the unit, a higher number of previous admissions and a higher number of previous violent episodes. No difference was found in terms of psychiatric diagnosis, socio-demographic variables, type of admission (voluntary versus involuntary), ward overcrowding and characteristics of violent episodes (means, aims and consequence). CONCLUSIONS: In spite of the low prevalence of violent incidents among Italian psychiatric inpatients, careful monitoring of clinical variables associated with repeated violent episodes may help physicians recognise and prevent violence episodes among acute psychiatric inpatients.

Efficacy of a short-term psychoeducational intervention for persistent non-organic insomnia in severely mentally ill patients. A pilot study.

Insomnia in psychiatric patients is frequently underestimated in clinical practice. Usually drugs are prescribed for the treatment of this disorder but non-pharmacological intervention can be successfully used. The present study aimed at evaluating the efficacy of a two-session psychoeducational intervention in improving persistent non-organic insomnia and reducing the administration of PRN therapy in severely mentally ill patients. A pre-post study was performed on 36 psychiatric patients admitted to a residential psychiatric unit. The Nocturnal Sleep Onset Scale (NSOS) and Daytime Sleepiness Scale (DSS), the sleep onset latency, the time awake after sleep onset and the numbers of awakenings were gathered 2 weeks before the intervention (T0), immediately prior the intervention (T1), 2 weeks after the last session of the intervention (T2) and a 3-month follow-up (T3). The total number of administrations of PRN therapy from T0 to T1 and from T1 to T2 were also examined. A significant reduction was shown on the NSOS, the sleep onset latency and in the time awake after sleep onset from T1 to T2 and from T1 to T3, while no significant difference was found between T0 and T1. A significant decrease on the mean number of administrations of PRN therapy was also found between 15 days before the intervention (T0-T1) and 15 days after intervention (T1-T2). The initial results of this study seems to suggest the possible efficacy of a short-term psychoeducational intervention on improving persistent non-organic insomnia in severely mentally ill patients. Further control studies are necessary to confirm these findings.

Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study.

A recent survey of clinicians' opinions suggested that antipsychotic polypharmacy is reserved for particularly severe cases, and that it is intended to avoid high doses of a single drug. In the present study, we tested these clinicians' reasons for antipsychotic polypharmacy in a sample of Italian psychiatric inpatients. During a 6-year recruitment period, all psychiatric patients receiving antipsychotic therapy at discharge from an inpatient facility were included. Sociodemographic and clinical data were collected, and the 18-item version of the Brief Psychiatric Rating Scale was administered on admission and before discharge. At discharge, data on length of inpatient stay, psychotropic drug therapy and treatment adherence were collected. Prescribed daily doses were converted into multiples of the defined daily doses. A total of 354 inpatients receiving antipsychotic treatment at discharge were included. Of these, 100 (28%) were discharged with two or more antipsychotic drugs. After background group differences were controlled for, positive symptoms, manic/hostility symptoms and polypharmacy on admission were predictors of polypharmacy at discharge. The risk of high-dose antipsychotics in patients receiving polypharmacy at discharge was 10-fold higher than that in patients receiving one antipsychotic (odds ratio 10.70, 95% confidence interval 4.78-23.97, P<0.001). The perception of clinicians is to reserve antipsychotic polypharmacy for severe, persistent and difficult-to-treat cases, and this was confirmed by the finding that patients discharged on two or more antipsychotic agents were more severely ill on admission. Conversely, the theoretical advantage of avoiding a high dose of a single drug is counterbalanced by the documented disadvantage of administering high total doses.

Use of the diagnostic criteria for psychosomatic research in oncology.

BACKGROUND: Psycho-oncology literature has shown that 30-50% of cancer patients meet the criteria for a psychiatric diagnosis, according to the usual nosographic classification (e.g. DSM). The Diagnostic Criteria for Psychosomatic Research (DCPR) have been shown to be useful in identifying psychological constellations in patients with medical illness. The aims of the study were to compare the DSM-IV and the DCPR in their application to cancer patients. METHOD: One hundred and forty-six patients with cancer underwent semistructured interviews to assess psychiatric morbidity and psychosocial syndromes according to the DSM-IV and the DCPR, respectively. The Brief Symptom Inventory (BSI) was also used to assess psychological stress symptoms. RESULTS: Sixty-five subjects (44.5%) met the criteria for a DSM-IV diagnosis (DSM cases), while 104 patients (71.2%) presented symptoms meeting the criteria for at least one DCPR syndrome. Three DCPR dimensions were more frequent than others, specifically Health Anxiety (37.7%), Demoralization (28.8%) and Alexithymia (26%). Among the subjects with no formal DSM-IV diagnosis (n = 81), 58% had at least one DCPR syndrome. DSM-IV cases had higher scores on several BSI subscales in comparison with patients with only one DCPR syndrome, while no difference was found in patients with more than one DCPR diagnosis. CONCLUSIONS: The DCPR system was found to be useful in oncology in investigating psychological conditions which are not identified by the DSM-IV alone. Assessment of more specific constructs, other than intensity of general stress symptoms, may give more specific information and help in tailoring psychological intervention for patients with cancer.

Patient opinions on the benefits of treatment programs in residential psychiatric care.

OBJECTIVE: To assess patients' opinions on the perceived benefit of treatment delivered during their stay in a residential facility. METHOD: We administered the Opinions on Curative Factors Questionnaire (OCFQ), which was developed from previous studies and assesses several treatment modalities and therapeutic factors, to a sample of 157 severely ill psychiatric patients admitted to a residential facility. RESULTS: All therapeutic factors tested by the OCFQ were considered helpful or very helpful by most of those sampled. The item with the highest score was "talking to doctor," followed by "free pass," "medication," "visitors," "nonhospital setting," "making friends with patients," "structure of daily life," "support from team," and "talking to nurses." The least-valued item was "group activities." CONCLUSION: Psychiatric patients consider several treatment factors to be helpful, especially those based on individual approaches or on a less restrictive therapeutic milieu that allows interactions with the outside world. These results may be a valuable contribution to improving treatment planning in residential facilities.

Effect of reboxetine on major depressive disorder in breast cancer patients: an open-label study.

BACKGROUND: Depression is a common disorder in cancer patients, and it is associated with reduced quality of life, abnormal illness behavior, pain, and suicide risk. A few studies have investigated the effects of tricyclic antidepressants and serotonin reuptake inhibitors in cancer patients. No data are available regarding the use of reboxetine, a norepinephrine reuptake inhibitor that has been shown to be safe (e.g., absence of clinically significant drug-drug interactions and cytochrome P450 metabolism) and effective in the treatment of depressed patients, including those with medical illness (e.g., Parkinson's disease, human immunodeficiency virus infection). METHOD: The effects of reboxetine were investigated in 20 breast cancer patients with a DSM-IV diagnosis of major depressive disorder in an open, prospective 8-week trial. Severity of depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D). Psychiatric symptoms (Brief Symptom Inventory [BSI]), styles of coping with cancer (Mini-Mental Adjustment to Cancer [Mini-MAC]), quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 [EORTC-QLQ-C30]), and Clinical Global Impressions scale scores were also monitored. RESULTS: At 8 weeks, a significant (p <.01) reduction was observed in HAM-D scores, several BSI dimension scores, and Mini-MAC hopelessness and anxious preoccupation scores. A significant (p <.05) improvement from baseline to endpoint was found on the EORTC-QLQ-C30 subfactors emotional, cognitive, dyspnea, sleep, and global. Discontinuation was necessary in 1 subject because of hypomanic switch and in another because of side effects (tachycardia, tension). Seven patients experienced transient side effects (e.g., mild anxiety, insomnia, sweating). CONCLUSION: In this open trial, reboxetine appeared to be well tolerated and promising in reducing depressive symptoms and maladjusted coping styles and in improving scores on quality-of-life parameters.