[About epidemiology of suicidal behavior: an investigation in the health-service district of Brixen]. / Zur Epidemiologie suizidalen Verhaltens: Eine Untersuchung im Gesundheitsbezirk Brixen.

OBJECTIVE: Aim of this investigation is to find out how many parasuicids as well as suicides are commited and which epidemiological characteristics (sex, age, substance addictions, relationships, job, life-events and suicide attempts in past) show people who commit suicide, and people who commiting parasuicide. After that we try to find variables predicting a suicide or variables what show a vulnerability to commit suicide. METHODS: Clinicans assess patients who commit parasuicide by the WHO-Parasuicide-Monitoring-Questionnaire and suicide victims by interview with the bereaved. Afterwards, data are assimilated and aggregated. RESULTS: In this period a mean of 37 (SD = 7.78) parasuicides and 6.32 (SD = 3.79) suicides happened yearly. The sample shows different characteristics in age, sex, life-events in the run-up to the action, job situation and parasuicide(s) in past. No differences were found between relationship and substance abuse/addiction and regarding both types of suicidal behavior. CONCLUSION: The incidence concerning suicide is slightly lower; the incidence with regard to parasuicide is lower than in other samples. Demographic variables show that people commiting suicide differ from those who commit parasuicide.

Italian psychiatric reform 1978: milestones for Italy and Europe in 2010?

The Italian psychiatric reform of 1978 was one of the most radical attempts in history to abolish the practise of custodial psychiatry using legislation. The work of the charismatic reformer Franco Basaglia had four main objectives, which have taken more than 30 years to achieve. Although the creation of outpatient mental health centres and a reduction in involuntary commitments occurred rapidly, the expensive development of small acute psychiatric departments in general hospitals as an alternative to psychiatric hospitals was implemented very slowly. According to a national survey by the Italian Ministry of Health, in 2001, there were a total of 9,300 acute beds for all of Italy, of which as many as 4,000 were in private facilities. With 1.72 acute beds per 10,000 inhabitants, Italy has one of the lowest figures in Europe of psychiatric beds. However, Italy's apparent and often praised low bed requirement places a large burden on families. The implementation of the reform process was most delayed and occurred at its worst in South Tyrol, in North Italy. In an effort to achieve a modern and progressive community-based psychiatric service, in particular one with more specialised services, mental health providers in this region have examined German, Austrian and Swiss models of psychiatric practice.

Delusional infestation: treatment outcome with antipsychotics in 17 consecutive patients (using standardized reporting criteria).

OBJECTIVE: The multietiological nature of delusional infestation (DI) implies that therapy needs to be customized according to the various forms of DI (primary/secondary). Usually, treatment of DI is difficult to achieve in psychiatric settings because of the patients' nonpsychiatric concept of the illness. METHODS: We analyzed the data of all consecutive DI patients seen in the Psychiatric Outpatient Department of the General Hospital Bruneck/Italy from 1998 to 2010, including structural brain imaging findings. Standardized reporting criteria are applied for the presentation of the cases in a naturalistic setting. RESULTS: Our sample consisted of 17 patients. Notably, 15 out of these 17 patients (88%) could be engaged in an antipsychotic treatment trial. With different, mainly second-generation antipsychotics, all but one patient profited from antipsychotics, at least after substances were changed: 12 (71%) of the cases reached full remission, and another 2 (12%) had partial remission. The average duration of treatment was remarkably long: 3.8 years. Eight cases were classified as secondary to a brain disorder or medical condition, four cases were classified as secondary to psychiatric disorders and five cases fulfilled the criteria for primary DI (i.e., delusional disorder somatic type). All cases secondary to a brain disorder/medical condition showed macroscopic brain lesions mainly in the basal ganglia. CONCLUSIONS: Our study confirmed previous experience that an excellent clinical outcome can be achieved in unselected patients with different DI forms provided that patients can be engaged in antipsychotic treatment. Although studies in DI are difficult to conduct, randomized controlled trials would be desirable to evaluate specific antipsychotic medication in DI in general and in the different forms of DI. More sophisticated investigations (single photon emission computed tomography and positron emission tomography) than structural brain imaging (magnetic resonance imaging and computed tomography) are needed to better elucidate underlying brain dysfunction in DI.

[The preconditions of postpartum dysphoria]. / Die Bedingungsvariablen der postpartalen Dysphorie.

Postpartum dysphoria (Baby Blues) is a puerperal-disease of mothers who have recently given birth; its prevalence in western industrialized countries ranges from 26 to 85% The baby-blues may begin during the first week after birth, lasts a few days and disappears without any medical treatment. Therefore there is still little research dealing with this phenomenon. The present study was carried out in Brixen, Italy, in the framework of the international Munich-Postpartum-Project and was done by means of a questionnaire. It showed that these women who had to face an insecure social environment after hospital discharge, had symptoms of a dysphoria. For that reason the Blues seems to be a phenomenon of socially distressed women.

Sex and ethnic differences among South Tirolean suicides: a psychological autopsy study.

OBJECTIVE: The aim of the research is to study whether any differences exist in the rates and characteristics of suicide by ethnicity and sex in South Tirol, Italy. METHODS: Psychological autopsy interviews were conducted for suicides who died between March 1997 and July 2006. RESULTS: 332 individuals belonging to the three major South Tirolean ethnic groups (Germans, Italians, Ladins [Ladin is a Rhaeto-Romance language related to the Venetian and Swiss Romansh languages]) died by suicide. Around 23% of the victims had experienced suicidal behaviour among family members, and more than 31% of them had experienced trauma during their childhood. Germans were 1.37 times more at risk to commit suicide than Italians (95% CI: 1.04/1.80; z=2.26, p<.05). 69% of the suicides had attended school for less than 8 years: Germans (OR=4.62; 95% CI: 2.52/8.47; p<.001) and Ladins (OR=11.24; 95% CI: 2.99/42.30; p<.001) were more likely to have lower education than Italians. There were several differences by ethnicity and sex but no sex-by-ethnicity interactions. CONCLUSIONS: The study indicated that suicide, an alarming health and social problem in South Tirol, may require different preventive interventions for men and women and for those of different ethnicities.

Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects.

OBJECTIVE: The present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care. METHOD: Sixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated. RESULTS: Most psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care. CONCLUSION: Our results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.

Information transmission defect identified and localized in language learning impaired children by means of electrophysiology.

Children with language processing deficits have various learning impairments and poor scholastic performance. In 3-10% of all children a specific language processing deficit can be identified by the Sound Connecting Sub-Test of the Illinois Test of Psycholinguistic-Abilities (SC-ITPA). These children among which we drew our index group (AS-Group) suffer from the disability to recognize isolated sounds as parts of words. Following linguistic terminology this is known as an auditory sequential sound processing deficit (ASSPD) Eighteen children (AS-Group) and 21 controls (C-Group) were subjected to mapped P300 evoked potential analyses of cortical response to acoustic stimulation in the oddball paradigm. The data presented here show that there exists significant relation between the P300 amplitude reduction and ASSPD. The P300 amplitude decrease measured in the AS-Group is due to a reduced information transmission in accordance with Johnson's Triarchic Model of the P300 Amplitude. The cerebral structures involved in poor language processing are localized at the left temporo-parietal cortex. This supports the hypothesis that the underlying neuronal defect of ASSPD is localized in the language center and not in the auditory pathway. The P300 amplitude may serve as electrophysiological tool to identify ASSPD and to quantify the degree of improvement in the course of specific therapy.