Consultation liaison psychiatry in otoneurology

Background and aims: Balance disorder is oneof the most common health problems (Perez etal., 2003). A huge amount of scientific literaturedescribes the coexistence of a significant linkbetween vestibular and psychiatric disorders(Monzani et al, 2006) and its neurobiologicbackground (Balanban et al., 2001). We aim todescribe the relationship between otoneurologyand psychiatry.Methods: We considered two conditions: 1-where anxiety has a predominant role inoriginating vestibular symptoms such as phobicpostural vertigo (Brandt, 1996), space andmotion discomfort, dizziness andlightheadedness in panic attacks (Furman andJacob, 2001); 2-when pre-existing vestibulardysfunction is worsened by anxiety symptoms,increasing vestibulo-oculo-motor reflex gain(Yardley et al, 1995) and reducing adaptationmechanisms in visuo-vestibular conflicts(Viaud-Delmon et al., 2000).Results: A critical review of scientific dataexploring how vestibular and psychiatricdisorders clinically interact will be presented,together with preliminary results concerning ourstudies on: psychopathological profile andalexithimia in patients suffering from positionalparossistic vertigo, anger in hearing impairedpatients, posturography and eating disorder,coping strategies in hyperacusic patients , bodyimage perception in patients using acousticprothesis.Conclusions: Scientific literature was examinedand potential applications explored concerningthe connection between otoneurology andpsychiatry

Testing TERS and MADRS on 400 pre-OLTx patients

Testing TERS and MADRS on 400 pre-OLTx patient

Differences in posturographic measures betweeneating disordered females and healthy subjects:preliminary results

Background and aims: Posturography is a non invasivetechnique to objectively assess postural control. Weinvestigated the relationship between stabilization indexesafter mirror exposure and body image psychologicalappraisal measures in a diagnosed eating disorderpopulation, comparing it with a healthy subject one.Methods: Clinical population (N=17) and control healthypopulation (N=17) were matched for age and sex. BMI wasrecorded and every subject was administered the Italianversions of psychometric instruments assessing body imageself-perception. Static posturography (S.Ve.P. Amplifon)was performed measuring body sway with eyes open (EO)or closed (EC) during exposure to a full size mirror (M) ofa fashion model (FM) a neutral object (NO) or a verticalbar (VB). We reported descriptive statistics for sociodemographicdata and t test to compare psychometric andposturographic scores.Results: Cases and controls significantly differed inpsychometric scoring scales measuring body imageconcerns and phobic reaction (p<.001). Posturographicmeasures were significantly only in the EO and VBcondition (p<.05) and in the M and FM ones (p<.01).Conclusions: Results confirm the hypothesis thatposturography measures of female eating disorderedpatients differ from those of a control group

What does it take to become a psychiatrist? Results from a survey on quality of training

What does it take to become a psychiatrist? Results from a survey on quality of trainin

Social disfunction and body disperception in patients with cochlear implants

Social disfunction and body disperception in patients with cochlear implant

Aripiprazole: effectiveness and safety under naturalistic conditions.

A retrospective study was conducted to examine aripiprazole's effectiveness and safety in a naturalistic treatment setting in both inpatients and outpatients affected by schizophrenia and other psychotic disorders. All patients with schizophrenia, schizoaffective and delusional disorders, and schizoid and schizotypal personality disorders treated with aripiprazole from March 1, 2005, to March 1, 2006, in the authors' community mental health service were divided into outpatient (n=26) and inpatient (n=17) groups; the average treatment periods were 204 days and 25 days, respectively. Effectiveness was evaluated by improvement of symptoms (a 25% reduction of Brief Psychiatric Rating Scale [BPRS] score from baseline) and functioning level (a 50% increase of Global Assessment of Functioning [GAF] scale score from baseline), as well as dropout rate. Adverse effects and their impact on treatment course were also evaluated. The final scores of the 2 scales showed a statistically significant difference from baseline (BPRS: p<.001 in the 2 groups; GAF: p<.005 in inpatients, p<.001 in outpatients). The average improvements in BPRS and GAF were 54% and 35%, respectively, in outpatients and 71% and 71% in inpatients. Side effects included anxiety, psychomotor agitation, insomnia, and psychotic symptom worsening. The dropout rate was 24% in inpatients and 23% in outpatients, largely because of the aforementioned side effects. The data, though limited by the small sample and naturalistic methodology, suggest that aripiprazole may be effective for both long- and short-term treatment, with a greater improvement among inpatients and a similar dropout rate between groups

The different psychological profiles of subjects attending melanoma screening campaigns and those delaying diagnosis: an aid for designing preventive campaigns?

Patient delay in seeking medical attention for melanoma (MM) constitutes one of the main challenges in designing prevention campaigns. No conclusive studies exploring psychological aspects of those patients, using standardized psychometric instruments, are currently available. We hypothesized that the attitude toward illness of subjects attending the melanoma screening day (EMD) would differ from patients diagnosed with MM following the usual clinical pathways. Five psychometric tests, assessing attitude toward illness, were administered both to EMD and MM groups, this latter further divided into two subgroups (good and bad detectors, GD and BD) considering the histo-clinical characteristics of the lesion. The Mann-Whitney U Test and Pearson Chi Square test were used to compare EMD patients with the other groups and to compare psychometric scores between GD and BD. BD and GD groups showed significant differences. Interestingly, the BD group was characterized by higher scores in Temperament and Character Inventory Fearful subscale, Multidimensional Health Locus of Control Powerful Others scale and Illness Behaviour Questionnaire General Hypochondriasis, Affective Disturbance and Irritability subscales. BD patients tend to react in a phobic manner to medical recommendations and they appear to favour external and more assertive help, which would suggest choosing a more direct approach in proposing a prevention campaign. Although this is a pilot study and further studies are needed, it gives new insight to build up more effective prevention campaigns for those patients.Patient delay in seeking medical attention for melanoma (MM) constitutes one of the main challenges in designing prevention campaigns. No conclusive studies exploring psychological aspects of those patients, using standardized psychometric instruments, are currently available. We hypothesized that the attitude toward illness of subjects attending the melanoma screening day (EMD) would differ from patients diagnosed with MM following the usual clinical pathways. Five psychometric tests, assessing attitude toward illness, were administered both to EMD and MM groups, this latter further divided into two subgroups (good and bad detectors, GD and BD) considering the histo-clinical characteristics of the lesion. The Mann-Whitney U Test and Pearson Chi Square test were used to compare EMD patients with the other groups and to compare psychometric scores between GD and BD. BD and GD groups showed significant differences. Interestingly, the BD group was characterized by higher scores in Temperament and Character Inventory Fearful subscale, Multidimensional Health Locus of Control Powerful Others scale and Illness Behaviour Questionnaire General Hypochondriasis, Affective Disturbance and Irritability subscales. BD patients tend to react in a phobic manner to medical recommendations and they appear to favour external and more assertive help, which would suggest choosing a more direct approach in proposing a prevention campaign. Although this is a pilot study and further studies are needed, it gives new insight to build up more effective prevention campaigns for those patients

Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres

The disturbed behaviour of acute in-patients can have serious consequences, and methods of management are contentious and vary between countries. Little is known about this variation and its relationship to the characteristics of in-patient populations

Suicide intervention skills in health professionals: a multidisciplinary comparison

Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian professionals. Two hundredand thirty two professionals (38 psychiatrists, 50 general practitioners, 34 psychiatric nurses, 60 doctors and nurses working in accident and emergency services, and50 medical students) completed the Suicide Intervention Response Inventory (SIRI-2) (Neimeyer & Bonelle, 1997) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups andpsychiatric nurses scored significantly higher than general practitioners in identifying appropriate responses to suicidal patients. Taken together, our findings suggest thenecessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners