Internet as a tool to estimate psychiatrists’ opinions on consultation activity in the Emergency Room: a mix-method survey

OBJECTIVES This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the Emergency Room (ER). Considerations and suggestions concerning the use of Internet-based surveys for research purposes are also offered. METHODS A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was made up of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Surveymonkey was used to collect responses. Data collection went on for two weeks, from June 1st until June 15th 2011. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency. RESULTS Out of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data for the research since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). Social emergencies were indicated as a rare cause of consultation (1.7%), yet they were considered particularly challenging by the 36.2% of psychiatrists. A large amount of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by the ER personnel, “poor autonomy of the personnel working in the ER” (38.2%), and “poor perceived safety” (30.9%) by the consultant. Yet, it is noticeable that the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER. CONCLUSIONS The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, though limited external validity might be a problem only partially addressed by adopting mixed-method strategies of research

Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence

INTRODUCTION: Animal assisted therapy (AAT) is a structured form of animal assisted intervention (AAI), which specifically adopts animals in healthcare services and education facilities, to achieve therapeutic goals. Although such interventions are widely used, nowadays, evidence supporting them is still largely lacking. A previously published review of the literature highlighted some promising effects of AAT on people presenting psychiatric disorders, though the quality of the studies included was generally low. In order to provide an update of recent evidence, the aim of this study was to systematically review randomized controlled trials (RCTs) published since 2000, involving people affected by mental disorders and receiving AAT. EVIDENCE ACQUISITION: The following databases were searched: CINHAL, EBSCO Psychology and Behavioural Science Collection, PubMed and Web of Science. 115 papers were obtained and screened: 28 were from CINHAL, PsycINFO and Psychology and Behavioural Science Collection altogether, 15 from PubMed and 72 from Web of Science. In addition to this, grey literature and references of already published reviews and meta-analyses on the topic were searched, resulting in the addition of 6 further articles. After screening, 10 RCTs were included in this review. EVIDENCE SYNTHESIS: Studies involving outpatients were more frequent than those involving inpatients; sample size was generally low. The majority of studies adopted scales routinely used in clinical trials, with a good level of validity and reliability. Five out of ten studies reported significant differences in the main outcomes favouring AAT. Most of the studies did not include any follow-up; yet, where prospective data were available, the benefits of AAT appeared long lasting. Drop-out rates were higher in studies involving outpatients. However, the only trial which enrolled both inpatients and outpatients showed a higher drop-out rate among the inpatients group, possibly due to their more severe psychopathology. CONCLUSIONS: Though a paucity of available studies partly limits our findings, AAT seems to improve empathy, socialization and communication, and to favour therapeutic alliance among patients who have difficulties with therapeutic programs adherence. AAT appears to be a feasible and well-received intervention, potentially with few or no side effects reported. However there is a need for further studies with larger sample sizes and high-quality research standards

Neuroenhancer use amongst Italian medical students: a survey

Introduction. Increasing use of substances by university students to improve cognitive performance ('neuroenhacement') has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco, but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy. Aims. To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose. Methods An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363). Results 271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3% ) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036). Conclusions Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research

Apple or pear? A cross sectional study on the association between body shape and symptoms of anxiety and depression in primary care female patients

INTRODUCTION - "Apple" body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders, especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far. AIM - To explore the association between WHR and symptoms of anxiety and depression in a female primary care sample. METHODS - Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy Practice. Exclusion criteria: age 80; use of antidepressants or antipsychotics; previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA. RESULTS - 125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score (β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were found in older groups. CONCLUSION - 'Pear” body shape (WHR<1), with a peripheral distribution of fat, is inversely associated to symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple” model, with a central fat distribution, could explain the lack of correlations in women >60 years

Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting

Background: Recent researches exploring the relationship between impaired glucidic tolerance, hyperglycemia or frank type II diabetes mellitus and symptoms of anxiety and depression, mostly conducted on in-patients or highly selected samples and on foreign populations, have reported conflicting results. Nevertheless, these medical and mental conditions are often comorbid in clinical practice. Chronic and systemic inflammation could represent the trait d\'union between these conditions. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. The aims of this research was to measure the association between hyperglycemia and symptoms of anxiety and/or depression in out-patients, and to fill the lack of studies on comorbidity between depression and anxiety disorders and medical conditions in Primary Care services. Method: The present was a cross-sectional study. We evaluated all consecutive patients undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis (schizophrenia, schizoaffective, bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major depression; pregnancy; previous stroke or heart attack; type I diabetes mellitus. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Blood Glucose measurements (BM) in the last 6 months were considered in our analysis. Hyperglycemia cutoff: blood glucose N100 mg/dl. The statistical analysis was performed using STATA with multiple linear regressions. Results: 209 subjects were recruited in our study (84 men and 125 women). Of those, 48 (22.9%) were affected by hyperglycemia: 22 were men and 26 women. Hyperglycemia was related to HADS-D score in the men sample (β = .44, p = .01). No association was found between hyperglycemia and HADS-A, either in men or in women. Conclusion: The presence of hyperglycemia, well-known cardiovascular risk factor, may have a clinical value in predicting the presence of depressive symptoms, especially in men. Further studies should examine whether our results are generalizable to other populations and whether they are applicable to clinical depression. Molecular researches could focus on clarifying the pathophysiological reasons for such association, also exploring reasons for sex differences

Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation

A theoretical guide for the integration of the clinical internships for interns and clinical tutors in the mental health professions

: The Degree Course in Psychiatric Rehabilitation Techniques from the University of Modena and Reggio Emilia (Italy) was established in 2001, with the aim of training health care workers with the competencies specified by the Ministerial Decree 182. Psychiatric Rehabilitation Technicians are graduated and qualified healthcare professionals who carry out rehabilitation and psychoeducational interventions with persons having mental health problems and related disabilities. The integration between theoretical knowledge and practical experimentation builds up professional competence and allows it to develop and consolidate profession-specific skills and to experiment with pre-socialisation for the job arena. Over the years, the necessity to develop an evaluation form of internship experience has arisen to provide detail in respect to the certification of competencies gained during the clinical internship, considering the complexity of the clinical services and of the service users that interns make contact with. The aim of this paper is to describe the Guide to Clinical Internships for Interns and Clinical Tutors, a useful instrument for interns to optimize their study and clinical internship experience for training as future mental health professionals with specific competencies in the technical and relational field and developing critical ability and autonomy of judgement

Use and Propensity to Use Substances as Cognitive Enhancers in Italian Medical Students

International media has paid attention to the use of substances by healthy subjects to enhance cognitive performance. Medical students are liable to use cognitive enhancers (CE) with the aim of improving academic performance. The study explored use and attitudes toward the use of CE in Italian medical students. The authors anonymously surveyed 433 medical students of the University of Modena and Reggio Emilia with an ad hoc 36-items questionnaire. CE were broadly defined as any substance taken with the purpose of improving cognitive functions, from readily available beverages and substances, such as coffee, tea, energy drinks, and supplements to prescription only medication, such as psychostimulants and modafinil. Response rate was 83.8% (n = 363). While the majority of the students (74.7%; n = 271) said that they had used substances to improvecognitivefunctions,only2students(0.6%)reportedtheuseofprescription-onlymedications in the last 30 days. Main reasons for not taking prescription-only drugs were concerns about safety and side effects, reported by 83.3% of students (n = 295). A positive attitude toward use was held by 60.3% (n = 219) subjects. The surveyed Italian medical students used many substances as CE, but this did not seem to apply significantly to psychostimulants. A multivariable analysis showed that the followingvariableswererelatedtothepropensitytousesubstancesasCE:malegender,self-reported memory impairment, concerns about worsening of cognitive performance, lifetime use of at least one illegal substance, use of any substance (both legal or illegal) in the last 30 days

Stigma on Mental Health among High School Students: Validation of the Italian Version of the Attribution Questionnaire-27 (AQ-27-I) in a High School Student Population

The purpose of this study was to describe the psychometric characteristics of the AQ-27-I in a high school student population. Students aged between 17 and 20 years and attending the fourth and fifth year of a scientific high school in Milan were approached at the school and were asked to fill in an anonymous socio-demographic form and the AQ-27-I. Cronbach&rsquo;s alpha was used to estimate the instrument reliability and confirmatory factor analysis (CFA) was conducted and compared to the original English version factor structure. The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach&rsquo;s alpha of 0.87 and only one subscale (Personal responsibility) with an alpha lower than 0.60. Fit indices were very positive for the Dangerousness Model supporting the factor structure and paths of the original version. The Personal Responsibility Model, on the other hand, showed some weakness, concerning the process dynamics of the model. The results obtained are similar with those from other studies carried out in Italy and other countries. The questionnaire can be used for the quantitative description of stereotypes, emotions and behaviors associated with stigma in mental health in high school student populations

Association between anxiety and depressive symptoms with metabolic syndrome in primary care: Results of an Italian cross-sectional study involving outpatients

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominal adiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation