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

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

The study has been supported by the University of Ferrara (University Funds for Scientific Research 2008–2009

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 3 days 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. (C) 2009 Elsevier B.V. All rights reserved

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