Study on psychoeducation enhancing results of adherence in patients with schizophrenia (SPERA-S): study protocol for a randomized controlled trial.

BACKGROUND: Poor adherence to pharmacotherapy negatively affects the course and the outcome of schizophreniaspectrum psychoses, enhancing the risk of relapse. Falloon and coworkers developed a Psychoeducation Program aimed at improving communication and problem-solving abilities in patients and their families. This study set out to evaluate changes in adherence to pharmacotherapy in patients diagnosed with schizophrenia-spectrum psychoses, by comparing one group exposed to the Falloon Psychoeducation Program (FPP) with another group exposed to family supportive therapy with generic information on the disorders. METHODS: 340 patients diagnosed with schizophrenia and related disorders according to standardized criteria from 10 participating units distributed throughout the Italian National Health System (NHS), will be enrolled with 1:1 allocation by the method of blocks of randomized permutations. Patients will be reassessed at 6, 12 and 18 months after start of treatment (duration: 6 months).The primary objective is to evaluate changes in adherence to pharmacotherapy after psychoeducation. Adherence will be assessed at three-month intervals by measuring blood levels of the primary prescribed drug using high pressure liquid chromatography, and via the Medication Adherence Questionnaire and a modified version of the Adherence Interview. Secondary objectives are changes in the frequency of relapse and readmission, as the main indicator of the course of the disorder.Enrolled patients will be allocated to the FPP (yes/no) randomly, 1:1, in a procedure controlled by the coordinating unit; codes will be masked until the conclusion of the protocol (or the occurrence of a severe negative event). The raters will be blind to treatment allocation and will be tested for blinding after treatment completion. Intention-to-treat will be applied in considering the primary and secondary outcomes. Multiple imputations will be applied to integrate the missing data. The study started recruitment in February 2013; the total duration of the study is 27 months. DISCUSSION: If the psychoeducation program proves effective in improving adherence to pharmacotherapy and in reducing relapse and readmissions, its application could be proposed as a standard adjunctive psychosocial treatment within the Italian NHS

Seasonality and suicide in Italy: amplitude is positively related to suicide rates

BACKGROUND: Recent studies have reported changes in the time patterns of suicide, with conflicting findings regarding the direction of these changes: data from Italy were investigated to evaluate the influence of recent social and medicine-related changes on the seasonality of suicides in the country. METHODS: A total of 71,227 male suicides and 26,466 female suicides occurring in Italy from 1974 to 2003 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by five-year intervals. RESULTS: The suicide rates of both males and females showed a rising trend, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality of suicides, with a clear peak in spring as against the other seasons, accounted for a statistically significant proportion of total variance: around 40% among males and 39% among females. Seasonality did not change across time in a relevant way; however, an anticipation of the peak was observed in both males and females over time, with amplitude increasing or decreasing as a function of yearly suicide rates. LIMITATIONS: Data could not be analysed according to age or to the method of suicide, since this information was not available across the whole time interval. CONCLUSION: The seasonal effect on mortality by suicide is positively related to suicide rates, so much that changes in suicide rates over time correspond to changes in suicide seasonality

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002. Amplitude is only positively related to suicide rates among females

BACKGROUND: Changes in the suicide rate within one region over time had been hypothesised to correspond to changes in suicide seasonality: a recent investigation from Italy confirmed such an assumption. Data from Slovenia were investigated to further evaluate the links between suicide rates and seasonal amplitude. METHODS: A total of 14325 male suicides and 4350 female suicides occurring in Slovenia from 1971 to 2002 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by eight-year intervals. Changes in rate over time were analysed with a test for trend based on regression analysis. RESULTS: The suicide rates of both males and females increased over time, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality decreased across time in both sexes; however, no change of the peak was observed over time. The amplitude of the major 12-month cycle was slightly positively related to suicide rates, but the correlation was only statistically significant among females (P=0.0053; males: P=0.22). LIMITATIONS: Data could not be analysed according to age, the method of suicide, or the diagnosis attributable to the deceased, since this information was not available. CONCLUSION: The study confirmed that the seasonal effect on mortality by suicide is positively related to suicide rates, so much so that changes in suicide rates over time correspond to changes in suicide seasonality, but in Slovenia this effect was only evident among females, further pointing towards differences by sex in the mechanics leading to suicide

The epidemiology of homicide in Italy by season, day of the week and time of day

Circadian and seasonal rhythms have an impact on the risk of violent death in humans, with more evidence available in suicide than in homicide. This study set out to investigate the pattern of deaths by homicide in Italy, taking into account the month, the day of the week and the time of day when the homicidal incident happened. Data based on official statistics on deaths by homicide (n = 3894) from 2003 to 2008 were analysed by spectral analysis and circular statistics techniques based on the Rayleigh test. Homicides showed seasonal distribution with a bimodal pattern, with summer (July and August) and winter (December and January) peaks over the other seasons. Homicides also peaked on Sundays and Mondays and were at their highest at night-time (00:00 to 5:59 hours). These rhythms in homicide victimization could be accounted for by social factors - within the framework of the routine activity theory - by psychological factors, including those leading to domestic violence, and by biological factors, including those impacting on impulse dyscontrol. The identification of risk or protective factors involved in the victim's surviving or succumbing to an assault might be important for the prevention of the worst outcome of injury at large, suicides and accidents included

Seasonality of suicide: relationship with the reason for suicide

AIMS: This study set out to test the hypothesis that the suicides that can be attributed to a psychiatric illness show a higher seasonality than the suicides due to any other reason. METHODS: All the suicides registered in Italy from 1984 to 2000 (57,796 deaths by suicide: males = 41,741, yearly rate = 11.3 per 100,000; females = 16,055, yearly rate = 4.0 per 100,000) were analyzed with circular statistic techniques, based on the maximization of mean vector length method and on the Rayleigh test. RESULTS: The suicides clearly attributed to a psychiatric illness were 35.0% among males and 51.3% among females. An economic reason for suicide was more frequently found among males; somatic illness or sentimental reasons were equally distributed in both sexes. The suicides attributable to a psychiatric illness showed a significantly higher seasonal unevenness than the suicides attributable to somatic illness and to sentimental or economic reasons. CONCLUSIONS: The main drawback of this study is that psychiatric diagnoses were not formally assessed by a forensic specialist. However, it succeeded in showing that the dynamics of suicidal behaviour are not unilineal: suicides due to psychiatric or somatic illness mainly happen in spring/summer and those due to economic difficulties mainly in December. Patients with psychiatric and/or somatic illness should be more carefully followed in spring/summer

Delusional profiles among young adults: a latent class analysis of delusion proneness

Delusional beliefs and experiences can predict the development of mental disorders within the spectrum of psychosis. The nature, content and prevalence of delusional experiences in the general population are still disputed topics. This study investigates the latent structure of delusion proneness in the non-clinical population. Eight hundred young adults (400 from Italy and 400 from the United Kingdom) completed the Peters et al. delusions inventory, a general population measure of delusional proneness. Latent class analysis was used to explore the latent structure of delusion proneness. Four classes were identified: low delusion proneness (including 28% of the sample), grandiosity (13%), paranoid thinking (41%) and positive psychotic beliefs (18%). Latent structures of sub-clinical symptoms can be observed also in non-clinical population; paranoid thinking is the most common delusional theme

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002

BACKGROUND: Recent studies have reported changes in the time patterns of suicide, with reduced seasonality in some European and Asian countries. Anyway conflicting data were reported on the fading of suicide seasonality, and in some countries a rising trend was reported. METHODS: Harmonic spectral analysis was used to analyze all suicides in Slovenia in the years 1971 to 2002 (14,325 among males; 4350 among females). Analyses of overall changes are based on data aggregated by intervals of 8 years. RESULTS: In both sexes, seasonal variance accounts for a statistically significant proportion of total variance (36.0% among males; 13.3% among females). Anyway in both sexes the season-attributable variance in the latest interval is considerably lower than in the preceding periods. LIMITATIONS: Data could not be analyzed according to age or to mental disorder diagnosis, since this information was not available. CONCLUSION: The seasonal effect on mortality by suicide is sensitive to change, but its causes seem not to be sex-dependant

Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy

The present study examined data on symptom patterns in the week prior to admission for suicide attempt, in a nationwide representative sample of patients. Socio-demographic, clinical, and treatment data was gathered for 1,547 patients admitted over a 12-day index period during the year 2004 to 130 public and 36 private psychiatric facilities in Italy. Patients were evaluated in terms of whether they had been admitted for having attempted suicide or not. A detailed checklist was used to assess symptom pattern at admission; diagnoses were based on ICD-10 categories. Two-hundred thirty patients (14.8%) in the sample had been admitted for suicide attempt. Patients with depression or with personality disorders were more frequently observed among suicide attempters. First-contact patients were significantly more likely to have been admitted after a suicide attempt, the only exception being individuals with bipolar disorder, manic phase. No diagnosis was statistically related to admission after suicide attempt, once symptoms pattern at admission had been accounted for. Disordered eating behavior, depressive symptoms, substance abuse, and non-prescribed medication abuse were positively related to attempted suicide, as were any traumatic events in the week prior to admission; symptoms of psychosis (hallucinations/delusions) and lack of self-care were negatively associated with suicide attempt admission. Greater attention to symptoms immediately preceding or concomitant with admission after a suicide attempt can be a key factor in establishing the best treatment plan and discharge strategy, the most effective community-service referral, and targeted intervention programmes for patients hospitalized for a suicide attempt