Combining an SSRI with an anticonvulsant in depressed patients with dysphoric mood: an open study

BACKGROUND: Several patients with unipolar depression present with prominent dysphoric mood. We aimed at examining the effectiveness of the combination of an SSRI with an anticonvulsant in such patients. METHODS: Thirty-five newly admitted outpatients with substantial anger, irritability, aggressiveness or hostility who were diagnosed a DSM-IV unipolar depressive disorder were rated on the Hamilton Depression Rating Scale (HDRS), the Clinical Global Improvement (CGI) scale, and a scale for the rapid dimensional assessment (SVARAD), were prescribed an SSRI and an anticonvulsant (usually valproate), and were followed up for 12 weeks. Repeated measures analysis of variance was used to test for within-subject changes in scale scores over time. RESULTS: Thirty-two and 23 patients attended the follow-up visits 4 and 12 weeks later, respectively. Significant decreases (p < .001) were observed in HDRS total score, HDRS and SVARAD anxiety factors, HDRS and SVARAD core depression factors, and SVARAD anger/irritability factor. Adjusting for age or gender did not change the results. Most patients (82%) were rated as improved or much improved on the CGI. CONCLUSION: Although our study has several limitations, we observed a remarkable improvement in most unipolar depressed outpatients with dysphoric mood treated with an SSRI and an anticonvulsant. The effectiveness of anticonvulsants might be linked to their action on symptoms of aggression and behavioural activation

PW08-03 The use of drugs for mood disorders in Italy: Preliminary results

Background:Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools).Objectives:The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression.Methods:Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute.Expected results:The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes

Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial

BACKGROUND: Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices. The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi – in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia. METHOD: Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores. RESULTS: 31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning. Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study). CONCLUSION: The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated

Description and validation of a geriatric multidimensional graphical instrument for promoting longitudinal evaluation

The debate about the adoption of standard multidimensional geriatric assessment instruments is mainly due to the lack of consensus on the feasibility and requirements for such instruments by both the health and the social care professions. A tool called ValGraf was developed in the attempt to give an original answer to these and other controversial issues. The aim of this study was to evaluate the ValGraf for acceptability, concurrent validity and factorial structure. The functional and cognitive impairments as ascertained by the ValGraf were compared with Katz index and Folstein\u2019s Mini Mental State Examination (MMSE). Subjects (N = 210) of four nursing homes were assessed by two independent teams of nurses. The factorial validity study involved 8280 subjects living in nursing homes. Assessments were conducted throughout the 2001 by 20 geriatricians. The agreement between the ValGraf sections concerning independence in daily living and Katz\u2019s index was almost total (r = 0.96) and that between ValGraf items on cognition andMMSE was very good (0.73). Factor analysis revealed that 13 coherent factors explained 53% of total variance. ValGraf was proved to be acceptable and comprehensive, criterion valid, at least as daily activities and cognitive status are concerned, and to have a coherent factorial structure

Progetto nazionale Salute mentale

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

The psychotic spectrum: a community-based study

Over the last years, there has been an increasing awareness and knowledge about bipolar spectrum disorders. However, descriptive data on bipolar I disorder with psychotic features (BPI-p) in comparison with schizophrenia (SCH) and schizoaffective disorder (SA) in mental health community services are scanty in the literature. We conducted a study with the aim of assessing the prevalence, clinical characteristics and levels of functioning of SCH, SA and BPI-p in a random sample of patients with psychotic symptoms recruited in nine departments of mental health. Patients with a psychotic disorder according to their treating clinicians were assessed using the SCID and a series of questionnaires to evaluate their psychopathology and level of functioning. Patients who received a DSM-IV diagnosis of SA (N=55), SCH (N=82), or BPI-p (N=60) represented the final sample. The three diagnostic groups showed similar demographic characteristics. Independently from the diagnosis, all patients had a long duration of illness and a persistent course. Uni-variate group comparisons showed that, as compared to SCH patients, BPI-p and SA patients did better in several measures of functioning and differed in frequency of psychotic symptoms. However, a multinomial logistic regression model in which only significantly different variables were entered showed similar levels of functioning in the three groups of patients. The three groups’ scores did not significantly differ on instruments that assessed dimensionally psychotic and affective symptoms during the previous mont