Clinical global impression-severity score as a reliable measure for routine evaluation of remission in schizophrenia and schizoaffective disorders

Aims: This study aimed to compare the performance of Positive and Negative Syndrome Scale (PANSS) symptom severity criteria established by the Remission in Schizophrenia Working Group (RSWG) with criteria based on Clinical Global Impression (CGI) severity score. The 6-month duration criterion was not taken into consideration. Methods: A convenience sample of 112 chronic psychotic outpatients was examined. Symptomatic remission was evaluated according to RSWG severity criterion and to a severity criterion indicated by the overall score obtained at CGI-Schizophrenia (CGI-SCH) rating scale (≤3) (CGI-S). Results: Clinical remission rates of 50% and 49.1%, respectively, were given by RSWG and CGI-S, with a significant level of agreement between the two criteria in identifying remitted and non-remitted cases. Mean scores at CGI-SCH and PANSS scales were significantly higher among remitters, independent of the remission criteria adopted. Measures of cognitive functioning were largely independent of clinical remission evaluated according to both RSWG and CGI-S. When applying RSWG and CGI-S criteria, the rates of overall good functioning yielded by Personal and Social Performance scale (PSP) were 32.1% and 32.7%, respectively, while the mean scores at PSP scale differed significantly between remitted and non-remitted patients, independent of criteria adopted. The proportion of patients judged to be in a state of well-being on Social Well-Being Under Neuroleptics-Short Version scale (SWN-K) were, respectively, 66.1% and 74.5% among remitters according to RSWG and CGI-S; the mean scores at the SWN scale were significantly higher only among remitters according to CGI-S criteria. Conclusions: CGI severity criteria may represent a valid and user-friendly alternative for use in identifying patients in remission, particularly in routine clinical practic

Victimization and mental disorders: results of a case-control study

Aims. The study aimed to evaluate prevalence rates of victimization in a sample of outpatients affected by psychotic or anxiety disorder. Methods. After informed consent 101 patients (50 affected by psychotic disorders and 51 affected by anxiety disorders according to DSM-IV TR) and a control group of non affected people matched according to gender, age, marital status and education were included in the study. Psychotic patients were submitted to evaluation by means of PANNS; control group was submitted to the MINI interview. All subjects (cases and controls) fulfilled a 14-item Victimization Questionnaire. Results. Subjects affected by mental disorders reported more frequently physical aggressions (6% vs 1% of controls, p=0.054), contact with police for help (22.8% vs 5% of controls, p<0.0001), insults or offences (39.6% vs 18.8% of controls, p=0-001), disturbing phone-calls (19.8% vs 8.9% of controls, p=0.027), stalking (5,9% vs 1% of controls p=0.054). during the last 12 months. Subjects with anxiety disorders reported victimization more frequently than psychotic patients. The comparison of the data collected in the present study with those from international literature show lower rates of victimization in our sample. Conclusions. People affected by mental illness, particularly non psychotic patients, seem to be more frequently submitted to some forms of violent and non violent victimization

A Different Approach in High Risk Patients for Ovarian Cancer: Single-port Vs Conventional Multi-port Access in Prophylactic Laparoscopic Bilateral Salpingo- oophorectomy (BSO).Comparison of Surgical Outcomes.

Background To evaluate the surgical outcomes associate risk-reducing salpingo-oophorectomy performing in single port comparing multi-port laparoscopy in women with high risk for ovarian cancer. SPAL- BSO is feasible and safe with favorable surgical and cosmetic outcomes compared to conventional laparoscopy. Methods Prospective, multicentric, case-control study of patients with a high risk of ovarian cancer undergoing a BSO. Ninety-nine out of 115 patients met the inclusion criteria and entered the study. Patients were informed about the two types of surgeries and were alternatively assigned to undergo an SPAL-BSO with optimal laparoscopic experience and at least 1 year of training for this procedure or an MPL-BSO performed by skilled laparoscopic surgeons without SPAL experience. Collected data were patient characteristics (age, BMI [kg/m2]), co-morbidity, type and duration of surgery, estimated blood loss (EBL), postoperative pain score, perioperative complications, length of hospital stay, use of analgesics, and cosmetic satisfaction. At the end of each procedure, intra-operative data—trocar introducing time, operative time, EBL, intra- and peri-operative complications, and conversion to standard-multi-access laparoscopy or laparotomy—were registered. Results In total we performed 99 surgical procedures: 49 SPAL-BSO (group A) and 50 MPL-BSO (group B). There were no differences in the demographic and preoperative data between the two groups. SPAL-BSO mean operative time was statistically significantly lower than MPL. The time of entry into the abdominal cavity was significantly lower in group A as was the extraction time of the specimens. Pain measured immediately after surgery in the recovery unit was lower in the SPAL-BSO group than in the MPL-BSO group. Moreover, postoperative pain scores after 6, 12, and 24 h were lower in the SPAL-BSO group compared with the MPL-BSO group. Cosmeti satisfaction was significantly higher in SPAL group (p<0.001). Conclusions SPAL-BSO is feasible and safe with favorable surgical and cosmetic outcomes compared to conventional multiport laparoscopy

Impulsivity and aggressiveness in bipolar disorder with co-morbid borderline personality disorder

Few studies to date have been performed to investigate impulsivity and aggressivity in patients with bipolar disorder (BD) and borderline personality disorder (BPD); the primary aim of the present study was to evaluate the impact of co-morbidity of BPD on impulsivity and aggressivity in patients affected by BD. A total of 57 patients (male = 20, female = 37) affected by BD (BD-I 51%; BD-II 49%) in clinical stable remission were recruited; 28 patients were affected by BD (49.1%), 18 by BD and BPD (31.6%) and 11(19.3%) by BD plus other personality disorders (OPD) (19.3%). They were assessed with the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, and were evaluated by means of the Clinical Global Impression (CGI)-severity and Global Assessment Functioning (GAF) scales, the Barratt Impulsivity Scale (BIS-11) and the Aggression Questionnaire (AQ). Mean total scores were significantly higher among BD/BPD patients with respect to BD and to BD/OPD, both on the BIS-11 and the AQ the rate of attempted suicides was approximately three times higher in BD/BPD patients with respect to BD and 7.6 times higher than in BD/OPD patients. The results of our study suggest that patients with co-morbid BD and BPD are more impulsive and aggressive. Furthermore, this co-morbid condition may be a risk factor for suicidality. (C) 2010 Elsevier Ireland Ltd. All rights reserved