Antonio Preti

The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project

Few data are available to estimate the prevalence of eating disorders (EDs) and their correlates in the community. This paper reports data on EDs obtained in the framework of the ESEMeD project, aimed at investigating the prevalence of non-psychotic mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain), using a new version of the Composite International Diagnostic Interview. The ESEMeD study was a general population cross-sectional household survey. In total, 21,425 respondents aged 18 or older provided data for the project between January 2001 and August 2003. A subsample (N=4139) underwent a detailed investigation on EDs. Lifetime estimated prevalence of anorexia nervosa, bulimia nervosa, binge eating disorder, sub-threshold binge eating disorder, and any binge eating were 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively, and they were 3-8 times higher among women for all EDs. However, since people under 18 were excluded from this study, our prevalence should be taken as lower-bound estimate of real frequencies. Indeed, cumulative lifetime prevalence analysis showed that the majority of eating disorders had their initial onset between 10 and 20 years of age. Role impairment and comorbidity with other mental disorders were highly common, yet only small proportions of patients with a lifetime diagnosis of EDs requested medical treatment. It still has to be proven whether early diagnostic identification and access to specialized care can reduce the burden caused by these disorders.

Seasonality in suicides: the influence of suicide method, gender and age on suicide distribution in Italy.

In order to ascertain if and how age, gender and choice of lethal means influence the seasonal distribution of suicide in Italy, data concerning all suicides registered in Italy from 1984 to 1995 have been analyzed, taking these variables into account. In the age group 14-65 years and over a total of 31771 male suicides (mean yearly rate, 12.6 per 100000) and 11984 female suicides (mean yearly rate, 4.4 per 100000) have been identified in Italy during the study period. Suicides in the younger age ranges, both among males and females, show a less marked asymmetrical seasonal distribution than those in the older age groups. Only suicides committed by violent methods (ICD 953-958) show clear evidence of seasonality, with a peak in spring and a low in late autumn. Suicides committed by non-violent methods (950-952) follow no seasonal trend in either sex. Spectral analysis reveals a circannual rhythm for violent suicides (ICD 953-958) in both genders. For male non-violent suicides (ICD 950-952), a period with a frequency of 0.0833 (12 months) has been identified, but with a polarity opposite to that of male violent suicides. For female non-violent suicides, no period of frequency of 0.0833 could be identified, but, as for female violent suicides, a period with frequency close to 0.2500 (4 months) has been found. Changes in climate, then, correlate with the monthly distribution of violent and non-violent suicides in opposite ways: male violent suicides show a significant positive relationship with indicators of temperature and exposure to the sun, and a significant negative relationship with indicators of humidity and rainfall. Female suicides show less significant relationships with climate indicators. Work aimed at suicide prevention should therefore take into account the complex influence of seasonal climate both on human biological rhythms (particularly on 5-HT related functions and their actions on mood and impulsivity) and on sociorelational habits.

Randomized-controlled trials in people at ultra high risk of psychosis: A review of treatment effectiveness

As an extension of the early intervention in psychosis paradigm, different focused treatments are now offered to individuals at ultra high risk of psychosis (UHR) to prevent transition to schizophrenia, however the effectiveness of these treatments is unclear. A systematic literature search in PubMed/Medline and PsycINFO was performed to derive information on randomized control trials (RCTs) in UHR samples. Seven reports were identified detailing results from five independent RCT studies. Two studies used antipsychotic drugs (one in combination with cognitive behavior therapy); one study employed cognitive therapy; one study used a two-year program of intensive community care with family psychoeducation; one study assessed the effectiveness of 3-months omega-3 polyunsaturated fatty acids (Omega-3 PUFAs) supplementation. Intensive community care and the Omega-3 PUFAs supplementation were effective in reducing the transition to psychosis at 12 months. Overall, rates of transition to psychosis at 1 year were 11% for focused treatment groups (n=180) and 31.6% for control UHR groups (n=157). Receiving any of the focused treatment was associated with a lower risk of developing psychosis if compared with no treatment or treatment as usual (Relative Risk=0.36; 95%CI: 0.22-0.59). The available evidence at 2/3 years follow-up indicates that the effects of focused treatments are not stable after intervention cessation and when treatment is delivered over a restricted time (e.g. 6 months or less), it may achieve only a delay in psychosis onset. Due to the heterogeneity in the interventions considered, the current results do not allow recommendation for any specific treatment.

DSM―IV personality disorders in the WHO World Mental Health Surveys

BACKGROUND Little is known about the cross-national population prevalence or correlates of personality disorders. AIMS To estimate prevalence and correlates of DSM-IV personality disorder clusters in the World Health Organization World Mental Health (WMH) Surveys. METHOD International Personality Disorder Examination (IPDE) screening questions in 13 countries (n = 21 162) were calibrated to masked IPDE clinical diagnoses. Prevalence and correlates were estimated using multiple imputation. RESULTS Prevalence estimates are 6.1% (s.e. = 0.3) for any personality disorder and 3.6% (s.e. = 0.3), 1.5% (s.e. = 0.1) and 2.7% (s.e. = 0.2) for Clusters A, B and C respectively. Personality disorders are significantly elevated among males, the previously married (Cluster C), unemployed (Cluster C), the young (Clusters A and B) and the poorly educated. Personality disorders are highly comorbid with Axis I disorders. Impairments associated with personality disorders are only partially explained by comorbidity. CONCLUSIONS Personality disorders are relatively common disorders that often co-occur with Axis I disorders and are associated with significant role impairments beyond those due to comorbidity.

The “Reading the Mind in the Eyes” test: Systematic review of psychometric properties and a validation study in Italy

Introduction. The “Reading the Mind in the Eyes” test (henceforth, Eyes test) is a simple but advanced Theory of Mind test, and it is widely used across different cultures. This study assessed the reliability and construct (convergent and discriminant) validity of the Eyes test in Italy. Methods. A sample of 18- to 32-year-old undergraduate students of both sexes (N=200, males=46%) were invited to fill in the Italian version of the Eyes test, the Empathy Quotient (EQ), the Toronto Alexithymia Scale (TAS), and the Marlowe-Crowne Social Desirability Scale (SDS). Results. Internal consistency (Cronbachs alpha) was .605. Confirmatory factor analysis provided evidence for a unidimensional model, with maximal weighted internal consistency reliability=.719. Test–retest reliability for the Eyes test, as measured by intraclass correlation coefficient, was .833 (95% confidence interval=.745 to .902). Females scored significantly higher than males on both the Eyes test and the EQ, replicating earlier work. Those participants who scored lower than 30 on the EQ (n=10) also scored lower on the Eyes test than those who did not (p<.05). Eyes test scores were not related to social desirability. Conclusions. This study confirms the validity of the Eyes test. Both internal consistency and test–retest stability were good for the Italian version of the Eyes test.

The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: state-of-the-art overview and future directions.

Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinsons disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.

A comprehensive meta-analysis of the risk of suicide in eating disorders

Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta‐analysis of the risk of suicide in eating disorders.

Auditory verbal hallucinations in persons with and without a need for care

Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.

The influence of seasonal change on suicidal behaviour in Italy

The seasonal variance of suicides and attempted suicides in Italy from 1974 to 1994 has been studied to determine the extent and the nature of the seasonal influence on suicidal behaviour. The relationship between some climatic factors and suicide and attempted suicide rates has also been analyzed. A significant effect of seasonal change on suicidal behavior, with a clear peak in spring has been detected (ANOVA: df = 3/248, F = 5.875, p = 0.0007 for suicide; df = 3/248, F = 6.198, p = 0.0004 for attempted suicide), with a greater seasonal effect on males than females. The monthly distribution of suicide deaths and of attempted suicides follows a significant direct relationship with exposure to sun, and an inverse relationship with rainfall levels. So, one of the possible explanations for the effect of seasonal change on suicidal behaviour could be the changing seasonal climate. The complex influence of seasonal climate on human biological rhythms, particularly on 5-HT (serotonin) related functions, together with its effects on sociorelational habits, should be considered for suicide prevention.

The influence of climate on suicidal behaviour in Italy

A growing number of studies report an asymmetry in the seasonal distribution of suicides, with a peak in the late spring months for both sexes. The aim of this study is to verify if the climate, apart from its seasonal change, exerts a direct influence on suicidal behaviour. To this end, deaths by suicide in 17 Italian towns which all have a meteorologic station have been analyzed, taking into account some climatic indicators. Results of analyses show an unequal distribution of suicides with respect to latitude, with a peak in the North. The distribution of deaths by suicide shows a negative relationship with mean yearly temperature values, max and min, and with sun exposure indicators, and a positive, but less significant relationship with rainfall values. As far as climatic variables considered as a whole are concerned, stepwise regression identifies three relevant factors with significant relationships to suicide rates: humidity grade, rainfall mean, and sunlight exposure. These three climatic indicators explain up to 63% (Adj R2) of the variance in the distribution of suicide rates for both genders, with sunlight exposure offering the most significant contribution, when regressed on suicide rates via a multiple regression model. Higher suicide rates, therefore, correspond to dry places which are less exposed to the sun. However, the variable which shows the most significant correlation with suicide rates for both sexes is not a climatic one, but the percentage of the population aged 65 and over. The distribution of people at greater biological risk for possible disruption of brain neurochemistry (i.e. older people), therefore, predicts the distribution of suicide rates. Climate contributes to this biological risk by modifying both the responsiveness of the circuits that control mood and behaviour, and also the frequency and intensity of social interaction.