C. Bressi

Short-Term Psychodynamic Psychotherapy Versus Treatment as Usual for Depressive and Anxiety Disorders: A Randomized Clinical Trial of Efficacy

This randomized clinical trial aimed to evaluate the clinical efficacy of short-term psychodynamic psychotherapy (STPP) in the treatment of patients suffering from anxiety or depressive disorders, as compared with a control case sample composed of patients undergoing treatment as usual (TAU). Sixty patients with depressive or anxiety disorders according to DSM IV-TR were randomly assigned in a 1:1 ratio to an intervention group (STPP) or control group for 12 months (T1). Primary outcome measures were the Symptom Checklist 90-Revised (SCL-90-R), the Inventory of Interpersonal Problems (IIP), and the Clinical Global Impression Improvement Scale. Intention to treat analysis revealed that patients who received STPP showed significantly more improvements in comparison with those who were in the TAU group on Clinical Global Impression Improvement Scale and IIP measures. This study offers evidence that STPP is an effective treatment for patients with anxiety or depressive disorders, and it could be more effective than TAU in improving interpersonal problems as measured by IIP.

The association between insight and symptoms in bipolar inpatients: An Italian prospective study

OBJECTIVE To evaluate potential differences in insight among bipolar manic, mixed and bipolar depressed inpatients and assess the role of clinical and demographic characteristics as possible predictors. METHOD One hundred and twenty consecutive inpatients divided into three diagnostic groups were studied on admission (T0), at discharge (T1) and at 18weeks after hospitalization (T2). The young mania rating scale (YMRS), the Hamilton rating scale for depression (HAMD) and the scale to assess unawareness of mental disorder (SUMD) were used. RESULTS Patients with mixed mania showed highest scores on the SUMD than patients with mania or bipolar depression. It was found a significant relationship between improvements in mania and in the insight. The level of insight at baseline was the only predictor of awareness in social consequences, moreover clinical and demographic characteristics were predictors of insight into mental illness. For what concerns insight about therapy benefits it was influenced by level of mania at baseline. CONCLUSION The three general dimensions of insight revealed significant differences among the three groups. Regression models suggest that insight is a multidimensional concept in which some aspects are state-related, associated with psychopathology, whereas others are trait-like qualities, not directly associated with symptoms and predicted only by level at baseline.

Systemic Family Therapy in Schizophrenia: A Randomized Clinical Trial of Effectiveness

Background: Although evidence suggests the effectiveness of cognitive and behaviorally oriented family therapies for schizophrenia, no specific randomized study has been carried out on Systemic Family Therapy (SFT). The purpose of this longitudinal prospective study was to evaluate the clinical effectiveness of SFT in the treatment of patients suffering from schizophrenia, as compared with a control case sample composed of patients undergoing routine psychiatric treatment. The study included a 2-year follow-up period and was conducted following the Milan School model. Methods: The case sample in the study was made up of 20 patients treated with SFT associated with routine psychiatric treatment, and 20 patients undergoing routine psychiatric treatment alone. Both groups of patients were re-evaluated at the end of treatment (T1) and 12 months after the end of treatment (T2) to assess the clinical course of the illness. Results: At the end of the follow-up period, we noticed an improved clinical course and a better pharmacological compliance in the group of patients treated with SFT. In the experimental case sample, 3 subjects (15%) had relapsed, compared to 13 patients (65%) in the control group (p = 0.03). No significant difference was found in the 2nd year of follow-up. Conclusions: Our study provides an innovative contribution with regard to the evaluation of the clinical effectiveness of SFT in the treatment of schizophrenic patients. The clinical results were significant, and we thus feel justified in continuing to use this type of therapy in integrated interventions involving schizophrenic patients.

Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study

OBJECTIVE The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. METHOD One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Youngs Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. RESULTS At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. CONCLUSION Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania.

Family assessment and linguistic interaction: analysis of the Camberwell Family Interview.

Expressed Emotion (EE) is a form of assessment of the family environment: it is highly reliable and has proved to be predictive for symptomatologic relapse with schizophrenic subjects. Rating is obtained by offering to relatives living with the schizophrenic patient a structured interview, the Camberwell Family Interview (CFI). In the present study we will undertake a linguistic analysis (with quantitative and semantic evaluation) of 16 CFI, in order to detect communication parameters likely to be correlated with basic EE categories (high and low EE). The results obtained demonstrate that high EE relatives show a more immediate response style and a greater amount of speech. Moreover, these subjects tend to neglect their task during the interview, starting in most cases a self-referred communication.

Cross-Informant Agreement on Preadolescent's Emotional and BehavioralProblems in a Non-Clinical Cohort of Northern Italy Subjects: A Pilot Study

Background: The emotional-behavioral repertoire has been extensively studied in children and adolescents, devoting less effort to preadolescence. Objective: To investigate the emotional-behavioral repertoire compared to different sources of information – parents versus children – on a pilot non-clinical sample of Italian preadolescents. Methods: Thirty pre-adolescents aged 11 to 14 years old (16 females, 14 males) are consecutively referred to the Service of Psychotherapy, Ospedale Maggiore Policlinico, Milan for an evaluation of their mental health status. Pre-adolescents and their parents were respectively asked to fill in the Youth Self- Report (YSR) and the Child Behavior Check List (CBCL). Results: Significant differences between mothers and fathers emerged at Syndrome Scales (SSs): Anxious/ Depressed (p=0.026), Social Problems (p=0.035); at DSM-oriented Scales (DOSs) in Emotional Problems (p=0.012) and at the scales in Internalization (p=0.019). There are also significant differences on the total score (p=0.035). Comparing answers reported by pre-adolescents versus those reported by their parents, the number of scales with significant differences increases (SSs. Anxious/Depressed: p=0.032; Somatic Complaints: p=0.004; Thought Problems: p=0.010; DOSs. Anxiety Problems: p=0.044; Somatic Problems: p=.006; Internalization: p=0.016), with influences also the total score (p=0.049). Discreet correlations in all the global scales and in total scores between pre-adolescents and mothers, but not fathers, were found. Conclusions: Parents show differences in their perception of children’s emotional- behavioral problems, especially of internalizing behaviors. These results suggest the specific importance of an extended family analysis at this stage of development.