Fiorino Mirabella

Prevalence of Psychiatric Disorders in an Italian Town: Low Prevalence Confirmed with Two Different Interviews

Background: In Italy, few studies on the prevalence of psychiatric disorders have considered all of the most common disorders and very few have adopted the most common tools, that is, the Composite International Diagnostic Interview (CIDI) and the Present State Examination (PSE). The objective of the present study was to estimate the prevalence of psychiatric disorders and its correlates in the town of Jesi, Italy, using the PSE and CIDI, administered 7 years apart. Methods: The two surveys were conducted among adults in Jesi (central Italy), using the PSE in 1993 and the CIDI in 2000. Participants were randomly chosen from the patient lists of general practitioners. Results: The one-month prevalence of persons with a psychiatric disorder was 7.3% (95% CI: 4.4–11.6) in 1993 and 6.0% (95% CI: 3.5–9.5) in 2000. The lifetime and 1-year prevalence rates were 21.0 and 8.2%, respectively. The most common disorders were depressive and anxiety disorders. Mood and anxiety disorders were more common among women and unmarried persons. Conclusions: The prevalence is lower than that in most other areas of the world yet consistent with estimates for Italian populations reported by studies using the same (or similar) tools.

Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment

Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

Micronutrients during pregnancy and child psychomotor development: Opposite effects of Zinc and Selenium

Abstract Studies on the impact of micronutrient levels during different pregnancy periods on child psychomotor functions are limited. The aim of this study was to evaluate the association between maternal plasma concentrations of selected micronutrients, such as: copper (Cu), zinc (Zn), selenium (Se), and child neuropsychological development. The study population consisted of 539 mother‐child pairs from Polish Mother and Child Cohort (REPRO_PL). The micronutrient levels were measured in each trimester of pregnancy, at delivery and in the cord blood. Psychomotor development was assessed in children at the age of 1 and 2 years using the Bayley Scales of Infant and Toddler Development. The mean plasma Zn, Cu and Se concentrations in the 1st trimester of pregnancy were 0.91±0.27 mg/l, 1.98±0.57 mg/l and 48.35±10.54 &mgr;g/l, respectively. There were no statistically significant associations between Cu levels and any of the analyzed domains of child development. A positive association was observed between Se level in the 1st trimester of pregnancy and child language and motor skills (&bgr;=0.18, p=0.03 and &bgr;=0.25, p=0.005, respectively) at one year of age. Motor score among one‐year‐old children decreased along with increasing Zn levels in the 1st trimester of pregnancy and in the cord blood (&bgr;=−12.07, p=0.003 and &bgr;=−6.51, p=0.03, respectively). A similar pattern was observed for the association between Zn level in the 1st trimester of pregnancy and language abilities at one year of age (&bgr;=−7.37, p=0.05). Prenatal Zn and Se status was associated with lower and higher child psychomotor abilities, respectively, within the first year of life. Further epidemiological and preclinical studies are necessary to confirm the associations between micronutrient levels and child development as well as to elucidate the underlying mechanisms of their effects. HighlightsWe assessed associations between micronutrient levels in pregnancy and child neuropsychological development.There were no associations between Cu levels and any domains of child development.A positive association was observed between Se and child language and motor skills.A negative association was found between Zn and child language and motor skills.

Environmental Tobacco Smoke Exposure during Pregnancy and Child Neurodevelopment

The developing fetus is especially vulnerable to environmental toxicants, including tobacco constituents. The aim of this study was to assess the impact of environmental tobacco smoke (ETS) exposure during pregnancy on child neurodevelopment within the first two years of life. The study population consisted of 461 non-smoking pregnant women (saliva cotinine level <10 ng/mL). Maternal passive smoking was assessed based on the cotinine level in saliva analyzed by the use of high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS) and by questionnaire data. The cotinine cut-off value for passive smoking was established at 1.5 ng/mL (sensitivity 63%, specificity 71%). Psychomotor development was assessed in children at the age of one- and two-years using the Bayley Scales of Infant and Toddler Development. Approximately 30% of the women were exposed to ETS during pregnancy. The multivariate linear regression model indicated that ETS exposure in the 1st and the 2nd trimesters of pregnancy were associated with decreasing child language functions at the age of one (β = −3.0, p = 0.03, and β = −4.1, p = 0.008, respectively), and two years (β = −3.8, p = 0.05, and β = −6.3, p = 0.005, respectively). A negative association was found for cotinine level ≥1.5 ng/mL in the 2nd trimester of pregnancy and child cognition at the age of 2 (β = −4.6, p = 0.05), as well as cotinine levels ≥1.5 ng/mL in all trimesters of pregnancy and child motor abilities at two years of age (β = −3.9, p = 0.06, β = −5.3, p = 0.02, and β = −4.2, p = 0.05, for the 1st, the 2nd, and the 3rd trimester of pregnancy, respectively; for the 1st trimester the effect was of borderline statistical significance). This study confirmed that ETS exposure during pregnancy can have a negative impact on child psychomotor development within the first two years of life and underscore the importance of public health interventions aiming at reducing this exposure.

Positive screening and risk factors for postpartum depression

The birth of a child may lead to the onset of psychopathological symptoms in the mother that vary in frequency and intensity [1,2], and to short/long-term effects on the mother’s and/or child’s health [3–7]. These symptoms usually regard some form of anxiety and depression which may cause little alarm but in some cases indicate serious problems. These include the condition defined as baby blues, which is short lasting, and characterized by mild symptoms and a minimal impact on functioning [8]. Postpartum psychosis [9,10] is definitely a more serious disorder, with a prevalence that can range between 0.1 to 0.2% [11], and an increased risk of suicide and infanticide [12]. From a clinical and statistical point of view, postpartum depression (PPD) is the most important psychological complication related to childbirth. Research studies have demonstrated that approximately 10– 15% of women who give birth are affected by PPD, with some variability in prevalence across different geographical locations and population groups [13–17]. There is also a substantial percentage of women who suffer postpartum anxiety, many of whom experience comorbid depressive symptoms. Literature regarding perinatal anxiety disorders reports a prenatal prevalence of 9–22%, and a postpartum prevalence of 11–21% [18]. The key risk factors linked with poorer postpartum mental health are well documented [19–22] and include: a past history of depression and/or anxiety [23–25], relationship problems with one’s partner [26], domestic violence [27], lack of social support

Timing and effectiveness of Brenner's IPT cognitive training in early psychosis. A pilot study

AIM The present study evaluates the outcome of cognitive training as part of Brenners Integrated Psychological Therapy (IPT) in two groups of individuals with a schizophrenic spectrum disorder (F20-F24 ICD-10). 28 participants were divided into either an experimental group or a control group. The experimental group was composed of 13 individuals (46%) with a mean age of 21.2 years and a mean duration of illness (since their first episode of psychosis FEP) of 15.6 months. The control group included 15 individuals (54%) with a mean age of 25.6 years and a mean duration of illness of 74.4 months (beyond the critical period). METHOD Participants underwent an assessment of cognitive functioning which focused on attention, memory, executive functioning and cognitive flexibility as measured by the WCST (Wisconsin Card Sorting Test). Each individual was tested pre- and 6-month post-intervention. The original IPT method was altered by reducing the frequency of sessions to once a week and by limiting our sessions to 2-3 individuals per group. RESULTS Cognitive flexibility (p<0.01) and long-term memory (p<0.01) improved only in the experimental group. These former skills worsened in the control group (p<0.01). Selective attention, short-term memory and verbal fluency improved in both groups (from p<0.05 to p<0.01). DISCUSSION AND CONCLUSIONS IPT cognitive training, when delivered in the early stages of psychosis (within 18 months from FEP), seems to be particularly effective in improving cognitive flexibility and long-term memory. We did not see improvements in those who had a longer duration of illness who also underwent the same treatment. Cognitive flexibility is linked to clinical insight and social cognition. Therefore, improving this function may lead to a better outcome for patients.

Positive screening and risk factors of postpartum depression in women who attended antenatal courses

AIM This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women. METHOD The sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated. RESULTS Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them. DISCUSSIONS AND CONCLUSIONS The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.AIM This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women. METHOD The sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated. RESULTS Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them. DISCUSSIONS AND CONCLUSIONS The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.

Sex-Dependent Impact of Low-Level Lead Exposure during Prenatal Period on Child Psychomotor Functions

The impact of exposure to lead on child neurodevelopment has been well established. However, sex differences in vulnerability are still not fully explained. We aimed at evaluating the effect of a low-level lead exposure, as measured between 20 to 24 weeks of pregnancy and in cord blood, on developmental scores up to 24 months of age in 402 children from the Polish Mother and Child Cohort (REPRO_PL). Additionally, sex-dependent susceptibility to lead at this very early stage of psychomotor development was assessed. The blood lead levels were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). In order to estimate the children’s neurodevelopment, the Bayley Scales of Infant and Toddler Development was applied. The geometric mean (GM) for blood lead level during 20–24 weeks of pregnancy was 0.99 ± 0.15 µg/dL and, in the cord blood, it was 0.96 ± 0.16 µg/dL. There was no statistically significant impact of lead exposure during prenatal period on the girls’ psychomotor abilities. Among the boys, we observed lower scores for cognitive functions, along with increasing cord blood lead levels (β = −2.07; p = 0.04), whereas the results for the language and motor abilities were not statistically significant (p > 0.05). Our findings show that fetal exposure to very low lead levels might affect early cognitive domain, with boys being more susceptible than girls. Education on health, higher public awareness, as well as intervention programs, along with relevant regulations, are still needed to reduce risks for the vulnerable population subgroups.

[Effectiveness of a manualized cognitive-behavioural intervention for postnatal depression].

AIM Important guidelines recommend cognitive-behavioural interventions for postnatal depression but in the clinical practice they are not really diffused. This study describes the results and effectiveness of a structured cognitive-behavioural intervention implemented in a public mental health department. METHODS The study involved 54 depressed women drawn from a community screening programme for postnatal depression in Bergamo province. Intervention was conducted on group and individual basis following a cognitive-behavioural programme of 10-15 weeks duration, including at least one partner session and adhered to a structured manual. Baseline and post intervention measures of depression and health were collected through validated rating scales. RESULTS Following treatment, a significant improvement was demostrated on Edinburgh Post Natal Depression Scale, Beck Depression Inventory, Patient Health Questionnaire-9, Short Form-12. The improvements were manteined after a 12 mounths follow up. CONCLUSIONS These results are encouraging and suggest that brief and structured cognitive behavioral interventions can be effective as a treatment for depression in postnatal period and routinely implemented in the clinical practice.

Strumenti di promozione della salute mentale e di potenziamento della resilienza: presentazione di un programma per l’applicazione in ambito scolastico

La salute mentale comprende le capacita di resilienza e di adattamento positivo che consentono alle persone sia di far fronte alle avversita che di sviluppare le propria potenzialita. I programmi condotti nell’ambito di attivita scolastiche curriculari fi nalizzati alla promozione di abilita sociali possono promuovere la salute mentale e ridurre i sintomi depressivi. Questo articolo descrive le caratteristiche e la prima applicazione in Italia di un programma di promozione della salute mentale nelle scuole di istruzione secondaria. Il programma richiede all’incirca, per il suo svolgimento, 20 sessioni da effettuarsi in classi della scuola secondaria con cadenza settimanale o quindicinale. La durata di ogni sessione puo andare da 60 a 90 minuti circa. Il programma si basa su un manuale per studenti composto da 18 capitoli su come comunicare in modo effi cace e assertivo, affrontare i confl itti e la rabbia, sviluppare l’autodisciplina, la negoziazione e la cooperazione e promuovere le relazioni interpersonali positive. Tredici differenti classi di 11 scuole medie inferiori e superiori, per complessivi 253 studenti di 13-18 anni, hanno partecipato volontariamente allo studio di fattibilita del programma. Di ogni capitolo del manuale sono stati valutati il gradimento e l’utilita dal punto di vista degli studenti partecipanti. Gli studenti hanno trovato il manuale accettabile e applicabile. Tuttavia, molti hanno osservato che le sessioni erano troppo brevi per raggiungere gli obiettivi pertinenti alla maggior parte dei capitoli. A seguito di una revisione, alcuni capitoli sono stati leggermente modifi cati. Per la facilita di applicazione, il programma potrebbe essere introdotto senza particolari criticita nell’ambito delle attivita curriculari nella scuola secondaria. Dopo la sua revisione, il manuale e stato inviato all’editore per la stampa.