Luca Bartoli

Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: Preliminary data

BACKGROUND Concerns have been expressed about the reliability and validity of the DSM-IV criteria for schizoaffective disorder, but no systematic study has been published up to now. METHODS The Cohens kappa for the individual items of the DSM-IV definition of schizoaffective disorder, manic episode and major depressive episode was evaluated in 150 patients independently interviewed by two psychiatrists using the Composite International Diagnostic Interview. The two-year outcome of patients with a consensus DSM-IV diagnosis of schizoaffective disorder was compared to that of patients with DSM-IV schizophrenia and schizophreniform disorder, using the Strauss-Carpenter Outcome Scale. RESULTS The Cohens kappa was 0.22 for the diagnosis of schizoaffective disorder, 0.71 for that of manic episode, and 0.82 for that of major depressive episode. Schizoaffective patients had a significantly better outcome than those with schizophrenia but a worse outcome than those with schizophreniform disorder. CONCLUSIONS The inter-rater reliability of the DSM-IV criteria for schizoaffective disorder is not satisfactory. The better outcome of DSM-IV schizoaffective disorder compared with schizophrenia seems to depend more on the inclusion, in the definition of schizophrenia but not in that of schizoaffective disorder, of the six-month duration and functional impairment criteria than on the different symptomatological patterns of the two conditions. LIMITATION The size of the sample of patients fulfilling DSM-IV criteria for schizoaffective disorder was small. CLINICAL RELEVANCE The study suggests that the clinical implications of the currently problematic diagnosis of schizoaffective disorder may be modest.

Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study

Objective: To assess the natural story of HIV‐associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors.

Early neuropsychological impairment in HIV-seropositive intravenous drug users: evidence from the Italian Multicentre Neuropsychological HIV Study

The aim of the Italian Multicentre Neuropsychological HIV Study is to assess the prevalence and natural history of cognitive deficit in intravenous drug users (IVDUS) during the asymptomatic phase of HIV infection. The study is currently being conducted in four centres (Napoli, Benevento, Verona and Pavia) whose catchment areas are characterized by different levels of prevalence of HIV infection. Cognitive evaluation is being performed by means of a standardized neuropsychological test battery. A total of 251 subjects (167 males and 84 females) have been recruited in the cross‐sectional phase of the study, including 75 asymptomatic HIV‐seropositive IVDUS (HIV+/IVDUS), 97 HIV‐seronegative IVDUS (HIV‐/IVDUS) and 79 non‐IVDU seronegative controls matched to IVDUS with regard to sex, age and educational level. The prevalence of global cognitive impairment (performance at least 1.5 standard deviations worse than the average of the control group, on at least two out of five tests) was significantly higher in HIV+/IVDUS than in either HIV‐/IVDUS (22.7% vs. 8.2%; P<0.01) or healthy controls (22.7% vs. 2.5%; P<0.001). The difference between HIV‐/IVDUS and healthy controls was not statistically significant (8.2% vs. 2.5%; P=0.19). The results of this study lend further support to the ‘cerebral reserve’ model. The cerebral reserve could indeed be reduced in IVDUS as a consequence of chronic exposure to the substance of abuse, so that these subjects become more vulnerable to direct and indirect neurotoxic effects of HIV.

Long-term outcome of lithium prophylaxis in bipolar disorder with mood-incongruent psychotic features: a prospective study

BACKGROUND No study has assessed systematically up to now the long-term outcome of lithium prophylaxis in bipolar patients with vs. without mood-incongruent psychotic features. METHODS All bipolar patients with mood-incongruent psychotic features who started lithium prophylaxis at a lithium clinic during 14 years were followed up prospectively for 5 years, along with a control group of non-psychotic bipolars. RESULTS Psychotic patients were significantly less likely than controls to be still on lithium after 5 years, and to present a reduction of at least 50% of time spent in hospital during the lithium treatment period compared with a pre-treatment period of the same duration. The time to 50% risk of readmission was significantly increased among both groups during lithium treatment. 39.6% of prospective episodes in psychotic patients did not include mood-incongruent psychotic features. LIMITATIONS This is a naturalistic study carried out at a lithium clinic. No control group of bipolar patients who did not receive lithium was available. CONCLUSIONS Lithium exerts a significant impact on the course of bipolar disorder with mood-incongruent psychotic features, although this impact is less pronounced than in classical manic-depressive illness.

The relationships of personal resources with symptom severity and psychosocial functioning in persons with schizophrenia: results from the Italian Network for Research on Psychoses study

The relationships of personal resources with symptom severity and psychosocial functioning have never been tested systematically in a large sample of people with schizophrenia. We applied structural equation models to a sample of 921 patients with schizophrenia collected in a nationwide Italian study, with the aim to identify, among a large set of personal resources, those that may have an association with symptom severity or psychosocial functioning. Several relevant demographic and clinical variables were considered concurrently. Poor service engagement and poor recovery style, as well as older age and younger age at onset, were related to greater symptom severity and poorer social functioning. Higher resilience and higher education were related to better social functioning only. Poor problem-focused coping and internalized stigma, as well as male gender and depression, were related to symptom severity only. The explored variables showed distinctive and partially independent associations with symptom severity and psychosocial functioning. A deeper understanding of these relationships may inform treatment decisions.

Correlations between negative symptoms and peripheral G protein levels in mononuclear leukocytes of deficit and nondeficit schizophrenics

Abstract. Receptor-coupled G proteins were measured in mononuclear leukocytes (MNL) of 17 drug-treated patients with deficit schizophrenia (DS) and 16 drug-treated patients with nondeficit schizophrenia (NDS). No significant difference was found in MNL levels of Gαs, Gαi, Gαq and Gβ proteins between the two groups; however, MNL levels of Gαs were inversely correlated to the severity of negative symptoms in DS patients, while MNL levels of Gαq were positively correlated to negative symptoms in NDS patients. Since Gαs and Gαq are coupled to D-1 and 5-HT2 receptors, respectively, these findings may support the hypothesis that a prevalent dysfunction of D-1 receptors is involved in the pathophysiology of negative symptoms in DS, whereas a prevalent dysfunction of 5-HT2 receptors underlies negative symptoms in NDS. These results must be regarded as preliminary because of the possible interference of antipsychotic drugs on the explored parameters.

Mood stabilizers in bipolar disorder

This chapter reviews the currently available evidence concerning the efficacy/effectiveness and tolerability of lithium and anticonvulsants in the treatment of manic and depressive episodes of bipolar disorder and in the prevention of the recurrences of the disorder. The focus of the review is strictly clinical; the extensive literature on the mechanisms of action of the above-mentioned drugs is not reviewed. Moreover, no mention is made of the special issues related to the use of lithium and anticonvulsants in the elderly, in children, and during pregnancy, because these topics are covered in other chapters of the present volume. The teratogenicity of lithium and anticonvulsants is, however, briefly dealt with.

Personal resources and depression in schizophrenia: The role of self-esteem, resilience and internalized stigma

Depression in schizophrenia represents a challenge from a diagnostic, psychopathological and therapeutic perspective. The objective of this study is to test the hypothesis that resilience and self-stigma affect depression severity and to evaluate the strength of their relations in 921 patients with schizophrenia. A structural equation model was tested where depression is hypothesized as affected by resilience, internalized stigma, gender and negative symptoms, with the latter two variables used as exogenous covariates and the former two as mediators. The analysis reveals that low resilience, high negative symptoms, female gender were directly associated with depression severity, and internalized stigma acted only as a mediator between avolition and resilience, with similar magnitude. The cross-sectional study design and the variable selection limit the generalizability of the study results. The model supports a complex interaction between personal resources and negative symptoms in predicting depression in schizophrenia. The clinical implication of these findings is that personal resources could be a significant target of psychosocial treatments.

Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition

The study aimed to explore premorbid academic and social functioning in patients with schizophrenia, and its associations with the severity of negative symptoms and neurocognitive impairment.