Luigi Pavan

The Hamilton Depression Rating Scale in normals and depressives

The Hamilton Rating Scale for depression (HDRS) has become the standard observer rating scale for depression, yet there are no adequate data from normal samples. The present study was carried out in northern Italy. The purposes were 1) to examine the ratings in normals and 2) to examine the scales validity in a different language and culture. The scale was used in 40 normals and 40 depressives who were matched. Two self‐rating scales of depression were administered: the Symptom Rating Test and the Symptom Questionnaire. The results show that the HDRS is a valid mea‐ sure in that it sensitively discriminates between depressed patients and normals. The findings support Hamiltons view that only the first 17 items of the scale are appropriate for computing the score. The use of self‐rating scales yielded additional information. The misclassification rate of the Symptom Rating Test was similar to that of the HDRS. The combined use of Research Diagnostic Criteria (RDC) and HDRS appears to be more reliable for the selection of depressed patients for research than the RDC only.

Large Bowel Disorders. I. Illness Configuration and Life Events

Stressful life events preceding disease onset were investigated in a consecutive series of 60 patients with large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis), using Paykels methodology. Ulcerative colitis and irritable bowel syndrome were frequently preceded by events generally regarded as undesirable and involving losses or exits from the social field, which would be specific of a depressed population, while appendicitis seemed to reflect more generic psychosocial difficulties.

Psychopathologic Aspects of Body Dysmorphic Disorder: A Literature Review

Body dysmorphic disorder (BDD) is a somatoform disorder characterized by the patient’s excessive concern with an imagined or minor defect in physical appearance. Patients with BDD often have been observed in aesthetic surgery settings seeking surgical enhancement at a reported prevalence of 6% to 15%. Published studies in the general population tend to aggregate a prevalence of 0.7% to 2.3%. This review aimed to search the literature for data on the prevalence, psychopathologic aspects, and comorbidity of BDD, and to provide an update on current BDD research. Relevant literature was identified by searching the Medline, PubMed, PsycINFO, and EMBASE databases. The following search words were used alone or in combination when appropriate: “body dysmorphic disorder,” “somatoform disorder,” “obsessive compulsive spectrum disorder,” “personality disorders,” “presurgical counseling,” “aesthetic surgery,” “cosmetic surgery,” and “plastic surgery.” Further articles were sourced from the reference lists of the articles ascertained through the search. Recent findings include the relationship between BDD and the obsessive-compulsive spectrum, treatment of BDD based on pharmacologic and psychological approaches, and the hypothesis that the often distinguished delusional and nondelusional variants of BDD very likely are the expression of a single disorder with varying degrees of severity. Retrospective outcome studies suggest that patients affected by BDD typically do not benefit from surgical treatment. In contrast, serotonin reuptake inhibitors and cognitive-behavior therapy appear to be good practice in addressing the disorder. Further research is needed to identify effective interventions for patients who do not respond to these treatment methods.

Large Bowel Disorders. II. Psychopathology and Alexithymia

Psychopathology and alexithymia were investigated in a consecutive series of 60 patients suffering from large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis). Patients with irritable bowel syndrome reported the highest percentage of psychiatric illness and the lowest alexithymic score. Conversely, patients with ulcerative colitis showed very pronounced alexithymic traits with limited psychopathology. Implications for psychosomatic research and treatment are discussed.

Psychosocial profiles of painful TMD patients

The aim of the present investigation is to test the null hypothesis that the presence of psychopathology in patients with temporomandibular disorders (TMD) is related to the presence of pain, independent of its location [(i.e. myofascial and/or temporomandibular joint (TMJ) pain]. Ninety-six (n = 96) patients affected by painful TMD underwent a clinical assessment in accordance with the research diagnostic criteria for TMD (RDC/TMD) guidelines and filled out the Symptoms Check List - Revised (SCL-90-R) instrument to investigate the presence of symptoms of psychopathology. Patients with myofascial pain, alone or combined with TMJ pain, endorsed the highest scores in all SCL-90-R scales and showed the highest percentage of abnormal values in the depression (DEP) and somatization (SOM) scales for the assessment of depressive and somatization symptoms. Nonetheless, anova revealed no significant differences between groups in any of the SCL-90-R scales, except than in the Positive Symptom Total Index (F = 3.463; P = 0.035), and the chi-squared test did not detect any significant differences between groups for the prevalence of abnormal scores in the DEP and SOM scales. The existence of a close association between pain and psychosocial disorders in TMD patients was supported by the present study. The null hypothesis is that no differences exist between patients with different painful TMD cannot be fully accepted for the presence of psychosocial disorders because of the trend evidencing higher SCL-90-R scores for myofascial pain patients, alone or combined with TMJ pain, with respect to TMJ pain alone.

Survey on Recent Suicidal Ideation Among Female University Hospital Physicians in Sweden and Italy (The HOUPE Study): Cross-Sectional Associations With Work Stressors

BACKGROUND Suicide rates among physicians are higher than in the general population, and rates among female physicians are particularly high. More female than male physicians report suicidal thoughts, with suicidal ideation being a well-recognized precursor of suicide. The urgent need to find the reasons for suicide risk in female physicians is underscored by societys increasing dependence on this group of health care providers. OBJECTIVE The aim of this paper was to identify potential risk and protective factors associated with recent suicidal ideation in female physicians. METHODS A cross-sectional survey analysis of work-related health, organizational culture, career paths, and working conditions was performed among permanently employed female physicians from the HOUPE (Health and Organisation among University Physicians in four European countries) study: 385 in Sweden and 126 in Italy. The main outcome measure was recent (within the prior 12 months) suicidal thoughts. RESULTS Overall, 13.7% and 14.3% of the participants from Sweden and Italy, respectively, reported suicidal thoughts within the prior 12 months. Among the physicians from Sweden, the most powerful multivariate model for such thoughts included 2 independent variables related to work: degrading experiences/harassment at work (odds ratio [OR], 3.03; 95% CI, 1.48-6.23), and work meetings to discuss stressful situations (OR, 0.36; 95% CI, 0.19-0.69). The model included self-diagnosis and self-treatment as a significant factor. Work meetings to discuss stressful situations were also in the multivariate model for the Italian physicians (OR, 0.21; 95% CI, 0.05-0.86), together with being given work assignments without adequate resources (OR, 5.0; 95% CI, 1.32-18.8). Significant non-work-related factors in the Italian model were younger age and seeking professional help for depression or burnout. CONCLUSIONS In both Sweden and Italy, work stressors have been identified that may increase the risk for suicide for female physicians. A potential protective factor was meetings to discuss stressful work experiences. These findings suggest that such meetings should be more broadly implemented.

Losses, Hostility, and depression.

Forty outpatients with a primary unipolar major depression of recent onset and a matched control group of employees were administered the hostility scale of the Kellner Symptom Questionnaire, depression was rated with the Hamilton Rating Scale for Depression, and life events were recorded in a structured interview. In a subgroup of depressives who had not reported losses, there was an association of hostility and depression, whereas no such association was found in depressives who had reported losses. The findings are consistent with those of previous studies showing that hostility is largely limited to a subgroup of depressives. In a substantial proportion of the depressives, depression and hostility are independent affects.

Consultation psychiatry in an Italian general hospital: A report on 500 referrals

Five-hundred consecutive referrals to the psychiatric consultation service at the University of Padua School of Medicine have been reviewed. In 69% of cases concurrent physical and psychiatric disorders were reported. There was a prevalence of females, working class patients, and individuals with limited schooling. Depression was the most common psychiatric disorder in all classes of organic disease and accounted for 37% of all psychiatric diagnoses, followed by anxiety neurosis (18.6%) and drug dependence (13.8%). In 10.8% of cases no psychiatric diagnosis was made.

Psychopathology and Clinical Features in an Italian Sample of Patients with Myofascial and Temporomandibular Joint Pain: Preliminary Data

Objective: Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures. Methods: Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS). Results: -Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. -HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. -SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales. Conclusions: TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.

Death Ideas, Suicidal Thoughts, and Plans Among Nursing Home Residents

Recent studies have shown that suicides are at least as frequent among Nursing Home (NH) residents as they are among older people in the general population. The objective of the present study was to evaluate the prevalence of death- and/or suicidal feelings, thoughts, and plans and any attempted suicides in a random, unselected sample (N = 288) of individuals aged 65-years-and-over, living in NHs located in the Veneto Region (the Italian North-East). One hundred seventy-two participants were surveyed with a response rate of 59.7%. Five sample questions were asked to investigate the presence of death- and suicidal thoughts, plans and behaviors in different time periods. Among the NH residents, 30.8% admitted having had death or suicidal thoughts or plans during the month prior to the interview. The oldest-old residents (85 + y) more frequently reported death-suicide ideation. This high frequency of death and/or suicidal feelings and thoughts among older NH residents should be carefully considered when planning and implementing health care programs in these facilities.