Epidemiologia e psichiatria sociale最新文献

Aim: To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifying the costs of these packages.

Methods: Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs.

Results: Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users.

Conclusion: It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Aims: Impulsivity is a multifaceted aspect of behavior that is prominent in psychiatric disorders and has serious behavioral consequences. This paper reviews studies integrating behavioral and physiological mechanisms in impulsivity and their role in severity and course of bipolar and related disorders.

Methods: This is a review of work that used questionnaire, human behavioral laboratory, and neurophysiological measurements of impulsivity or related aspects of behavior. Subjects included individuals with bipolar disorder, substance-use disorders, antisocial personality disorder, and healthy controls.

Results: Models of impulsivity include rapid-response impulsivity, with inability to reflect or to evaluate a stimulus adequately before responding, and reward-based impulsivity, with inability to delay response for a reward. In normal subjects, rapid-response impulsivity is increased by yohimbine, which increases norepinephrine release. Impulsivity is increased in bipolar disorder, whether measured by questionnaire, by measures of rapid-response impulsivity, or by measures of ability to delay reward. While affective state has differential effects on impulsivity, impulsivity is increased in bipolar disorder regardless of affective state or treatment. Impulsivity, especially rapid-response, is more severe with a highly recurrent course of illness or with comorbid substance-use disorder, and with history of medically severe suicide attempt. In antisocial personality disorder, rapid-response impulsivity is increased, but reward-based impulsivity is not. In general, impulsivity is increased more in bipolar disorder than in antisocial personality disorder. In combined bipolar disorder and antisocial personality disorder, increased impulsivity is associated with substance-use disorders and suicide attempts.

Conclusions: Impulsivity is associated with severe behavioral complications of bipolar disorder, antisocial personality disorder, and substance-use disorders.

Research has found that depression is more common among individuals with diabetes and is associated with worse diabetes outcomes including treatment nonadherence, worse glycemic control, higher risk of diabetes complications, greater functional impairment, and increased risk of mortality. These patterns of association have led to an increase in research investigating the relationship between diabetes and depression. There remain important questions about the relationship between depression and diabetes and an unmet need for treatment approaches that are successful in ameliorating depression and improving diabetes outcomes. The current commentary discusses several conceptual issues related to the measurement of depression in diabetes, argues for the importance of health behavior and treatment adherence in approaching the problem of depression in diabetes, and provides an example of a treatment approach that incorporates the treatment of depression with strategies aimed at improving treatment adherence in order to maximize effects on diabetes outcomes.

Aims: This paper seeks to provide a methodology to assess the cost-effectiveness of anti-stigma campaigns for people with mental health problems.

Methods: The costs of running a national campaign in Scotland were obtained and combined with the number of adults in the Scottish population and the estimated number of people with improved attitudes towards people with mental health problems. A decision model was constructed to estimate the economic impact of a campaign in terms of increased use of services by people with depression and increased work time.

Results: If the campaign caused 10% of changed attitudes then it was estimated to cost pound 35 per one less person who felt that people with mental health problems were dangerous and pound 186 per one less person who felt the public needs protection from people with mental health problems. The decision model suggested extra economic benefits (employment gains minus service costs) as a result of an anti-stigma campaign compared to the absence of a campaign.

Conclusions: Data on the economic impact of anti-stigma campaigns are scarce and evaluation is intrinsically difficult. We have demonstrated a method to conduct such analyses. The model proposed here should be tested further as data become available.

Although the anatomy of the parietal lobe has been under-investigated in schizophrenia, some magnetic resonance imaging studies have shown decreased volumes, suggesting its possible implication for the pathophysiology of the disease.

Depression is frequently seen in patients with medical illnesses yet the link between medical illnesses and depression remains unclear. There is increasing data to suggest that the array of depressive symptoms experienced by the medically-ill may involve inflammation. The activation of the immune system and the subsequent release of innate immune products such as cytokines can have important effects on behaviour. The treatment of choice for chronic viral hepatitis C, interferon-alpha IFN-alpha, acutely induces the production and release of other innate immune cytokines, and has been indicated to cause clinically significant depression in 30% of patients receiving treatment. This in turn can impair quality of life and affect treatment compliance. We and others use IFN-alpha induced depression as a model to identify alterations in psychological and biological pathways that predispose to depression in the medically-ill, and thus provide an explanatory link between inflammation and the subsequent behavioural changes. In this editorial, we aim to describe the main biological pathways involved in IFN-induced depression and to discuss psychological, clinical and biological factors that have been found to predict those who will develop more severe psychiatric symptoms during treatment with IFN-alpha. Among these, particular attention would be given to psychological traits, genetic polymorphisms regulating inflammation and serotonergic function, and changes in plasma levels of pro-inflammatory cytokines.