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Marchesi C, Affaticati A, Monici A, De Panfilis C, Ossola P, Tonna M. Severity of core symptoms in first episode schizophrenia and long-term remission. Psychiatry Res 2015; 225:129-132. [PMID: 25467699 DOI: 10.1016/j.psychres.2014.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 10/07/2014] [Accepted: 11/03/2014] [Indexed: 11/15/2022]
Abstract
A definable concept of symptomatic remission in schizophrenia has been proposed by the Remission in Schizophrenia Working Group (RSWG). Nevertheless no studies to date assessed eventual differences in core symptoms at onset between remitters and non-remitters. The present study evaluated whether the severity of core symptoms differed among 48 patients with first episode schizophrenia (FES), and whether it predicted long-term (16-years) remission. Particularly, the present study aimed to verify if RSWG remission criteria might identify a sub-group of patients with mild core symptoms at their first episode. In the present study the severity of core symptoms was significantly lower in remitted than in non-remitted patients; interestingly, five out of the eight core symptoms already satisfied the severity criteria for remission in most remitted patients. Among the core symptoms only the severity of social withdrawal predicted the long-term outcome, while age at onset, duration of untreated psychosis and employment status did not exert any effect. Concluding, patients with FES presenting, mild core symptoms, particularly low negative symptoms, were more likely to reach long-term remission. Therefore, RSWG remission criteria seem to identify a subgroup of FES patients with mild severe core symptoms so with a higher probability to reach remission.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy; Mental Health Department, Local Health Service, Parma, Italy.
| | | | - Alberto Monici
- Mental Health Department, Local Health Service, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy; Mental Health Department, Local Health Service, Parma, Italy
| | - Paolo Ossola
- Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy
| | - Matteo Tonna
- Mental Health Department, Local Health Service, Parma, Italy
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Marchesi C, Ossola P, Scagnelli F, Paglia F, Aprile S, Monici A, Tonna M, Conte G, Masini F, De Panfilis C, Ardissino D. Type D personality in never depressed patients at their first acute coronary syndrome. Psychother Psychosom 2014; 83:190-1. [PMID: 24752175 DOI: 10.1159/000358525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Carlo Marchesi
- Psychiatry Unit, Department of Neuroscience, University of Parma, Parma, Italy
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Marchesi C, Affaticati A, Monici A, De Panfilis C, Ossola P, Tonna M. Predictors of symptomatic remission in patients with first-episode schizophrenia: a 16years follow-up study. Compr Psychiatry 2014; 55:778-84. [PMID: 24461689 DOI: 10.1016/j.comppsych.2013.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Recent views on schizophrenia outcome and treatment suggest that symptomatic remission is possible, and a definition of remission has been proposed by the Remission in Schizophrenia Working Group (RSWG). This study evaluated whether patients who achieved remission after several years of illness (R) showed psychopathological differences at the onset of their disorder compared to non-remitted (NR) patients. METHOD Forty-eight patients with first-episode schizophrenia were evaluated with the Positive and Negative Symptoms Scale (PANSS) both at the onset of illness and after a mean period of 16years. Patients were defined as R or NR according to the RSWG criteria. RESULTS Eighteen patients (37.5%) were classified as R at follow-up. At onset, R patients showed a lower illness severity, less severe negative and general psychopathology symptoms compared to NR. Furthermore, they underwent fewer psychotic episodes than NR over the course of follow-up. Remission was predicted by lower severity of negative and general psychopathology symptoms at onset and by lesser number of psychotic episodes during follow-up. CONCLUSIONS The symptomatic remission may be a viable outcome in schizophrenia, particularly for patients with a mild illness and less severe negative symptoms at onset and with few psychotic episodes over time.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Italy; Mental Health Department, Local Health Agency, Parma, Italy.
| | | | - Alberto Monici
- Mental Health Department, Local Health Agency, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Italy; Mental Health Department, Local Health Agency, Parma, Italy
| | - Paolo Ossola
- Department of Neuroscience, Unit of Psychiatry, University of Parma, Italy
| | - Matteo Tonna
- Mental Health Department, Local Health Agency, Parma, Italy
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Marchesi C, Ossola P, Scagnelli F, Paglia F, Aprile S, Monici A, Tonna M, Conte G, Masini F, De Panfilis C, Ardissino D. Type D personality in never-depressed patients and the development of major and minor depression after acute coronary syndrome. J Affect Disord 2014; 155:194-9. [PMID: 24274964 DOI: 10.1016/j.jad.2013.10.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type D personality (TDP) has been proposed as a risk factor for the development of depressive symptoms after an acute coronary syndrome (ACS). However, contrasting findings emerged about its predicting power on the onset of depression, since an overlap between TDP and depressive symptoms has been proposed. The present study was aimed to verify whether TDP predicts the development of a depressive disorder in the 6 months after the discharge from hospital. METHODS Two hundred fifty consecutive patients were recruited, at the Coronary Intensive Care Unit at the University Hospital of Parma, who were both presenting their first ACS and had no history of depression. The presence and the severity of major (MD) and minor (md) depression were evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Hospital Anxiety and Depression Scale (HADS) respectively. Type D Personality was assessed with the DS14, both at baseline and at 1, 2, 4 and 6 month follow ups. RESULTS Out of 250 subjects (81.2% males), MD was diagnosed in 12 patients (4.8%) and md in 18 patients (7.2%). At baseline risk factors for a post-ACS depressive disorder were HADS depression scores, whereas TDP, or its subscales, did not showed any effect. LIMITATION The small amount of patients with incidence of depression, due to highly selective inclusion criteria, tempers the reliability of our results. CONCLUSION Our data suggests that TDP does not predict the development of depressive disorders in never-depressed patients at their first ACS, when the baseline depression severity was controlled.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Francesca Scagnelli
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Francesca Paglia
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Sonja Aprile
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | | | | | - Giulio Conte
- Department of Cardiology, University Hospital, Parma, Italy
| | - Franco Masini
- Department of Cardiology, University Hospital, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
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De Panfilis C, Marchesi C, Cabrino C, Monici A, Politi V, Rossi M, Maggini C. Patient factors predicting early dropout from psychiatric outpatient care for borderline personality disorder. Psychiatry Res 2012; 200:422-9. [PMID: 22503328 DOI: 10.1016/j.psychres.2012.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 12/31/2011] [Accepted: 03/14/2012] [Indexed: 11/29/2022]
Abstract
Despite obvious clinical need, factors underlying early treatment discontinuation among 'real world' borderline personality disorder (BPD) patients are still unknown. This study investigates individual characteristics that can predict early (<three months) dropout among BPD outpatients at a general psychiatric service. Out of a sample of 1437 consecutively treatment-seeking psychiatric outpatients, 162 BPD subjects have been identified by means of the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Personality. Sociodemographic, clinical and personality variables potentially relevant for dropout were assessed for all participants at baseline. Early dropouts (n=54) were compared to continuers (n=108) on all measures. Logistic regression was then used to identify independent predictors of early dropout. A history of suicide attempts predicted early discontinuation, whereas the presence of an eating disorder and of avoidant personality features protected from early dropout. If confirmed, these findings may help clinicians operating in general psychiatric settings with estimating the risk of premature treatment discontinuation, and stress the need to specifically address suicidal behaviours in order to improve treatment retention among borderline outpatients. In this regard, implementing general psychiatric care with specialised, evidence-based psychotherapeutic interventions may be deemed necessary.
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Affiliation(s)
- Chiara De Panfilis
- Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy.
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