Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study.

Aims: To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries.

Methods: People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress.

Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries.

Aims: To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries.

Methods: People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale.

Lifestyles of Patients with Functional Psychosis Compared to Those of a Sample of the Regional General Population: Findings from a Study in a Community Mental Health Service of the Veneto Region, Italy.

Unhealthy lifestyles contribute, with other risk factors, to the high prevalence of mortality and physical comorbidity among mental patients compared to the general population. We collected data on the lifestyles of 193 subjects with psychosis in contact with a Community Mental Health Service in north-eastern Italy and compared them with a representative sample (total: 3219 subjects) of the general population of the same region. Diet, exercise, smoking and alcohol consumption were worse in mental patients.

Physical health promotion in patients with functional psychoses receiving community psychiatric services: Results of the PHYSICO-DSM-VR study.

Objectives: Psychotic patients have poorer health behaviours, including poor diets and sedentary lifestyles increasing their risk for obesity, diabetes, hypertension, and dyslipidaemia, and tend to have a shorter life expectancy as compared to nonpsychiatric populations. Lifestyle intervention programmes that target modifiable risk factors in such patients have produced uneven results. The objective was to evaluate the efficacy of a package of health promotion strategies to improve diet and physical exercise in psychotic patients.

The INTERPRET-DD study of diabetes and depression: a protocol.

Aim: People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe.

Development of the ITHACA Toolkit for monitoring human rights and general health care in psychiatric and social care institutions.

Background. Human rights violations are commonly experienced by people in psychiatric and social care institutions. States and private organizations providing such health and social services must comply with international human rights law.

Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials.

Background: Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population, due primarily to premature cardiovascular disease. A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation. It takes into consideration not only risks such as gender, age, and family history that are inherently non-modifiable, but also those such as obesity, smoking, diabetes, hypertension, and dyslipidemia that are modifiable through behavioural changes and improved care.

The predictive validity of subjective adherence measures in patients with schizophrenia.

Despite frequent use of subjective adherence measures in patients with schizophrenia as well as other chronic conditions, there are several reports that question the validity of these instruments. Three well known, representative subjective measures are the Medication Adherence Questionnaire (MAQ), the Drug Attitude Inventory (DAI), and the Compliance Rating Scale (CRS). In this study we explored the predictive validity of these instruments in a European sample of 119 stabilized outpatients with schizophrenia.

Effect of medication-related factors on adherence in people with schizophrenia: a European multi-centre study.

Aim: To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment.

Methods: The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona, Italy; Leipzig, Germany; London, Great Britain). Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective).

An empirical method to identify patterns in the course of psychotic episodes of people with schizophrenia.

Objective: This paper illustrates the process of constructing, selecting and applying simple measures in order to empirically derive patterns of course of psychotic episodes in schizophrenia.

Method: Data were collected with a composite instrument constructed for a multi-centre, follow-up randomized controlled trial of adherence therapy for people with schizophrenia. The instrument included a retrospective weekly assessment of psychotic/non-psychotic status, which was used to derive the measures, and the DSM-IV course specifiers.

Long-term monitoring and evaluation of a new system of community-based psychiatric care. Integrating research, teaching and practice at the University of Verona.

The South-Verona community psychiatric service (CPS) was implemented in 1978, according to Law 180, by the Department of Psychiatry of the University of Verona. Since then this CPS provides prompt, comprehensive and coherent answers to patients' needs, psychological and social, as well as practical, while trying to decrease and control symptoms. Special emphasis is given to integrating different interventions, such as medication, rehabilitation, family support, and social work.

Course of adherence to medication and quality of life in people with schizophrenia.

This study examined the relationship over time of adherence to anti-psychotic medication and quality of life in people with schizophrenia, taking into account effects of mediating variables. Data on on adherence, quality of life, attitude towards medication, side effects, symptom severity, and level of functioning at baseline and 1-year follow-up were obtained from 373 participants in a multi-centre trial. Participants randomised to the intervention group were offered eight sessions of adherence therapy.

[Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project].

Aims: To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tranquilization.

Methods: Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT'S Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services.

Results: In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs.

[Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project].

Aims: The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT'S Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia.

Methods: Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations.

SF-36 scales, and simple sums of scales, were reliable quality-of-life summaries for patients with schizophrenia.

Objective: To examine the feasibility and reliability of the Medical Outcomes Study 36 Item Short Form Health Survey (SF-36) for patients with schizophrenia, focusing on the eight scales and various aggregate summary measures.

Study Design And Setting: Secondary analysis of data from the European multicenter QUATRO medication adherence trial and the Regional Psychosis Project from The Netherlands. Methods included exploratory and confirmatory factor analyses and estimation of aggregate score reliability using Cronbach's alpha and Tarkkonen's generalized reliability index.

Adherence therapy for people with schizophrenia. European multicentre randomised controlled trial.

Background: There is equivocal evidence of the effectiveness of adherence therapy in improving treatment adherence and clinical outcomes for people with schizophrenia.

Aims: To evaluate the effectiveness of adherence therapy in improving quality of life for people with schizophrenia.

Method: A 52-week, single-blind, multicentre randomised controlled trial of the effectiveness of adherence therapy.

Adherence to medication and quality of life in people with schizophrenia: results of a European multicenter study.

Quality of life is often severely impaired in people with schizophrenia, and adherence to antipsychotic medication has been consistently found to be low in this population. Although there is a considerable amount of evidence on these two variables in schizophrenia research, there is only limited knowledge on how they relate to one another. The aim of this study is to develop a meaningful model of the relationship between quality of life and adherence that includes mediating variables.

Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience.

Objective: To describe the development of a community-based mental health service, the patterns of care provided by this new service established in 1978 and its costs.

Method: The South-Verona Psychiatric Case Register, the South-Verona Outcome Project and studies designed to assess costs provided process and outcome data.

Results: This paper summarizes descriptive statistics as well as the results of some evaluative studies conducted over the last 25 years in Verona, Italy.

Does additional care provided by a consumer self-help group improve psychiatric outcome? A study in an Italian community-based psychiatric service.

This study compares the two-year clinical and social outcome, the use of services and the direct costs of patients of the South-Verona Community Psychiatric Service who were members of a self-help group, with those who were not. Use of services and costs in the two years before the baseline were compared with those occurring two years after the baseline. Self-help subjects decreased their use of hospital stay as to number of admissions and days in hospital, with a reduction of costs; they were more satisfied as to work/education while non self-help matches presented an increase of unmet needs.

Reassessing treatment environments after two decades: client and staff perceptions of an Italian community mental health service environment, then and now.

Community-based psychiatric services and programs developed in accordance with the 1978 Italian psychiatric reform have now been in operation for a quarter of a century. The paper presents the results of a study in which three treatment environments of South-Verona, i.e.

Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice.

Objective: To estimate the proportion of off-label prescriptions of antipsychotics (APs) in ordinary in-patient practice.

Method: From the South-Verona Psychiatric Case Register all admissions to the in-patient unit during 2001-02 were extracted. Prescriptions of APs were defined off-label when dispensed outside the licensed indications.

Psychiatric rehabilitation. An open-network orientation.

Objective: To discuss the difficulties encountered in providing rehabilitation to multi-problematic clients, and possible remedies.

Method: The principles of psychiatric rehabilitation are outlined in the frame of the bio-psycho-social model and in the light of long-term follow-up studies. The limits of professional services and the importance of natural networks for successful rehabilitation and social adjustment are highlighted.