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D Berardi

Publications and source records attributed to D Berardi.

17 recordsLinked to original sources
PubMed2006

Integration between general practice and mental health services in Italy: guidelines for consultation-liaison services implementation.

PURPOSE: This paper illustrates some guidelines for the implementation of Consultation-liaison services in contexts where GPs work alone. We present some activity data of our experience in the period 1999-2004 and a critical evaluation of what works and what does not work. CONTEXT: In Italy single-sited spontaneous initiatives of co-operation and integration between general practice and psychiatry have been implemented in many regions. Recently, the Italian Health Care Government has begun to encourage integration between primary and secondary care for the management of mental health. The Bologna Consultation-liaison Service opened in 1999 in one area. The service was first located in the Community Mental Health Centre and subsequently in a medical non-psychiatric outpatient service. In 2002, the services were implemented in the overall city area, and the Bologna Consultation-liaison Service had its own office in the centre of the town. DATA SOURCE: Data have been collected by reviewing clinical charts. They include clinical (mental status examination, progress notes) and socio-demographic data, assessment scales that measure psychological distress and disability, reports for GPs, and consultation outcome. CONCLUSION: A consultation-liaison service like the one proposed in this paper could contribute to an efficient and fully-integrated collaborative management of common psychiatric disorders, reducing the use of mental health services.

Journal Article↗
PubMed2000

Enhancing the capacity of food consumption surveys of short duration to estimate long-term consumer-only intakes by combination with a qualitative food frequency questionnaire.

In principle, a proper risk assessment for a food chemical requires that the time-frame for food chemical intake estimates matches the time-frame for the toxicological assessments upon which the safety statements (ADI, PTWI, etc.) are based. For food additives, the toxicological assessments are based on exposure over a lifetime. While food consumption data cannot be collected over the lifetimes of individuals, the information should reflect habitual intakes as closely as possible. This study investigated the possibility of combining a 3-day food diary with a food frequency questionnaire to estimate mean consumer-only food intakes comparable to estimates based on a 14-day diary. The study population consisted of 948 teenagers and analysis was based on 32 clearly defined foods. For 47% of the foods, the difference was < or = 1 g/day. When expressed as portion sizes, 56% of the foods showed differences representing < 5% of an average portion and no food showed a difference > 14% of an average portion. When between-method differences (portions/day) were plotted against the mean of the methods, the mean between-method difference was 0.02(+/- 0.06) portions/day with limits of agreement of -0.10 to 0.14. This preliminary investigation suggests that the combined 3-day diary and FFQ method provides comparable estimates of mean consumer only intakes to a 14-day diary. Therefore, a qualitative FFQ may be a useful adjunct to a food consumption survey of short duration if estimates of longer term food intakes are required.

Adolescent↗
PubMed2000

Clinical correlates of akathisia in acute psychiatric inpatients.

This study identified acute and chronic akathisia in acute psychiatric inpatients receiving conventional antipsychotic medication, and evaluated the clinical characteristics, risk factors and clinical implications of the condition. Akathisia and other movement disorders were systematically assessed in patients consecutively admitted to an acute psychiatric ward over one year. Akathisia was diagnosed in 15 (21%) of 72 patients. Akathisia, developing as an acute condition in seven patients, generally presented with the subjective experience of dysphoria and unease without restless movements. This acute akathisia developed during the first few days of hospitalization and was associated with both a higher average dose of antipsychotic medication and a greater increase in dosage. In the remaining eight cases, akathisia was already present on admission, and thus classified as chronic. Those patients with chronic akathisia exhibited both subjective restlessness and the characteristic restless movements. Chronic akathisia was unrelated to antipsychotic dosage. The proportion of patients with akathisia who discontinued drug treatment was significantly higher than that for patients without the condition. Patients with acute akathisia tended to drop-out of treatment and those with the chronic form tended to have treatment withdrawn by the prescribing clinician. One interpretation is that the subjective distress of acute akathisia may be particularly difficult for patients to tolerate and leads them to stop medication, while patients with more chronic akathisia may have become more accepting of the experience. Repetitive movements of the legs were observed more commonly in those with chronic rather than acute akathisia, and may represent a way of achieving some limited respite.

Adult↗
PubMed1999

Overweight and Obesity among secondary school children in Central Italy.

Childhood and adolescent obesity prevalence rates have steadily increased in industrialised countries in the last 20 years. Current rates of obesity range between 6 and 30%. Several studies showed that risk factors for weight gain in school age are strongly linked to low physical activity and family environmental factors (parents' education and job, number of family members, number of hours spent on watching television, etc.). In order to plan a nutritional and health educational programme, a study was conducted on the nutritional status of the school age population of the Province of Frosinone, Central Italy, and family factors that can influence it. Three percentage of the school age population of the Province of Frosinone (2053 students) and their families were randomly sampled from the Province school district database. In each of the 12 recruited schools, a meeting with teachers and students was arranged to discuss aims and methods of research and to collect informed consent by students. Each student was interviewed about physical activity, and underwent the following measurements: height, weight, bicipital, tricipital, sub-scapular and over-iliacal skinfolds, sexual development. Students' parents were asked to answer a questionnaire about family structure, parents' educational level and job, parents' height and weight, presence in the family of pathologies as hypertension or diabetes. One thousand three hundred fifty-seven students (66% of the target population) and 1802 parents (66.5% of the responders' population) agreed to enter the study. Students' age range was 8 years (11-19 years; mean age was 14.9, SD, 2.55). Among them 8.4% were considered obese, with a higher prevalence in male population (9.8%) as compared to female population (6.5%). Of these responders, 21.4% were considered at risk of overweight with no statistical difference due to gender. Statistically significant correlations of teenagers' risk of overweight and obesity with nutritional conditions of parents, mother's educational level and amount of weekly physical activity were observed. Number of children in the family, parents' age and job do not appear to be correlated to obesity or risk of overweight. Our results show that, although the prevalence of obesity in the students population in the Province of Frosinone is comparable to other Italian Provinces and lower than other industrialised countries such as USA, the percentage of students at risk of overweight is particularly high. Main risk factors for developing obesity seem to be linked to parents' nutritional conditions, mother's educational level and children's physical inactivity and this should lead to intensify efforts for preventive interventions both at family level (focused on parents) and at school.

Adolescent↗
PubMed1999

Intake of saccharin, aspartame, acesulfame K and cyclamate in Italian teenagers: present levels and projections.

The intake of saccharin, aspartame, acesulfame K and cyclamate was assessed in 212 Italian teenagers aged 13-19 in 1996. Total daily intake of intense sweeteners was assessed on the basis of dietary records (14 consecutive days). The sweetener content of sugar-free products (soft drinks, candies, chewing gums, yoghurts, jam and table-top sweeteners) was provided by manufacturers. Sugar-free products were consumed by 77% of the subjects. Mean daily intake among consumers was 0.24 mg/kg body weight (bw) for cyclamate (13 subjects), 0.21 mg/kg bw for saccharin (9 subjects), 0.03 mg/kg bw for aspartame (162 subjects), and 0.02 mg/kg bw for acesulfame K (56 subjects). No subject exceeded the ADI (Acceptable Daily Intake) of an intense sweetener. Projections based on the present levels of use of intense sweeteners in sugar-free products and on the dietary pattern observed in the sample suggest that approaching the ADI could be possible only if subjects with high intakes of both soft drinks and table-top sugar substituted these items with respectively sugar-free beverages and table-top sweeteners containing either saccharin or cyclamate.

Adolescent↗
PubMed1999

Mental, physical and functional status in primary care attenders.

OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.

Adult↗
PubMed1998

Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case-control study.

BACKGROUND: Pharmacologic and clinical risk factors for neuroleptic malignant syndrome have been suggested. High neuroleptic dose, rapid dosage increase, and parenteral administration were identified as risk factors in a case-control study; however, there are limited data regarding potential clinical risk factors. METHODS: To examine potential clinical risk factors, we conducted a case-control study, comparing 12 cases to 24 controls, all treated with neuroleptics at our center. In addition to examining previously postulated pharmacologic risk factors, we also assessed for presence of psychomotor agitation, confusion, disorganization, and catatonia. RESULTS: Significant differences were found between cases and controls for psychomotor agitation, confusion, disorganization, catatonia, mean and maximum neuroleptic dose, parenteral neuroleptic injections, neuroleptic dose increase within 5 days of the episode, magnitude of neuroleptic dose increase from initial dose, and extrapyramidal signs. CONCLUSIONS: This study demonstrated that psychopathological features such as psychomotor agitation, confusion, disorganized behavior, and catatonia may be risk factors for the neuroleptic malignant syndrome, in addition to pharmacologic risk factors and extrapyramidal signs, including akathisia. In clinical practice, careful monitoring for prodromal signs of neuroleptic malignant syndrome is required during neuroleptic treatment of patients with psychomotor agitation, confusion, and/or disorganization, while in the presence of catatonia these drugs should be avoided.

Adult↗
PubMed1997

Identification of psychiatric distress by primary care physicians.

The aims of the present study were to evaluate the extent to which primary care physicians' (PCPs) identification of psychiatric distress is related to a number of nonpsychopathological factors, such as patient sociodemographic and health-related characteristics, and to assess the impact of depression on PCP identification of psychiatric distress, controlling for patient sociodemographic and health-related characteristics. Two patient samples were chosen to explore these issues: 1) patients not fulfilling any ICD-10-defined or subthreshold psychiatric diagnosis and, 2) patients with an ICD-10 diagnosis of current depression. Patients attending 46 primary care clinics during an index period were screened by the General Health Questionnaire (GHQ)-12 and selected for a second stage interview according to GHQ score. Among the 559 interviewed patients, 123 had no mental disorder and 66 had an ICD-10 current depressive disorder. Identification of psychiatric distress by the PCP was associated with retirement among subjects without mental disorders but not among depressed patients. Patient's negative overall health self-perception and severity of physical illness were significantly related to identification of psychiatric distress in the two groups, whereas neither disability nor reason for medical consultation had a significant effect. Patients with current depression, compared with those without, were 4.3 times more likely to be identified by PCPs as having psychiatric distress when adjusting for all the above nonpsychopathological variables. Patients with depression and comorbid anxiety disorders were more likely to be recognized by the PCP as compared with those with pure depression. Finally, among depressive symptoms, diurnal variation and symptoms related to suicidal tendencies were predictive of identification of psychiatric distress, whereas increase of appetite was negatively associated with PCP recognition.

Adult↗
PubMed1997

Atypical neuroleptic malignant syndrome associated with clozapine treatment.

Clozapine is an atypical neuroleptic drug that was initially thought not to cause neuroleptic malignant syndrome (NMS). The authors report a case of NMS associated with clozapine use, developed in a patient without previous history of NMS. Considering that 13 such cases (including ours) have been reported so far, NMS should be considered in the differential diagnosis of a febrile patient treated with clozapine.

Aged↗
PubMed1994

[Neuroleptic malignant syndrome. Case reports].

Neuroleptic malignant syndrome is a serious adverse reaction of neuroleptic drug therapy, composed of mental status changes, muscular rigidity, hyperthermia, signs of autonomic instability and typical laboratory findings. The syndrome has received increased attention in the scientific literature since 1980; nevertheless some weighty issues regarding clinical symptoms, etiopathogenesis and treatment require additional studies. This paper presents 9 cases of neuroleptic malignant syndrome prospectively observed in 8 inpatients and 1 outpatient with different psychiatric diagnosis. Levenson's diagnostic criteria were fulfilled in 7 cases; the remaining two had slighter symptoms. So neuroleptic malignant syndrome is to be considered a rare but not unusual side effect of neuroleptics. The risk of syndrome doesn't seem to be correlated with chemical class, D2 receptor affinity and total dosage of neuroleptics; a key factor seems instead to be a quick loading rate of neuroleptics. Seven of 9 cases displayed severe changes in mental status (clouding of consciousness that varies from stupor to coma), violent psychomotor excitement and aggressiveness before the onset of the syndrome. Such clinical features seem themselves, in our experience, to be potential risk factors besides reason for an increase of neuroleptic dosage. Neuroleptic malignant syndrome usually is preceded by prodromal signs, the most important appearing the worsening of alterations in consciousness. Symptoms of neuroleptic malignant syndrome usually appear abruptly and in some cases with a dramatic course; they last, in cases with favourable outcome, a few days to two weeks from neuroleptic withdrawal; by far the worst outcome, instead, occurs if diagnosis and drug discontinuation are not carried out early. The first measure in the treatment of neuroleptic malignant syndrome consists of prompt discontinuation of all neuroleptic medications and other psychopharmacological cures, except for benzodiazepines, and institution of supportive therapy; such interventions can resolve the most of cases. Three patients treated with bromocriptine and/or dantrolene didn't display a different duration of clinical symptoms and rate of complications if compared to patients treated with supportive therapy only. Use of bromocriptine or dantrolene, or both, therefore should be considered as a second line of action. In four cases, neuroleptics were reintroduced within few days of recovery; low potency neuroleptics were employed, given low doses which gradually increased: in none of the 4 cases did the patients experience partial or complete recurrence of neuroleptic malignant syndrome.

Adult↗
PubMed1993

[Neuroleptic-induced dysphoric response in non-schizophrenic patients].

In 50 psychiatric inpatients treated with neuroleptics we observed neuroleptic-induced dysphoria in 4% and neuroleptic-induced akathisia in 18% of the cases. In our sample there was no schizophrenics among dysphoric responders. We discuss the implication of the findings and the relationship between dysphoric response and subjective phenomena of akathisia.

Adult↗
PubMed1987

Hypnosis with self-cutters.

Hypnotic techniques can add to effective therapy with self-cutting patients, but only in the context of a strong, communicative, and flexible relationship. "Neutral hypnosis" and relaxation techniques can be employed to counteract the frightening depersonalization that leads to the cutting. In turn, techniques of uncovering and controlled regression are possible.

Adolescent↗
PubMedDate not supplied

[Parotid tumors: a diagnostic and therapeutic protocol in 81 surgical cases].

AIM: In the last five years we cured 81 patients divided in two groups: the first was managed inordinately, the second according to a diagnostic and therapeutic protocol. METHODS: The first 23 patients were differently evaluated, before surgery, by means of traditional sialography, US, CT, CT sialography, MR, larger bore needles and FNAB. Neoplasm enucleations, atipic resections, superficial and total conservative parotidectomies were performed. The following 58 patients were evaluated and cured according to a diagnostic and therapeutic protocol. RESULTS: Diagnostic and therapeutic time were shortened, patients endurance improved and cost lowered. DISCUSSION: We think that many diagnostic procedures are useless and delay operation that, if possible, must be performed according to principles of radical extirpation.

Adenoma, Pleomorphic↗