Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subject... more Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives. The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both pat...
Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However... more Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.
This study examined the prevalence of Axis I and II psychopathology and its relationship with qua... more This study examined the prevalence of Axis I and II psychopathology and its relationship with quality of life in candidates for bariatric surgery. Consecutive obese subjects (N = 282) with a body mass index (BMI) of 30 kg/m(2) or more received a thorough psychiatric assessment including the Structured Clinical Interviews for DSM-IV Axis I and II Disorders; the Hamilton Rating Scale for Depression; the Bulimic Investigatory Test, Edinburgh; and the short-form Quality of Life Enjoyment and Satisfaction Questionnaire. Subjects were recruited between November 2001 and March 2006. The overall prevalence of lifetime Axis I disorders in the sample was 37.6%. Mood disorders were the most common diagnoses (22.0%). Anxiety disorders and eating disorders were found in 18.1% and 12.8% of the sample, respectively. Alcohol or substance use disorders were uncommon. The percentage of subjects meeting criteria for at least 1 lifetime Axis I disorder did not vary by BMI class or gender. The prevalence of current Axis I disorders was 20.9% (N = 59). Fifty-five subjects (19.5%) met criteria for at least 1 Axis II disorder. Cluster C disorders, including avoidant, dependent, and obsessive-compulsive personality disorders, comprised virtually all the disorders in the sample (N = 53, 18.8%). Quality of life was poor, unrelated with gender or BMI, and significantly more impaired in individuals with comorbid Axis I and II disorders compared with those without disorders (p = .035). About one fifth of the sample presented with a current Axis I disorder, and the same percentage had a personality disorder. Although obesity surgery is not contraindicated based on psychiatric disorders, adequate preoperative treatment should be provided to individuals in need of psychiatric support to improve the postoperative outcome and reduce the risk of complications.
The incidence of reported meningococcal disease in Italy is among the lowest in Europe. The trend... more The incidence of reported meningococcal disease in Italy is among the lowest in Europe. The trend of the disease was increasing up to 2005 and then declined after the gradual introduction of a universal Men C vaccination program in 17/21 Italian regions. Since 2006, in Emilia-Romagna region vaccination against Neisseria meningitidis serogroup C was actively offered free of charge in a single dose to the age groups 12-15 months and 14-15 years, in addition to people with defined epidemiological risk. Our aim was to measure the impact of vaccination on the incidence of meningococcal disease caused by different serogroups among the population of Emilia Romagna Region, Northern Italy (approximately 4.5 million inhabitants) subdivided by age. Using surveillance data, we computed the incidence rates of Neisseria meninigitidis related invasive disease per 100.000 inhabitants for the years 2000 to 2012. In addition, the percentage change in incidence and the mortality rates were calculated....
Clinical practice and epidemiology in mental health : CP & EMH, 2006
The formation of social bonding is fundamental for several animals, including humans, for its rel... more The formation of social bonding is fundamental for several animals, including humans, for its relevant and obvious impact upon reproduction and, thus, survival of the species. Recent data would suggest that oxytocin might be one of the mediators of this process. Given the paucity of data on the possible involvement of oxytocin in human attachment, the present study was aimed to explore the possible relationships between the plasma levels of this neuropeptide and romantic attachment in healthy subjects. Forty-five healthy subjects who volunteered for the study, were included in the study. The romantic attachment was assessed using the Italian version of the so-called "Experiences in Close Relationships" (ECR), a self-report questionnaire for measuring this parameter in adults. The results showed that attachment anxiety and oxytocin are positively linked in romantic attachment to a statistically significant degree (r = 0.30, p = 0.04), that is, the higher the oxytocin levels...
The study aimed to assess the construct validity, internal consistency and factor structure of th... more The study aimed to assess the construct validity, internal consistency and factor structure of the Specific Levels of Functioning Scale (SLOF), a multidimensional instrument assessing real life functioning. The study was carried out in 895 Italian people with schizophrenia, all living in the community and attending the outpatient units of 26 university psychiatric clinics and/or community mental health departments. The construct validity of the SLOF was analyzed by means of the multitrait-multimethod approach, using the Personal and Social Performance (PSP) Scale as the gold standard. The factor structure of the SLOF was examined using both an exploratory principal component analysis and a confirmatory factor analysis. The six factors identified using exploratory principal component analysis explained 57.1% of the item variance. The examination of the multitrait-multimethod matrix revealed that the SLOF factors had high correlations with PSP factors measuring the same constructs and...
European Archives of Psychiatry and Clinical Neuroscience - EUR ARCH PSYCHIAT CLIN NEUROS, 2003
The aim of this paper is to provide the prevalence rates of mild, moderate and severe symptoms of... more The aim of this paper is to provide the prevalence rates of mild, moderate and severe symptoms of social anxiety in a sample of high school students and to analyze gender differences and associated impairment levels within these three levels of severity. Five hundred and twenty students were assessed with the Social Anxiety Spectrum Self-Report (SHY-SR), a questionnaire that explores social anxiety spectrum. By applying two cut-off scores determined on a separate sample by using ROC analysis, the large majority (73.3 %) of subjects were classified as low scorers, 9% as medium scorers and 17.7% as high scorers. Fears related to social situations were reported both by high and medium scorers. Functional impairment defined by avoidance and school difficulties was more common among high scorers, but it was also reported to a significant extent by medium scorers. Compared to low and medium scorers, high scorers showed a higher F/M ratio (about 4:1) and a more homogeneous symptomatologica...
Recent guidelines recommend early surgical treatment of hip fractures in the elderly. The aim of ... more Recent guidelines recommend early surgical treatment of hip fractures in the elderly. The aim of the present study is to analyse the factors delaying surgical treatment of hip fractures in elderly patients by more than 2 days and to investigate whether these factors are consistent between a teaching and a community hospital. Retrospective cohort study using hospital discharge records and patients' charts. Orthopaedics and traumatology departments of a teaching hospital and a small town hospital in Northern Italy. 1768 consecutive patients aged 65 years or more who underwent surgery for hip fractures between 2004 and 2007. Surgery for hip fracture. Surgery within two days from admission. 938 (53.1%) patients were operated within 2 days of admission to the hospital. Logistic regression models were used to examine potential predictors of surgery delay including gender, age, hospital, comorbidity, type of intervention (partial or total hip replacement, reduction and internal fixation), International Normalized Ratio (INR), Haemoglobin (Hb), American Society of Anaesthesiologists (ASA) score, and day of admission (categorized as Monday to Wednesday, Thursday-Friday, Saturday-Sunday). Age, type of intervention (partial or total hip replacement), INR score > 1.5 and an ASA score of 4 compared to 1-2, admission on Thursday-Friday or Saturday-Sunday and the interaction hospital × arrhythmia significantly predicted a surgery delay of more than 2 days. Both organization and medical problems accounted for delays of surgical treatment of hip fractures. Established protocols aimed to optimize the patient flow logistics and to manage comorbidities are crucial to make hospitals more patient-centred and to improve patient outcomes.
Social Psychiatry and Psychiatric Epidemiology, 2009
To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatie... more To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.
Empirical data on the impact of personality pathology on acute treatment outcome for depression a... more Empirical data on the impact of personality pathology on acute treatment outcome for depression are mixed, in part because of challenges posed by assessing trait-like personality patterns while patients are in an active mood episode. To our knowledge, no previous study has examined the effect of personality pathology on maintenance treatment outcome. By maintenance treatment we refer to long-term treatment provided to prevent depression recurrence among remitted patients. Structured Clinical Interviews for the DSM-III-R Personality Disorders (SCID-II) were obtained on a sample of 125 recurrently depressed women following sustained remission of the acute mood episode and prior to entering maintenance treatment. SCID-II interviews were then repeated following 1 and 2 years of maintenance interpersonal psychotherapy. At the pre-maintenance assessment, 21.6% of the sample met SCID-II personality disorder criteria. Co-morbid personality pathology was related to an earlier age of onset, more previous depressive episodes, and a greater need for adjunctive pharmacotherapy to achieve remission of the acute mood episode. Co-morbid personality pathology predicted both higher rates of depression recurrence and a shorter time to recurrence over the 2-year course of maintenance treatment. Notably, among those patients who remained depression-free, continuous levels of personality pathology steadily declined over the 2-year course of maintenance therapy. Results highlight the need for early and effective intervention of both episodic mood disorder and inter-episode interpersonal dysfunction inherent to the personality disorders. Future maintenance treatment trials are needed to clarify the relationship between episodic mood disorder and personality function over time.
Typologies of anxiety, depression and somatization symptoms were investigated in individuals with... more Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship. The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category. Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms. These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.
Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subject... more Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives. The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both pat...
Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However... more Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.
This study examined the prevalence of Axis I and II psychopathology and its relationship with qua... more This study examined the prevalence of Axis I and II psychopathology and its relationship with quality of life in candidates for bariatric surgery. Consecutive obese subjects (N = 282) with a body mass index (BMI) of 30 kg/m(2) or more received a thorough psychiatric assessment including the Structured Clinical Interviews for DSM-IV Axis I and II Disorders; the Hamilton Rating Scale for Depression; the Bulimic Investigatory Test, Edinburgh; and the short-form Quality of Life Enjoyment and Satisfaction Questionnaire. Subjects were recruited between November 2001 and March 2006. The overall prevalence of lifetime Axis I disorders in the sample was 37.6%. Mood disorders were the most common diagnoses (22.0%). Anxiety disorders and eating disorders were found in 18.1% and 12.8% of the sample, respectively. Alcohol or substance use disorders were uncommon. The percentage of subjects meeting criteria for at least 1 lifetime Axis I disorder did not vary by BMI class or gender. The prevalence of current Axis I disorders was 20.9% (N = 59). Fifty-five subjects (19.5%) met criteria for at least 1 Axis II disorder. Cluster C disorders, including avoidant, dependent, and obsessive-compulsive personality disorders, comprised virtually all the disorders in the sample (N = 53, 18.8%). Quality of life was poor, unrelated with gender or BMI, and significantly more impaired in individuals with comorbid Axis I and II disorders compared with those without disorders (p = .035). About one fifth of the sample presented with a current Axis I disorder, and the same percentage had a personality disorder. Although obesity surgery is not contraindicated based on psychiatric disorders, adequate preoperative treatment should be provided to individuals in need of psychiatric support to improve the postoperative outcome and reduce the risk of complications.
The incidence of reported meningococcal disease in Italy is among the lowest in Europe. The trend... more The incidence of reported meningococcal disease in Italy is among the lowest in Europe. The trend of the disease was increasing up to 2005 and then declined after the gradual introduction of a universal Men C vaccination program in 17/21 Italian regions. Since 2006, in Emilia-Romagna region vaccination against Neisseria meningitidis serogroup C was actively offered free of charge in a single dose to the age groups 12-15 months and 14-15 years, in addition to people with defined epidemiological risk. Our aim was to measure the impact of vaccination on the incidence of meningococcal disease caused by different serogroups among the population of Emilia Romagna Region, Northern Italy (approximately 4.5 million inhabitants) subdivided by age. Using surveillance data, we computed the incidence rates of Neisseria meninigitidis related invasive disease per 100.000 inhabitants for the years 2000 to 2012. In addition, the percentage change in incidence and the mortality rates were calculated....
Clinical practice and epidemiology in mental health : CP & EMH, 2006
The formation of social bonding is fundamental for several animals, including humans, for its rel... more The formation of social bonding is fundamental for several animals, including humans, for its relevant and obvious impact upon reproduction and, thus, survival of the species. Recent data would suggest that oxytocin might be one of the mediators of this process. Given the paucity of data on the possible involvement of oxytocin in human attachment, the present study was aimed to explore the possible relationships between the plasma levels of this neuropeptide and romantic attachment in healthy subjects. Forty-five healthy subjects who volunteered for the study, were included in the study. The romantic attachment was assessed using the Italian version of the so-called "Experiences in Close Relationships" (ECR), a self-report questionnaire for measuring this parameter in adults. The results showed that attachment anxiety and oxytocin are positively linked in romantic attachment to a statistically significant degree (r = 0.30, p = 0.04), that is, the higher the oxytocin levels...
The study aimed to assess the construct validity, internal consistency and factor structure of th... more The study aimed to assess the construct validity, internal consistency and factor structure of the Specific Levels of Functioning Scale (SLOF), a multidimensional instrument assessing real life functioning. The study was carried out in 895 Italian people with schizophrenia, all living in the community and attending the outpatient units of 26 university psychiatric clinics and/or community mental health departments. The construct validity of the SLOF was analyzed by means of the multitrait-multimethod approach, using the Personal and Social Performance (PSP) Scale as the gold standard. The factor structure of the SLOF was examined using both an exploratory principal component analysis and a confirmatory factor analysis. The six factors identified using exploratory principal component analysis explained 57.1% of the item variance. The examination of the multitrait-multimethod matrix revealed that the SLOF factors had high correlations with PSP factors measuring the same constructs and...
European Archives of Psychiatry and Clinical Neuroscience - EUR ARCH PSYCHIAT CLIN NEUROS, 2003
The aim of this paper is to provide the prevalence rates of mild, moderate and severe symptoms of... more The aim of this paper is to provide the prevalence rates of mild, moderate and severe symptoms of social anxiety in a sample of high school students and to analyze gender differences and associated impairment levels within these three levels of severity. Five hundred and twenty students were assessed with the Social Anxiety Spectrum Self-Report (SHY-SR), a questionnaire that explores social anxiety spectrum. By applying two cut-off scores determined on a separate sample by using ROC analysis, the large majority (73.3 %) of subjects were classified as low scorers, 9% as medium scorers and 17.7% as high scorers. Fears related to social situations were reported both by high and medium scorers. Functional impairment defined by avoidance and school difficulties was more common among high scorers, but it was also reported to a significant extent by medium scorers. Compared to low and medium scorers, high scorers showed a higher F/M ratio (about 4:1) and a more homogeneous symptomatologica...
Recent guidelines recommend early surgical treatment of hip fractures in the elderly. The aim of ... more Recent guidelines recommend early surgical treatment of hip fractures in the elderly. The aim of the present study is to analyse the factors delaying surgical treatment of hip fractures in elderly patients by more than 2 days and to investigate whether these factors are consistent between a teaching and a community hospital. Retrospective cohort study using hospital discharge records and patients' charts. Orthopaedics and traumatology departments of a teaching hospital and a small town hospital in Northern Italy. 1768 consecutive patients aged 65 years or more who underwent surgery for hip fractures between 2004 and 2007. Surgery for hip fracture. Surgery within two days from admission. 938 (53.1%) patients were operated within 2 days of admission to the hospital. Logistic regression models were used to examine potential predictors of surgery delay including gender, age, hospital, comorbidity, type of intervention (partial or total hip replacement, reduction and internal fixation), International Normalized Ratio (INR), Haemoglobin (Hb), American Society of Anaesthesiologists (ASA) score, and day of admission (categorized as Monday to Wednesday, Thursday-Friday, Saturday-Sunday). Age, type of intervention (partial or total hip replacement), INR score > 1.5 and an ASA score of 4 compared to 1-2, admission on Thursday-Friday or Saturday-Sunday and the interaction hospital × arrhythmia significantly predicted a surgery delay of more than 2 days. Both organization and medical problems accounted for delays of surgical treatment of hip fractures. Established protocols aimed to optimize the patient flow logistics and to manage comorbidities are crucial to make hospitals more patient-centred and to improve patient outcomes.
Social Psychiatry and Psychiatric Epidemiology, 2009
To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatie... more To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.
Empirical data on the impact of personality pathology on acute treatment outcome for depression a... more Empirical data on the impact of personality pathology on acute treatment outcome for depression are mixed, in part because of challenges posed by assessing trait-like personality patterns while patients are in an active mood episode. To our knowledge, no previous study has examined the effect of personality pathology on maintenance treatment outcome. By maintenance treatment we refer to long-term treatment provided to prevent depression recurrence among remitted patients. Structured Clinical Interviews for the DSM-III-R Personality Disorders (SCID-II) were obtained on a sample of 125 recurrently depressed women following sustained remission of the acute mood episode and prior to entering maintenance treatment. SCID-II interviews were then repeated following 1 and 2 years of maintenance interpersonal psychotherapy. At the pre-maintenance assessment, 21.6% of the sample met SCID-II personality disorder criteria. Co-morbid personality pathology was related to an earlier age of onset, more previous depressive episodes, and a greater need for adjunctive pharmacotherapy to achieve remission of the acute mood episode. Co-morbid personality pathology predicted both higher rates of depression recurrence and a shorter time to recurrence over the 2-year course of maintenance treatment. Notably, among those patients who remained depression-free, continuous levels of personality pathology steadily declined over the 2-year course of maintenance therapy. Results highlight the need for early and effective intervention of both episodic mood disorder and inter-episode interpersonal dysfunction inherent to the personality disorders. Future maintenance treatment trials are needed to clarify the relationship between episodic mood disorder and personality function over time.
Typologies of anxiety, depression and somatization symptoms were investigated in individuals with... more Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship. The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category. Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms. These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.
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