A series of barriers may limit regular physical activity in subjects affected by mental disorders; these barriers should be taken into account and appropriately addressed.

Joint goniometry is a common mode of clinical assessment used in many disciplines, in particular rehabilitation [1][2][3]. One way to perform joint goniometry is through the use of computer-aided joint measurements from digital photographs [4][5][6][7][8]. This method entails a complex procedure to obtain the range of motion (ROM) value, which consists of the picture being manipulated upon by dedicated software once it has been downloaded from the camera to a computer.Recently, a new iPhone (Apple Inc, Cupertino, CA)-based application (app) functioning as a virtual goniometer, DrGoniometer (DrG; C.D.M. srl, Milano, Italy), has been developed to provide a simpler, faster measurement of limb joint mobility ( Figure 1). Measurements with the DrG app are obtained by positioning a virtual goniometer, visible on the smartphone screen, on a picture previously taken by the mobile camera. The software creates an easily retrievable patient database. After selecting the patient, the clinician chooses the desired joint from a list and the respective motion to measure (eg, flexion, extension), then simply takes a photo of the limb, saves it, measures the joint angle, and observes the value. For research purposes, it is possible to blind the rater to the angular value. Notes can be added to each picture. The measurements and pictures are stored in the smartphone database for further analysis, if required. All data can be easily downloaded to a computer to obtain direct written reports.We assessed the reliability (intra-and interrater correlation and agreements analysis) of DrG in comparison with a small plastic universal goniometer (UG) [1] for elbow ROM measurement [9]. Twenty-eight pictures of elbows of healthy subjects, measured by UG at different angles, were assessed with DrG by 7 raters, selected as expert clinicians and working in 2 different facilities. Measurements were repeated after 1 week. Each picture was judged adequate, that is, without evident perspective error. Raters were blinded to all joint angles values. The 392 measurements were used to assess: the intraclass correlation coefficient (ICC) for intrarater and interrater reliability [9]; and the agreement between the DrG and UG, considering 10°as the acceptable interval (width) within which 95% of differences between measurements by the DrG and UG are expected to lie (limits of agreement, LoA ϭ -5°, ϩ5°) [10,11].The results showed high intra-and interrater correlation (ICC ϭ 0.998, 95% confidence interval 0.998-0.999, and ICC ϭ 0.998, 95% confidence interval 0.996-0.999, respectively). The width of 95% LoA between DrG and UG was equal to 10.26°( LoA ϭ ϩ4.51°, Ϫ5.75°).In a 1985 report, Fish and Wingate [2] assessed the accuracy of elbow goniometry by comparing a manual goniometer with (conventional) photographic measurements. They found that the accuracy of elbow angle measurement via photography was greater than via the standard goniometer. The authors explained the difference by stating that the precision of the photographic method was dependent on the use ...

BackgroundStudies performed to assess the relevance of duration of untreated psychosis (DUP) as a predictor of long-term outcome (i.e. follow-ups of ten years or more) are somewhat limited. The aim of this study was to evaluate the potential association between DUP and very long-term outcome (16-33 yrs) of schizophrenia by means of a retrospective design.MethodsRetrospective data obtained from clinical records were collected regarding DUP and outcome variables (number of hospitalizations; number of attempted suicides; course of illness; GAF scores at last observation) for a cohort of 80 outpatients (52 Males, 28 Females, mean age 51.0+/-11.58 years) affected by schizophrenia according to DSMIVTR attending a university community mental health centre.ResultsMean duration of follow up was 25.2 +/- 8.68 years; mean duration of untreated psychosis was 49.00 months (range 1-312 mo), with no significant difference according to gender. Patients with a shorter DUP (=/< 1 year) displayed more frequent “favourable” courses of illness (28.9% vs 8.6%) (p = 0.025), more frequent cases with limited (=/< 3) number of hospital admissions (85.7% vs 62.1%) (p = 0.047) and a better functioning (mean GAF score = 50.32+/-16.49 vs 40.26+/-9.60, p = 0.002); regression analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, functioning (GAF scores).ConclusionA shorter DUP appears to act as a significant predictor of better outcome in schizophrenia even in the very long-term.

No abstract

Latency to first pharmacological treatment [duration of untreated illness (DUI)] in psychiatric disorders can be measured in years, with differences across diagnostic areas and relevant consequences in terms of socio-occupational functioning and outcome. Within the psychopathological onset of a specific disorder, many factors influence access and latency to first pharmacotherapy and the present study aimed to investigate such factors, through an ad-hoc developed questionnaire, in a sample of 538 patients with diagnoses of schizophrenia-spectrum disorder (SZ), mood disorder (MD), and anxiety disorder (AD). Patients with SZs showed earlier ages at onset, first diagnosis and treatment, as well as shorter DUI compared with other patients (43.17 months vs. 58.64 and 80.43 months in MD and AD; F=3.813, P=0.02). Patients with MD and AD reported more frequently onset-related stressful events, benzodiazepines as first treatment, and autonomous help seeking compared with patients with SZs. In terms of first therapist, psychiatrist referral accounted for 43.6% of the cases, progressively decreasing from SZ to MD and AD (57.6, 41.8, and 38.3%, respectively). The opposite phenomenon was observed for nonpsychiatrist clinician referrals, whereas psychologist referrals remained constant. The present findings confirm the presence of a relevant DUI in a large sample of Italian patients with different psychiatric disorders (5 years, on average), pointing out specific differences, in terms of treatment access and latency, between psychotic and affective patients. Such aspects are relevant for detection of at-risk patients and implement early intervention programs.