Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Efficacy of Telemedicine for Improving Depression Outcomes in Primary Care
Brief Summary: Background: In Italy, several recent studies found that a large percentage of patients attending Primary Care (PC) clinics meet criteria for at least one common mental disorder, as they show high rates of depression, anxiety, and co-morbid anxiety and depression. These patients may experience significant functional impairment and suffer from unexplained somatic symptoms, and often remain undetected and untreated. Consistent evidence for the effectiveness of organized care programs for depression, by improving quality of care and treatment adherence, is now available. Fundamental elements of these programs include algorithms to prompt the proper and timely implementation of evidence-based treatments, structured outcome assessment and systematic outreach. Telemedicine tools may represent a valuable strategy for improving depression outcomes in PC.

Aims: 1.To develop and employ computer-based assessment to more accurately and timely detect patient depression in PC settings; 2.To evaluate the feasibility and effectiveness of a care support program developed in conjunction with the PC-based assessment for patients suffering from depression, as based on two main objectives: 2a.To support GP decisions with treatment algorithms and improve the quality of GP and mental health service collaboration; 2b.To improve patient compliance and treatment adherence by using appropriate telecommunication tools and technologically advanced tools to conduct systematic routine assessment. Although much of this system will be computer-based, live telephonic and in-person contacts will also be included as needed.

Study Design: The study is a randomized controlled trial, involving four PC group clinics (GCs) located in two areas of Northern Italy. Two PC clinics will use the experimental protocol; the other two will serve as controls.

The study will compare two different conditions:

* Group 1 (experimental): GPs will use a Computer Decision Support System with treatment algorithms and advice and supervision from a consultant psychiatrist. Patients will receive reminders via mobile texting or automatic mobile (or landline) phone calls to improve adherence to the treatment prescribed.
* Group 2 (control): GPs will provide TAU, will make their own decisions and will therefore not use the CDSS. Patients will not receive any reminders. All enrolled patients will be administered and will fill in the IDS-SR at baseline, 3 and 6-months: the IDS-SR score will be used as a primary endpoint.


Options:
A: Inclusion Criteria:

* Must be able to understand and sign the informed consent form approved by the Institutional Review Board (IRB)
* Must successfully answer all the questions on the Informed Consent quiz indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study
* Have a current diagnosis of schizophrenia
* Taking no more than 1 oral antipsychotic on the day before randomization
* Have been placed into custody at least twice with one of them leading to incarceration within the 24 months previous to study start, with the last release occurring within the 90 days before the first day of screening
* in the opinion of the investigator, may benefit from a change in their prior antipsychotic treatment
* Have available a designated individual (eg, family member, case manager, significant other, probation/parole officer) who has knowledge of the patient and is generally aware of the patient's daily activities, and who agrees to let the study site personnel know of changes in the patients circumstances when the patient is not able to provide this information, ie, arrests, protocol-defined hospitalizations, emergency room visits, becoming homeless, etc.
* Have either an address or phone number where they can be reached, or be accessible to the designated individual
* Must agree to receive regular injections for 15 months if randomly assigned to the paliperidone palmitate treatment group, or continue with oral study medication treatment for 15 months if randomly assigned to the oral antipsychotic treatment group
* Women must be postmenopausal (for at least 2 years), surgically sterile (hysterectomy or bilateral oophorectomy, tubal ligation, or otherwise be incapable of pregnancy), abstinent, or if sexually active, be practicing a highly effective method of birth control

Exclusion Criteria:

* Allergies, hypersensitivity (anaphylaxis-type reaction), or intolerance to risperidone or paliperidone
* Actively abusing intravenous drugs within the past 3 months or have an opiate dependence disorder
* Have a positive urine drug screen test for barbiturates, cocaine, amphetamines, or opiates at screening
* Women who are pregnant or breast-feeding, or planning to become pregnant
* Have received injectable antipsychotic treatment within 2 injection cycles prior to screening
* Received treatment with clozapine within 3 months of screening
* Are at a high risk of violence in the next 15 months, in the opinion of the investigator
* who have a history of sex offenses including felony sex offenses, child molestation
B: Inclusion Criteria:

* Patients aged 18-65 years
* PHQ-9 score of \>or=14 at baseline
* IDS-SR score of \>or=26 at baseline
* No filling of antidepressant medication prescription for 270 prior days
* Illiteracy or the lack of working telephone to receive reminders.

Exclusion Criteria:

* Current diagnosis of alcohol or substance dependence
* History of Bipolar Disorder determined by a baseline Composite International Diagnostic Interview (CIDI) screening scale of lifetime mania/hypomania
* Any current prescription for mood stabilizer or antipsychotic medication
* Female with positive pregnancy test
* General medical conditions which contraindicate antidepressant medications
* Clinical status requiring inpatient or day hospital treatment.
C: Inclusion Criteria:

* DSM-IV diagnosis of PTSD
* Experienced traumatic event at least 12 weeks prior to study entry
* Willingness to discontinue current CBT or antidepressant treatment

Exclusion Criteria:

* Current diagnosis of schizophrenia or delusional disorder
* Medically unstable bipolar disorder, depression with psychotic features, or depression requiring psychiatric treatment
* Current diagnosis of alcohol or substance dependence within 3 months prior to study entry
* Ongoing intimate relationship with the perpetrator of the traumatic event
* History of nonresponse to either CBT or sertraline
* Medical contraindication for sertraline
D: Inclusion Criteria:

* Admitted to an acute care psychiatric ward.
* Diagnosed with schizophrenia (ICD-10 codes: F20-F29)
* Aged 16 to 65 years old at admission
* No prior experience of psychiatric admission (first-admission)

Exclusion Criteria:

* Diagnosed with moderate to severe mental retardation
* Diagnosed with organic mental disorders (ICD10 codes: F00-F09)
* Having poor Japanese language skill
* Severe conceptual disorganization as measured by brief psychiatric rating scale of 5 or more.

Answer: B