1
|
Buoli M, Cesana BM, Fagiolini A, Albert U, Maina G, de Bartolomeis A, Pompili M, Bondi E, Steardo L, Amore M, Bellomo A, Bertolino A, Di Nicola M, Di Sciascio G, Fiorillo A, Rocca P, Sacchetti E, Sani G, Siracusano A, Di Lorenzo G, Tortorella A, Altamura AC, Dell'Osso B. Which factors delay treatment in bipolar disorder? A nationwide study focussed on duration of untreated illness. Early Interv Psychiatry 2021; 15:1136-1145. [PMID: 33058435 DOI: 10.1111/eip.13051] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
AIM The aim of the present study was to detect factors associated with duration of untreated illness (DUI) in bipolar disorder (BD). METHOD A total of 1575 patients were selected for the purposes of the study. Correlation analyses were performed to analyse the relation between DUI and quantitative variables. The length of DUI was compared between groups defined by qualitative variables through one-way analyses of variance or Kruskal-Wallis's tests according to the distribution of the variable. Linear multivariable regressions were used to find the most parsimonious set of variables independently associated with DUI: to this aim, qualitative variables were inserted with the numeric code of their classes by assuming a proportional effect moving from one class to another. RESULTS An inverse significant correlation between length of DUI and time between visits in euthymic patients was observed (r = -.52, P < .001). DUI resulted to be longer in patients with: at least one lifetime marriage/partnership (P = .009), a first psychiatric diagnosis of major depressive disorder or substance abuse (P < .001), a depressive polarity of first episode (P < .001), no lifetime psychotic symptoms (P < .001), BD type 2 (P < .001), more lifetime depressive/hypomanic episodes (P < .001), less lifetime manic episodes (P < .001), presence of suicide attempts (P = .004), depressive episodes (P < .001), hypomanic episodes (P = .004), hospitalizations (P = .011) in the last year. CONCLUSIONS Different factors resulted to increase the length of DUI in a nationwide sample of bipolar patients. In addition, the DUI was found to show a negative long-term effect in terms of more suicidal behaviour, more probability of hospitalization and depressive/hypomanic episodes.
Collapse
Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro," Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | | | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, Psychiatric Section, University of Trieste, Trieste, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea de Bartolomeis
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Roma, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Emi Bondi
- Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, School of Medicine, University of Turin, Turin, Italy
| | - Emilio Sacchetti
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriele Sani
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Psychiatry and Clinical Psychology, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Psychiatry and Clinical Psychology, Policlinico Tor Vergata Foundation, Rome, Italy
| | | | - Alfredo Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, California, USA.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | | |
Collapse
|
2
|
Janca A, Burke JD, Isaac M, Burke KC, Costa JA, Silva E, Acuda SW, Altamura AC, Chandrashekar CR, Miranda CT, Tacchini G. The World Health Organization somatoform disorders schedule. A preliminary report on design and reliability. Eur Psychiatry 2020; 10:373-8. [DOI: 10.1016/0924-9338(96)80340-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/1995] [Accepted: 04/18/1995] [Indexed: 12/25/2022] Open
Abstract
SummaryThe World Health Organization (WHO) Somatoform Disorders Schedule (SDS) is a highly standardized instrument for the assessment of somatoform disorders according to the tenth revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual (DSM-IV). The SDS was produced in the framework of the WHO International Study of Somatoform Disorders and tested for its reliability in Brazil, India, Italy, the USA and Zimbabwe. A sample of 180 patients from general psychiatry, primary care and general medical settings were interviewed with the SDS within a three-day interval by nonclinician and clinician interviewers. The agreement between the two interviews was tested using the intraclass correlation coefficients (ICC) and kappa statistic. The test-retest reliability of the SDS was found to be very good (the ICC for all the centres was 0.76; overall kappa value for SDS questions was 0.58; one-third of SDS questions had a kappa value of 0.60 or higher). The field test results of the SDS indicated that the instrument may be administered in larger studies by non-clinician interviewers without compromising the ability to document the prevalence of somatoform disorders in different cultures.
Collapse
|
3
|
Altamura AC, Buoli M, Cesana BM, Fagiolini A, de Bartolomeis A, Maina G, Bellomo A, Dell'Osso B. Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study. Aust N Z J Psychiatry 2019; 53:772-781. [PMID: 30658550 DOI: 10.1177/0004867418823268] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. METHODS A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student's t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. RESULTS Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed (p < 0.01) and never married/partnered (p < 0.01); have an earlier age at onset (p < 0.01); more frequently receive a first diagnosis different from a mood disorder (p < 0.01); have a shorter duration of untreated illness (p < 0.01); have a more frequently hypomanic/manic prevalent polarity (p < 0.01) and a prevalent manic-depressive type of cycling (p < 0.01); present a lower lifetime number of depressive episodes (p < 0.01), but have more manic episodes (p < 0.01); and less insight (p < 0.01) and more hospitalizations in the last year (p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). CONCLUSION Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Mario Cesana
- 2 Unit of Biostatistics and Biomathematics, University of Brescia, Brescia, Italy.,3 Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Fagiolini
- 4 Department of Mental Health and Department of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Andrea de Bartolomeis
- 5 Section of Psychiatry and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maina
- 6 Department of Mental Health, San Luigi-Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonello Bellomo
- 7 Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Bernardo Dell'Osso
- 8 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,9 CRC 'Aldo Ravelli' for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,10 UOC Psichiatria 2, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,11 Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | | |
Collapse
|
4
|
Mauri MC, Paletta S, Di Pace C, Reggiori A, Cirnigliaro G, Valli I, Altamura AC. Correction to: Clinical Pharmacokinetics of Atypical Antipsychotics: An Update. Clin Pharmacokinet 2019; 58:1219-1220. [PMID: 31214940 DOI: 10.1007/s40262-019-00797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pharmacokinetics of CRP was tested in small short-term studies in both healthy volunteers and in subjects with schizophrenia, with similar results [242].
Collapse
Affiliation(s)
- Massimo Carlo Mauri
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy.
| | - Silvia Paletta
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy
| | - Chiara Di Pace
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy
| | - Alessandra Reggiori
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy
| | - Giovanna Cirnigliaro
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy
| | - Isabel Valli
- Department of Psychosis Studies, King's College London, London, UK
| | - Alfredo Carlo Altamura
- Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy
| |
Collapse
|
5
|
Delvecchio G, Mandolini GM, Arighi A, Prunas C, Mauri CM, Pietroboni AM, Marotta G, Cinnante CM, Triulzi FM, Galimberti D, Scarpini E, Altamura AC, Brambilla P. Structural and metabolic cerebral alterations between elderly bipolar disorder and behavioural variant frontotemporal dementia: A combined MRI-PET study. Aust N Z J Psychiatry 2019; 53:413-423. [PMID: 30545239 DOI: 10.1177/0004867418815976] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Elderly bipolar disorder (BD) and behavioural variant of frontotemporal dementia (bvFTD) may exhibit similar symptoms and both disorders are characterized by selective abnormalities in cortical and subcortical regions that are associated with cognitive and emotional impairments. We aimed to investigate common and distinct neural substrates of BD and bvFTD by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET) techniques. METHODS 3-Tesla MRI and 18 fluorodeoxyglucose-PET scans were acquired for 16 elderly BD patients, 23 bvFTD patients with mild cognitive impairments and 68 healthy controls (48 for PET and 20 for MRI analyses). RESULTS BD and bvFTD patients exhibit a different localization of grey matter reductions in the lateral prefrontal cortex, with the first group showing grey matter decrease in the ventrolateral prefrontal cortex and the latter group showing grey matter reductions in the dorsolateral prefrontal cortex as well as unique grey matter and metabolic alterations within the orbitofrontal cortex. The bvFTD group also displayed unique volumetric shrinkage in regions within the temporo-parietal network together with greater metabolic impairments within the temporal cortex and more extensive volumetric and metabolic abnormalities within the limbic lobe. Finally, while the BD group showed greater grey matter volumes in caudate nucleus, bvFTD subjects displayed lower metabolism. CONCLUSION This MRI-PET study explored, for the first time to the best of our knowledge, structural and functional abnormalities in bvFTD and elderly BD patients, with the final aim of identifying the specific biological signature of these disorders, which might have important implications not only in prevention but also in differential diagnosis and treatment.
Collapse
Affiliation(s)
- Giuseppe Delvecchio
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Mario Mandolini
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Arighi
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 'Dino Ferrari' Center, Milan, Italy
| | - Cecilia Prunas
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Massimo Mauri
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna M Pietroboni
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 'Dino Ferrari' Center, Milan, Italy
| | - Giorgio Marotta
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Maria Cinnante
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Maria Triulzi
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 'Dino Ferrari' Center, Milan, Italy
| | - Elio Scarpini
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 'Dino Ferrari' Center, Milan, Italy
| | - Alfredo Carlo Altamura
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- 1 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,4 Department of Psychiatry and Behavioural Sciences, UT Houston Medical School, Houston, TX, USA
| |
Collapse
|
6
|
Marotta G, Delvecchio G, Pigoni A, Mandolini G, Ciappolino V, Oldani L, Madonna D, Grottaroli M, Altamura AC, Brambilla P. The metabolic basis of psychosis in bipolar disorder: A positron emission tomography study. Bipolar Disord 2019; 21:151-158. [PMID: 30506616 DOI: 10.1111/bdi.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Psychotic symptoms are a common feature in bipolar disorder (BD), especially during manic phases, and are associated with a more severe course of illness. However, not all bipolar subjects experience psychosis during the course of their illness, and this difference often guides assessment and pharmacological treatment. The aim of the present study is to elucidate, for the first time, the FDG uptake dysfunctions associated with psychosis in BD patients with and without a history of past psychotic symptoms, through a positron emission tomography (PET) approach. METHODS Fifty BD patients with lifetime psychotic symptoms, 40 BD patients without lifetime psychotic symptoms and 27 healthy controls (HC) were recruited and underwent an 18F-FDG-PET session. RESULTS Compared to HC, BD subjects shared common FDG uptake deficits in several brain areas, including insula, inferior temporal gyrus and middle occipital gyrus. Moreover, we found that BD patients with a history of past psychotic symptoms had a unique FDG uptake alteration in the right fusiform gyrus compared to both BD patients without lifetime psychotic symptoms and HC (all P < 0.01, cFWE corrected). CONCLUSIONS Overall, our results suggest that FDG uptake alterations in brain regions involved in emotion regulation are a key feature of BD, regardless the presence of past psychosis. Finally, we demonstrated that the FDG uptake reduction in fusiform gyrus is associated with the presence of past psychotic symptoms in BD, ultimately leading towards the idea that the fusiform gyrus might be considered a putative biomarker of psychosis.
Collapse
Affiliation(s)
- Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Scientific Institute, IRCCS E. Medea, Pordenone, Italy
| | - Alessandro Pigoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianmario Mandolini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Madonna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marika Grottaroli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry and Behavioural Sciences, UT Houston Medical School, Houston, TX, USA
| |
Collapse
|
7
|
Oldani L, Benatti B, De Carlo V, Cortinovis I, Altamura AC, Dell'Osso B. A new tool to assess duration of untreated illness: Psychopathological Onset and Latency to Treatment Questionnaire (POLT-Q). Riv Psichiatr 2019; 53:290-298. [PMID: 30667395 DOI: 10.1708/3084.30762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Duration of untreated illness (DUI) has been increasingly investigated as a predictor of clinical outcome and course in different psychiatric disorders. To date, however, there are no tools for measuring this variable. Our group developed the Psychopathological Onset and Latency to Treatment Questionnaire (POLT-Q), focused on the onset of psychiatric disorders. Aim of this study was to assess the reproducibility and manageability of POLT-Q. METHODS Fifty consecutive in- and out-patients aged 16-65 with different DSM-5 psychiatric disorders were recruited. Two raters were present during the interview: one of them administered the POLT-Q to the patient and both independently completed the questionnaire. Collected values were compared using Cohen's Kappa test and McNemar test. RESULTS 62.5% of the replies showed a 100% consistency between the two raters. In the 6.25% the agreement was <95%. For all the replies, the K coefficient was >0.8, a high degree of agreement. DISCUSSION AND CONCLUSION The POLT-Q assesses variables related to the psychopathological onset and first pharmacological treatment and, according to present findings, it represents a convenient, reliable and standardised measure for DUI. Further studies on larges sample are needed to confirm our preliminary results.
Collapse
Affiliation(s)
- Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Vera De Carlo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ivan Cortinovis
- Laboratory G. A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Italy - CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, Italy - Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| |
Collapse
|
8
|
Calvo A, Delvecchio G, Altamura AC, Soares JC, Brambilla P. Gray matter differences between affective and non-affective first episode psychosis: A review of Magnetic Resonance Imaging studies: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2019; 243:564-574. [PMID: 29625792 DOI: 10.1016/j.jad.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/22/2018] [Accepted: 03/14/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-affective and affective psychoses are very common mental disorders. However, their neurobiological underpinnings are still poorly understood. Therefore, the goal of the present review was to evaluate structural Magnetic Resonance Imaging (MRI) studies exploring brain deficits in both non-affective (NA-FEP) and affective first episode psychosis (A-FEP). METHODS A bibliographic search on PUBMED of all MRI studies exploring gray matter (GM) differences between NA-FEP and A-FEP was conducted. RESULTS Overall, the results from the available evidence showed that the two diagnostic groups share common GM alterations in fronto-temporal regions and anterior cingulate cortex. In contrast, unique GM deficits have also been observed, with reductions in amygdala for A-FEP and in hippocampus and insula for NA-FEP. LIMITATIONS Few small MRI studies with heterogeneous methodology. CONCLUSIONS Although the evidences are far to be conclusive, they suggest the presence of common and distinct pattern of GM alterations in NA-FEP and A-FEP. Future larger longitudinal studies are needed to further characterize specific neural biomarkers in homogenous NA-FEP and A-FEP samples.
Collapse
Affiliation(s)
- A Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| | - G Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A C Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - J C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA
| | - P Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; IRCCS "E. Medea" Scientific Institute, Bosisio Parini LC, Italy.
| |
Collapse
|
9
|
Pigoni A, Delvecchio G, Altamura AC, Soares JC, Fagnani C, Brambilla P. The role of genes and environment on brain alterations in Major Depressive Disorder: A review of twin studies: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2018; 234:346-350. [PMID: 29100658 DOI: 10.1016/j.jad.2017.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/11/2017] [Accepted: 10/22/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although it has been consistently reported the important role of genetic and environmental risk factors on structural and functional alterations in Major Depressive Disorder (MDD), the mechanism and the magnitude of the interactions between specific genetic and/or environmental risk factors on brain structures in this disabling disorder are still elusive. Therefore, in the last two decades an increased interest has been devoted to neuroimaging investigations on monozygotic and dizygotic twin samples mainly because their intrinsic characteristics may help to separate the effects of genetic and environmental risk factors on clinical phenotypes, including MDD. METHODS In this context, the present review summarizes results from structural and functional Magnetic Resonance Imaging studies that investigated twin samples in correlation with MDD. RESULTS Overall the results confirmed that a) MDD is characterized by significant alterations in selective brain areas presiding over emotion recognition and evaluation, including amygdala, insula and prefrontal cortices, and b) both genetic and environmental risk factors play a key role in the pathophysiology of this disorder. LIMITATIONS Few MRI studies exploring MDD in twin samples. CONCLUSIONS The specific contribution of both aspects is still not fully elucidated especially because genes and environment have an impact on the same brain areas, which are particularly vulnerable in MDD. Expansion of the current twin sample sizes would help to clearly establish the potential relationship between risk factors and the development of MDD.
Collapse
Affiliation(s)
- A Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A C Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - J C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA
| | - C Fagnani
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - P Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; IRCCS "E Medea" Scientific Institute, Bosisio Parini, LC, Italy.
| |
Collapse
|
10
|
Serati M, Delvecchio G, Orsenigo G, Perlini C, Barillari M, Ruggeri M, Altamura AC, Bellani M, Brambilla P. Potential Gender-Related Aging Processes Occur Earlier and Faster in the Vermis of Patients with Bipolar Disorder: An MRI Study. Neuropsychobiology 2018; 75:32-38. [PMID: 28803247 DOI: 10.1159/000477967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the last decades, there has been increasing interest in investigating the role of the vermis in bipolar disorder (BD), especially because of its involvement in cognitive processes. The main aims of this study were to explore the integrity of the vermis and elucidate the role of demographic and clinical variables on vermis volumes in BD patients, stratified according to gender. METHODS T1-weighted images were obtained for 38 BD patients and 38 healthy controls using a 1.5-T MRI scanner. Images were analyzed with a PC workstation with BRAINS2 software on a Linux system. Anatomical regions were traced manually from a blinded operator, with respect to subject identity and other clinical variables. RESULTS The direct comparison between the 2 groups showed no significant gray matter differences in vermis volumes. Interestingly, vermis volumes were significantly inversely associated with chronological age and age of BD onset, particularly in male subjects. CONCLUSIONS Our study provides evidence of the impact of aging on the vermis in BD, potentially related to earlier and faster gender-related neurodegenerative phenomena occurring during the progression of the disease.
Collapse
Affiliation(s)
- Marta Serati
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Mauri MC, Paletta S, Di Pace C, Reggiori A, Cirnigliaro G, Valli I, Altamura AC. Clinical Pharmacokinetics of Atypical Antipsychotics: An Update. Clin Pharmacokinet 2018; 57:1493-1528. [DOI: 10.1007/s40262-018-0664-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
12
|
Ciappolino V, Delvecchio G, Agostoni C, Mazzocchi A, Altamura AC, Brambilla P. The role of n-3 polyunsaturated fatty acids (n-3PUFAs) in affective disorders. J Affect Disord 2017; 224:32-47. [PMID: 28089169 DOI: 10.1016/j.jad.2016.12.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/22/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Among emerging treatments for depressive disorders several studies suggested that n-3 polyunsaturated fatty acids (n-3PUFAs) supplementation can be used. However, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) differ in terms of biochemistry, metabolism and therapeutic effects. Therefore, a clear picture of their specific and different role on affective disorders has not yet emerged. OBJECTIVES To investigate the effects of n-3PUFAs on affective disorders including major depression, bipolar disorder and perinatal depression. METHODS a comprehensive search on PUBMED, Medline and PsychINFO of all RCTs using n-3PUFAs patients with depressive symptoms published up to April 2016 was performed. We included trials that examined unipolar or bipolar disorder and trials that investigated depressive symptoms in relation to pregnancy. Trials were excluded if the depressive symptomatology was related to other primary organic diseases. RESULTS 264 RCT studies were identified but only 36 met the inclusion criteria. First, it has been reported that n-3PUFAs supplementation might have clinical benefits on depressive symptoms. Second, EPA supplement, rather than DHA, seems to be more effective in treating major depression. Third, n-3PUFAs can have beneficial effects in bipolar depression but not in perinatal depression. CONCLUSIONS there are only some evidence on the efficacy of n-3PUFAs in affective disorders especially to unipolar and bipolar depression not powered enough to confirm a therapeutic effect for affective disorder. Therefore, further studies with larger and more homogeneous samples, are required to confirm these effects.
Collapse
Affiliation(s)
- Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Carlo Agostoni
- Pediatric Clinic, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy
| | - Alessandra Mazzocchi
- Pediatric Clinic, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, TX, USA.
| |
Collapse
|
13
|
Serati M, Barkin JL, Orsenigo G, Altamura AC, Buoli M. Research Review: The role of obstetric and neonatal complications in childhood attention deficit and hyperactivity disorder - a systematic review. J Child Psychol Psychiatry 2017; 58:1290-1300. [PMID: 28714195 DOI: 10.1111/jcpp.12779] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Attention deficit and hyperactivity disorder (ADHD) is a developmental disorder characterized by an inability to sustain attention, activity levels and impulse control, and, according to the latest studies, the prevalence is about 8% and in some countries less than 1%. Currently, it is well-known that complications during the perinatal period have significant implications on child's physical and mental health. Purpose of the present paper is to review the literature about the association between perinatal complications and future risk of an ADHD diagnosis. METHODS A research in the main database sources has been conducted to obtain a systematic review on the perinatal risk factors of ADHD. RESULTS Among perinatal complications, available data indicate low birth weight (LBW) (Cohen's d effect size range: 0.31-1.64-small effect size) and preterm birth (PB) (range d: 0.41-0.68) as the most important factors associated with a future diagnosis of ADHD. CONCLUSIONS PB and LBW children should be carefully monitored for an early diagnosis of ADHD limiting the impact of the disease in life span. A systematic review focusing on these risk factors have not been published until now, in the next future preventive strategies should be developed in order to minimize ADHD onset.
Collapse
Affiliation(s)
- Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Giulia Orsenigo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
14
|
Squarcina L, Houenou J, Altamura AC, Soares J, Brambilla P. Association of increased genotypes risk for bipolar disorder with brain white matter integrity investigated with tract-based spatial statistics: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summarise relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2017. [PMID: 28648753 DOI: 10.1016/j.jad.2017.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) studies, which allow the in-vivo investigation of brain tissue integrity, have shown that bipolar disorder (BD) patients present signs of white matter dysconnectivity. In parallel, genome-wide association studies (GWAS) identified several risk genetic variants for BD. I METHODS In this mini-review, we summarized DTI studies coupling tract-based spatial statistics (TBSS), a reliable technique exploring white matter axon bundles, and genetics in BD. We performed a bibliographic search on PUBMED, using the search terms "TBSS", "genetics", "genome", "genes", "polymorphism", "bipolar disorder". RESULTS Ten studies met these inclusion criteria. ANK3 and ZNF804A polymorphisms have shown the most consistent results, with the risk alleles showing abnormal white matter integrity in patients with BD. LIMITATIONS Current studies are limited by the investigation of single SNPs in small and chronically treated samples. CONCLUSIONS Most considered TBSS-DTI studies found associations between decreased white matter integrity and genetic risk variants. These results suggest an involvement of dysmyelination in the pathogenesis of BD. The combination of TBSS with genotyping can be powerful to unveil the role of white matter in BD, in conjunction with risk genes. Future DTI studies should combine TBSS and GWAS in large populations of drug-free or minimally treated patients with BD at the onset of the disease.
Collapse
Affiliation(s)
- L Squarcina
- IRCCS "E. Medea" Scientific Institute, Bosisio Parini, Italy
| | - J Houenou
- APHP, Hôpitaux Universitaires Mondor, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Créteil, France; UNIACT, Psychiatry Team, Neurospin Neuroimaging Platform, CEA Saclay, Gif-Sur-Yvette, France
| | - A C Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - J Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, USA
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, TX, USA.
| |
Collapse
|
15
|
Delvecchio G, Pigoni A, Perlini C, Barillari M, Ruggeri M, Altamura AC, Bellani M, Brambilla P. Sexual dimorphism of the planum temporale in schizophrenia: A MRI study. Aust N Z J Psychiatry 2017; 51:1010-1019. [PMID: 28410561 DOI: 10.1177/0004867417702748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Anatomical alterations in the superior temporal gyrus have been consistently reported in patients with schizophrenia, and they have mostly been linked to positive symptoms, including hallucinations and thought disorders. The superior temporal gyrus is considered one of the most asymmetric and lateralized structure of the human brain, and the process of lateralization seems to vary according to gender in the normal population. However, although it has been consistently suggested that patients with schizophrenia did not show normal brain lateralization in several regions, only few studies investigated it in the superior temporal gyrus and its sub-regions considering the effects of gender. In this context, the aim of this study was to evaluate sexual dimorphism in superior temporal gyrus volumes in a sample of patients with schizophrenia compared to age- and gender-matched healthy controls. METHODS A total of 72 right/left-handed males (40 schizophrenia patients and 32 healthy controls) and 45 right/left-handed females (18 schizophrenia patients and 27 healthy controls) underwent clinical evaluation and a 1.5T magnetic resonance imaging scan. Gray and white matter volumes of regions of interest within the superior temporal gyrus were manually detected, including the Heschl's gyrus and the planum temporale. RESULTS Female patients with schizophrenia presented a reduction in left planum temporale gray matter volumes ( F = 4.58, p = 0.03) and a lack of the normal planum temporale asymmetry index ( t = 0.27; p = 0.79) compared to female controls ( t = 5.47; p = 0.001). No differences were found between males for any volumes or laterality indices. Finally, in female patients with schizophrenia, Heschl's gyrus gray and white matter volumes negatively correlated with positive symptoms ( r = -0.56, p = 0.01). CONCLUSION Our results showed that sexual dimorphism plays a key role on planum temporale in schizophrenia, underlining the importance of gender as a modulator of brain morphology and lateralization of schizophrenia.
Collapse
Affiliation(s)
- Giuseppe Delvecchio
- 1 Scientific Institute, IRCCS 'Eugenio Medea', San Vito al Tagliamento, Italy
| | - Alessandro Pigoni
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Cinzia Perlini
- 3 Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,4 InterUniversity Centre for Behavioural Neurosciences, University of Verona, Verona, Italy
| | - Marco Barillari
- 5 Section of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Mirella Ruggeri
- 6 Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alfredo Carlo Altamura
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marcella Bellani
- 4 InterUniversity Centre for Behavioural Neurosciences, University of Verona, Verona, Italy.,7 Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Brambilla
- 2 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,8 Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
16
|
D'Urso G, Dell'Osso B, Rossi R, Brunoni AR, Bortolomasi M, Ferrucci R, Priori A, de Bartolomeis A, Altamura AC. Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression. J Affect Disord 2017; 219:25-30. [PMID: 28505499 DOI: 10.1016/j.jad.2017.05.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/01/2017] [Accepted: 05/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. METHODS Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS. RESULTS Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response. LIMITATIONS Open-label design, the lack of control group, and minor differences in stimulation protocols. CONCLUSIONS No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients.
Collapse
Affiliation(s)
- Giordano D'Urso
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA
| | - Rodolfo Rossi
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital of São Paulo, São Paulo, Brazil
| | - Marco Bortolomasi
- Casa di cura Villa Santa Chiara, Quinto di Valpantena, Verona, Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, University of Milan, Italy; III Clinica Neurologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Andrea de Bartolomeis
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy
| |
Collapse
|
17
|
Delvecchio G, Altamura AC, Soares JC, Brambilla P. Pituitary gland in Bipolar Disorder and Major Depression: Evidence from structural MRI studies: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summarise relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2017; 218:446-450. [PMID: 28412090 DOI: 10.1016/j.jad.2017.03.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The function of the hypothalamo-pituitary-adrenal axis (HPA) has been widely investigated in mood disorders based on its role in regulating stress response. Particularly, Magnetic Resonance Imaging (MRI) reports have explored pituitary gland (PG) in both bipolar disorder (BD) and major depressive disorder (MDD). In this context, the present review summarizes the results from MRI studies with the final aim of commenting on the presence of common or distinct PG structural alterations between these two disabling illnesses. METHODS A bibliographic search on PUBMED of all MRI studies exploring PG volumes in BD and MDD as well as first-degree relatives (RELs) from 2000 up to October 2016 was performed. RESULTS Following the screening process of the available literature it can be said that a) PG enlargement has been found in both BD and MDD, therefore potentially representing a common neurobiological marker characterizing mood disorders, and b) PG volumes are moderated by age and sex in both illnesses, although the direction and the extent of this moderation are still not fully clear. LIMITATIONS Few MRI studies with heterogeneous results. CONCLUSIONS These hypotheses must be taken with caution especially because the heterogeneity of the results of the studies reviewed does not allow for a definite answer about the role of PG in affective disorders. Therefore, larger longitudinal studies investigating PG volumes in BD and MDD patients at the early phases of the illness, by considering females and males separately, are needed to further corroborate these findings.
Collapse
Affiliation(s)
- G Delvecchio
- IRCCS "E. Medea" Scientific Institute, San Vito al Tagliamento, Italy
| | - A C Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - J C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
| |
Collapse
|
18
|
Dell'Osso B, Benatti B, Rodriguez CI, Arici C, Palazzo C, Altamura AC, Hollander E, Fineberg N, Stein DJ, Nicolini H, Lanzagorta N, Marazziti D, Pallanti S, Van Ameringen M, Lochner C, Karamustafalioglu O, Hranov L, Figee M, Drummond L, Grant J, Denys D, Cath D, Menchon JM, Zohar J. Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry 2017; 45:36-40. [PMID: 28728093 DOI: 10.1016/j.eurpsy.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age<vs≥65years, and then divided on the basis of the median age of the sample (age<vs≥42years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests). RESULTS G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P<.001), showing a significantly later age at onset (29.4±15.1 vs 18.7±9.2years, P<.001), a more frequent adult onset (75% vs 41.1%, P<.001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P<.05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P=.07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P<.05). CONCLUSIONS G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.
Collapse
Affiliation(s)
- B Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - B Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
| | - C I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - C Arici
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - C Palazzo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - E Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, 10467 New York, USA
| | - N Fineberg
- Mental Health Unit, Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital, AL7 4HQ Welwyn Garden City, UK
| | - D J Stein
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, 7935 Cape Town, South Africa
| | - H Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), 03100 Mexico City, Mexico; Carracci Medical Group, 03100 Mexico City, Mexico
| | - N Lanzagorta
- Carracci Medical Group, 03100 Mexico City, Mexico
| | - D Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria, Università di Pisa, 56126 Pisa, Italy
| | - S Pallanti
- Department of Psychiatry, University of Florence, and Institute of Neurosciences, 50121 Florence, Italy
| | - M Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON L8S 4L8 Hamilton, Canada
| | - C Lochner
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, 7599 Stellenbosch, South Africa
| | - O Karamustafalioglu
- Department of Psychiatry, Sisli Eftal Teaching and Research Hospital, 34371 Istanbul, Turkey
| | - L Hranov
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum, 1797 Sofia, Bulgaria
| | - M Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - L Drummond
- National and Trustwide Services for OCD/BDD, SW London and St George's NHS Trust, SW17 7DJ London, UK
| | - J Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 60607 Chicago, USA
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - D Cath
- Department of Clinical and Health Psychology, Utrecht University, 3512 Utrecht, The Netherlands
| | - J M Menchon
- Psychiatry Unit at Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - J Zohar
- Department of Psychiatry, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel
| |
Collapse
|
19
|
Grassi S, Orsenigo G, Serati M, Caletti E, Altamura AC, Buoli M. Cognitive correlates of neuroimaging abnormalities in the onset of schizophrenia: A case report. World J Psychiatry 2017; 7:128-132. [PMID: 28713691 PMCID: PMC5491478 DOI: 10.5498/wjp.v7.i2.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/23/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Increasing evidence shows that cognitive impairment and brain abnormalities can appear early in the first episodes of schizophrenia, but it is currently debated how brain changes can correlate with clinical presentation of schizophrenic patients. Of note, this report describes the case of a young schizophrenic male presenting parietal magnetic resonance/positron emission tomography abnormalities and cognitive impairment, documented by specific neuropsychological tests. In our knowledge only few studies have investigated if neuropsychological abnormalities could be concomitant with both structural and functional neuroimaging. This case shows that impairment in specific cognitive domains is associated with structural/functional brain abnormalities in the corresponding brain areas (frontal and parietal lobes), supporting the hypothesis of disconnectivity, involving a failure to integrate anatomical and functional pathways. Future research would define the role of cognitive impairment and neurodegeneration in psychiatric nosography and, in particular, their role in the early phases of illness and long-term outcome of schizophrenic patients.
Collapse
|
20
|
Buoli M, Serati M, Caldiroli A, Galimberti D, Scarpini E, Altamura AC. Pharmacological Management of Psychiatric Symptoms in Frontotemporal Dementia: A Systematic Review. J Geriatr Psychiatry Neurol 2017; 30:162-169. [PMID: 28351199 DOI: 10.1177/0891988717700506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psychiatric symptoms in patients with frontotemporal dementia (FTD) are highly prevalent and may complicate clinical management of these patients. Purpose of the present article is to present and discuss available data about the pharmacological treatment of psychiatric symptoms in patients with FTD. A research in the main database sources has been conducted to obtain an overview of the pharmacological management of psychiatric symptoms in patients with FTD. The search strategy included the following terms-"FTD and psychiatry," "FTD and behavioural disturbances," and "FTD and treatment". Pathophysiology of psychiatric symptoms in FTD is different from other types of dementia. Although drugs for Alzheimer disease appear to be ineffective for the treatment of psychiatric symptoms of FTD, preliminary evidence supports a possible usefulness of serotonergic antidepressants for these patients. Data are too scanty to draw definitive conclusions, but antidepressant treatment, particularly with serotonergic compounds, may improve psychiatric symptoms in patients with FTD. Large observational studies are needed to confirm this preliminary evidence, and a lot of effort and collaboration between neurologists and psychiatrists will be definitely crucial for future research of effective treatments for FTD.
Collapse
Affiliation(s)
- Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serati
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- 2 Department of Neurology, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elio Scarpini
- 2 Department of Neurology, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
21
|
Vettoretti S, Buoli M, Guenzani D, Caldiroli L, Carnevali GS, Serati M, Altamura AC, Messa P. MP466GERIATRIC PATIENTS WITH ADVANCED CHRONIC KIDENY DISEASE HAVE A HIGH PREVALENCE OF UNDIAGNOSED PSYCHIATRIC SYMPTOMS AND POORER QUALITY OF LIFE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx173.mp466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Maggioni E, Bianchi AM, Altamura AC, Soares JC, Brambilla P. The putative role of neuronal network synchronization as a potential biomarker for bipolar disorder: A review of EEG studies. J Affect Disord 2017; 212:167-170. [PMID: 28159382 DOI: 10.1016/j.jad.2016.12.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
Impaired intra-hemispheric and inter-hemispheric communication play a major role in the pathophysiology and cognitive disturbances of bipolar disorder (BD). Brain connectivity in BD has been largely investigated using magnetic resonance imaging (MRI) techniques, which have found alterations in prefronto-limbic coupling. In contrast, evidence for functional neural circuitry abnormalities in BD is less consistent. Indeed, just a few studies employing the electroencephalographic (EEG) technique, enabling the exploration of oscillatory brain dynamics, addressed this issue. Therefore, in the present review we summarize the results from EEG studies examining connectivity in patients with BD, to further clarify the putative role of neuronal network synchronization as a potential biomarker of this disabling mental illness.
Collapse
Affiliation(s)
- E Maggioni
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A M Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - A C Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Texas, USA
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Texas, USA.
| |
Collapse
|
23
|
Buoli M, Serati M, Caldiroli A, Cremaschi L, Altamura AC. NEURODEVELOPMENTAL VERSUS NEURODEGENERATIVE MODEL OF SCHIZOPHRENIA AND BIPOLAR DISORDER: COMPARISON WITH PHYSIOLOGICAL BRAIN DEVELOPMENT AND AGING. Psychiat Danub 2017; 29:24-27. [DOI: 10.24869/psyd.2017.24] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Mauri MC, Reggiori A, Paletta S, Di Pace C, Altamura AC. Paliperidone for the treatment of schizophrenia and schizoaffective disorders - a drug safety evaluation. Expert Opin Drug Saf 2017; 16:365-379. [PMID: 28140680 DOI: 10.1080/14740338.2017.1288716] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Paliperidone, the major active metabolite of risperidone, is a second-generation antipsychotic that has been developed as an extended-release (ER) oral formulation and a long-acting injectable paliperidone palmitate (PP) formulation. Paliperidone has demonstrated efficacy in the reduction of acute schizophrenia symptoms and clinical benefits were maintained also in the long-term treatments. Paliperidone ER and PP are generally well tolerated with a predictable adverse event profile. Areas covered: Data from studies evaluating safety and tolerability in the acute and maintenance treatment of schizophrenia with paliperidone are reviewed. The reported treatment-emergent adverse events of these formulations are discussed. Expert opinion: In the treatment of schizophrenia and schizoaffective disorders the safety profile has a central role because it can enhance patient compliance. In fact treatment-emergent adverse events are one of the main causes of discontinuation in these patients. In particular the main limitation in the administration of paliperidone could be represented by the onset of hyperprolactinemia (especially in women) and of mild parkinsonism. Paliperidone has a high impact on current long-term drug strategies, especially given the new 3 month long-acting injectable formulation of PP.
Collapse
Affiliation(s)
- M C Mauri
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - A Reggiori
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - S Paletta
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - C Di Pace
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - A C Altamura
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| |
Collapse
|
25
|
Oldani L, Porta M, Servello D, Zekaj E, DellAcAAOsso B, Altamura AC. Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD: Acute and 12-Month Follow-Up Results. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/neuropsychiatry.1000283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Altamura AC, Delvecchio G, Marotta G, Oldani L, Pigoni A, Ciappolino V, Caletti E, Rovera C, Dobrea C, Arici C, Benatti B, Camuri G, Prunas C, Paoli RA, Dell'osso B, Cinnante C, Triulzi FM, Brambilla P. Structural and metabolic differentiation between bipolar disorder with psychosis and substance-induced psychosis: An integrated MRI/PET study. Eur Psychiatry 2016; 41:85-94. [PMID: 28049086 DOI: 10.1016/j.eurpsy.2016.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET). METHODS Twenty-seven BD type I psychotic patients with (n=10) or without (n=17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired. RESULTS Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients. CONCLUSIONS These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.
Collapse
Affiliation(s)
- A C Altamura
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - G Delvecchio
- Scientific Institute IRCCS "E. Medea", San Vito al Tagliamento (PN), Italy
| | - G Marotta
- Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Oldani
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Pigoni
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - V Ciappolino
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - E Caletti
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - C Rovera
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - C Dobrea
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - C Arici
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - B Benatti
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - G Camuri
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - C Prunas
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - R A Paoli
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - B Dell'osso
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford University, CA, USA
| | - C Cinnante
- Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F M Triulzi
- Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA.
| |
Collapse
|
27
|
Rovera C, Mauri MC, Bertin E, Di Pace C, Paletta S, Reggiori A, De Gaspari IF, Cattaneo D, Mari D, Altamura AC. Duloxetine in elderly major depression disorder: effectiveness and drug plasma level evaluation. Hum Psychopharmacol 2016; 31:349-55. [PMID: 27400882 DOI: 10.1002/hup.2544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/02/2016] [Accepted: 05/27/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this open-label naturalistic study was to assess clinical outcomes and the predictive value of duloxetine plasma levels in major depressive disorder in the elderly. METHODS This naturalistic, open-label design involved 35 outpatients aged between 65 and 87 years. Duloxetine plasma levels were collected in 24 patients after the first month. Patients were evaluated using 21-item Hamilton Rating Scales for Depression, Hamilton Rating Scales for Anxiety, the Clinical Global Impression Severity, Mini Mental State Examination, Cumulative Illness Rating Scale, Barthel Index and Beck's Depression Inventory. RESULTS Duloxetine plasma levels at T2 ranged from 4.9 to 201.9 ng/mL without a significant correlation between duloxetine dose and plasma levels. A significant improvement in mean 21-item Hamilton Rating Scales for Depression total scores at T2,T3, T4, T9 and T12 and a progressive significantly decrease of the mean Hamilton Rating Scales for Anxiety scores from T3 to T12 were observed. CONCLUSIONS The levels of duloxetine in plasma do not correlate with a greater clinical improvement, indeed appear to adversely affect the improvement of the Beck Depression Inventory and Hamilton Rating Scales for Anxiety. This could be explained by an increase in side effects that may aggravate the discomfort felt by the patient. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Chiara Rovera
- Department of Neuroscience and Mental Health, Clinical Psychiatry, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy.
| | - Massimo Carlo Mauri
- Department of Neuroscience and Mental Health, Clinical Psychiatry, Clinical Psychopharmacology Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Elena Bertin
- Geriatric Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Chiara Di Pace
- Department of Neuroscience and Mental Health, Clinical Psychiatry, Clinical Psychopharmacology Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Silvia Paletta
- Department of Neuroscience and Mental Health, Clinical Psychiatry, Clinical Psychopharmacology Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alessandra Reggiori
- Department of Neuroscience and Mental Health, Clinical Psychiatry, Clinical Psychopharmacology Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Ilaria Francesca De Gaspari
- Department of Neuroscience and Mental Health, Clinical Psychiatry, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Neuroscience and Mental Health, Clinical Psychiatry, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| |
Collapse
|
28
|
Garzitto M, Picardi A, Fornasari L, Gigantesco A, Sala M, Fagnani C, Stazi MA, Ciappolino V, Fabbro F, Altamura AC, Brambilla P. Normative data of the Magical Ideation Scale from childhood to adulthood in an Italian cohort. Compr Psychiatry 2016; 69:78-87. [PMID: 27423348 DOI: 10.1016/j.comppsych.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
Abstract
The assessment of schizotypy allows to identify people at risk to develop psychosis. For this purpose, psychometric tools have been developed, such as the Magical Ideation Scale (MIS). This scale investigates attenuated forms of thought transmission experiences, thought withdrawal and aberrant beliefs, related to positive schizotypy. This study aims at providing an Italian version of the MIS and its normative data in the general population from childhood to adulthood, being the first study evaluating subjects under 17year-old. The Italian MIS version was translated by three independent operators and administered to 1378 non-clinical participants, stratified into four age groups (i.e., 8-13, 14-17, 18-24 and 25-34). The unidimensionality of the scale was supported, and its internal consistency was satisfactory (i.e., ordinal Cronbach's αs ranging from 0.86 to 0.90 in different age groups), as well as test-retest reliability (i.e., 1-month ICC of 0.82 in a retested sub-sample). Normative data for the age groups were provided. Specific gender and age-related differences in MIS score were found, i.e. females scored higher than males in the 25-34 age group, which in general, as a group, scored lower than all the other age groups. This study provided evidence of reliability for the Italian version of the MIS in childhood and adolescence, for the first time, as well as in adulthood, showing specific gender and age effects in the early adult cohort.
Collapse
Affiliation(s)
| | - Angelo Picardi
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | - Antonella Gigantesco
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Michela Sala
- Department of Mental Health, Asti-Alessandria, Italy
| | - Corrado Fagnani
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Maria Antonietta Stazi
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Fabbro
- Scientific Institute IRCCS "Eugenio Medea", Italy; Department of Medical and Biological Sciences, University of Udine, Italy
| | - Alfredo Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
| |
Collapse
|
29
|
D'Urso G, Bruzzese D, Ferrucci R, Priori A, Pascotto A, Galderisi S, Altamura AC, Bravaccio C. Transcranial direct current stimulation for hyperactivity and noncompliance in autistic disorder. World J Biol Psychiatry 2016; 16:361-6. [PMID: 25800799 DOI: 10.3109/15622975.2015.1014411] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the safety, efficacy, and feasibility of inhibitory transcranial direct current stimulation (tDCS) for the treatment of behavioural abnormalities of autistic patients. METHODS Twelve young adult patients with autistic disorder were enrolled. All subjects presented intellectual disability and most of them had speech impairment. The Aberrant Behavior Checklist (ABC) was administered as the primary outcome measure before and after a 2-week tDCS course. All subjects received 10 daily applications of 20 min/1.5 mA/cathodal (inhibitory) tDCS over the left dorso-lateral pre-frontal cortex. RESULTS Eight out of 10 study completers improved in their abnormal behaviours, reaching an average reduction of 26.7% of the total ABC score. The remaining two patients showed no changes. In the whole group of completers, among the five subscales contributing to the significant reduction of the total score, the most remarkable and statistically significant change was seen in the subscale assessing hyperactivity and non-compliance (-35.9%, P = 0.002). No adverse effects were reported. CONCLUSIONS Inhibitory tDCS improved the ABC rating scores for autistic behaviours. Owing to its ease of use, cost-effectiveness and the limited availability of specific treatment strategies, tDCS might be a valid therapeutic option to be tested in autistic patients.
Collapse
Affiliation(s)
- Giordano D'Urso
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Seconda Università di Napoli , Naples , Italy
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Serati M, Redaelli M, Buoli M, Altamura AC. Perinatal Major Depression Biomarkers: A systematic review. J Affect Disord 2016; 193:391-404. [PMID: 26802316 DOI: 10.1016/j.jad.2016.01.027] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/04/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression.
Collapse
Affiliation(s)
- M Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy.
| | - M Redaelli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - M Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| |
Collapse
|
31
|
Palazzo MC, Arici C, Dell'Osso B, Cremaschi L, Grancini B, Camuri G, Benatti B, Oldani L, Dobrea C, Cattaneo A, Altamura AC. Access and latency to first antipsychotic treatment in Italian patients with schizophrenia and other schizophrenic spectrum disorders across different epochs. Hum Psychopharmacol 2016; 31:113-20. [PMID: 26948428 DOI: 10.1002/hup.2518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/23/2015] [Accepted: 12/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The duration of untreated illness (DUI) is a measure to express the latency to first psychopharmacological treatment: it differs among psychiatric disorders, being influenced by several illness-intrinsic and environmental factors. The present study aimed to assess differences in DUI and related variables in patients with schizophrenia (SKZ) versus other schizophrenic spectrum disorders (SSDs) across different epochs. METHODS 101 SKZ or SSD patients were assessed with respect to DUI and related variables through clinical interview and questionnaire. RESULTS Patients with SKZ showed earlier ages of onset, first diagnosis and first antipsychotic treatment compared with patients with other SSDs (F = 11.02, p < 0.001; F = 12.68, p < 0.001; F = 13.74, p < 0.001, respectively) who showed an earlier access to benzodiazepines than SKZ patients (F = 6.547; p < 0.05). Dividing the total sample by the epoch of onset (before 1978; between 1978-2000; after 2000) showed a significantly later age of onset in patients with onset within the two most recent epochs (F = 7.46; p < 0.001) and a reduced DUI across epochs (from 144 to 41 to 20 months, on average; F = 11.78, p < 0.001). CONCLUSION Schizophrenic patients showed earlier onset and longer DUI compared with patients with other SSDs. Data on the total sample showed a later age of onset and a reduced DUI across epochs.
Collapse
Affiliation(s)
- Maria Carlotta Palazzo
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Arici
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA
| | - Laura Cremaschi
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Grancini
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Camuri
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Benatti
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Dobrea
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alma Cattaneo
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Neuroscience and Mental Health, University of Milan, Department of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
32
|
Abstract
Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.
Collapse
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
33
|
Abstract
BACKGROUND An increasing number of studies identifies the duration of illness (DI) as an important predictor of outcome in patients affected by major psychoses (MP). The aim of the present paper was to revise medical literature about DI and its effects on MP, focusing in particular on the relationship between DI and outcome with particular reference to treatment response, suicidal risk, cognitive impairment and social functioning. METHODS A search in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while papers considering other variables such as duration of untreated episode/illness were excluded. MP included the diagnoses of schizophrenia, bipolar disorder and major depressive disorder. RESULTS Available data show that DI influences treatment response, suicidal risk and loss of social functioning in schizophrenic patients, while results are more controversial with regard to cognitive impairment. In bipolar disorder, a long DI has been associated with less treatment response, more suicidal risk and cognitive impairment, but more data are needed to draw definitive conclusions. Finally, studies, regarding DI of illness and its predictive value of outcome in major depressive disorder show contradictory results. CONCLUSIONS DI appears a negative outcome factor particularly for schizophrenia, while with regard to mood disorders, more data are needed to draw definitive sound conclusions.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- Alfredo C Altamura, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Via F. Sforza 35, 20122, Milan , Italy
| | | | | |
Collapse
|
34
|
Abstract
Appropriate use of antidepressant in patients with hepatic impairment requires careful consideration of how the hepatic illness may affect pharmacokinetics. This review aims to analyze pharmacokinetic profile, plasma level variations so as the metabolism of several antidepressants relating to their use in patients with an hepatic impairment. Due to the lack of data regarding hepatic impairment itself, the review is focused mainly on studies investigating pharmacokinetics in hepatic cirrhosis or alcohol-related conditions. More data on reduced hepatic metabolism can be extrapolated by drug studies conducted in elderly populations. Dose adjustment of antidepressants in these patients is important as most of these drugs are predominantly metabolized by the liver and many of them are associated with dose-dependent adverse reactions. As no surrogate parameter is available to predict hepatic metabolism of drugs, dose adjustment according to pharmacokinetic properties of the drugs is proposed. There is a need for a more balanced assessment of the benefits and risks associated with antidepressants use in patients with hepatic impairment, particularly considering pharmacokinetic profile of the drugs to ensure that patients, who would truly benefit from these agents, are not denied appropriate treatment. In conclusion, kinetic studies for centrally acting drugs including antidepressants with predominant hepatic metabolism should be carried out in patients with liver disease to allow precise dose recommendations for enhanced patient safety.
Collapse
Affiliation(s)
- Massimo Carlo Mauri
- Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, IRCCS Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy,
| | | | | | | |
Collapse
|
35
|
Altamura AC, Caldiroli A, Buoli M. Pharmacokinetic evaluation of fluvoxamine for the treatment of anxiety disorders. Expert Opin Drug Metab Toxicol 2015; 11:649-60. [DOI: 10.1517/17425255.2015.1021331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
36
|
Abstract
RATIONALE Cognitive impairment in schizophrenia patients is associated with poor outcome and it represents one of main challenges of pharmacological treatment. Unfortunately, second-generation antipsychotics have not yielded the expected results in the improvement of these symptoms. OBJECTIVE The purpose of the present review paper is to summarize and discuss the available data about the efficacy of non-antipsychotic drugs in the treatment of cognitive symptoms of schizophrenia. METHODS A research in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while studies with schizoaffective patients have been excluded. RESULTS Several non-antipsychotic compounds have been tested with the purpose to improve cognitive symptoms in schizophrenia patients, but no molecule has a significant pro-cognitive activity. CONCLUSION Available data do not support the superiority of non-antipsychotic drugs vs. placebo for cognitive enhancement in schizophrenia. Preliminary results indicate mirtazapine, mianserine, lamotrigine, tandospirone, cyproheptadine, valacyclovir and omega-3 fatty acids as the most promising compounds, however no definitive conclusions can be drawn in the light of small sample size studies.
Collapse
Affiliation(s)
- M Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
37
|
Mauri MC, Paletta S, Colasanti A, Miserocchi G, Altamura AC. Clinical and neuropsychological correlates of major depression following post-traumatic brain injury, a prospective study. Asian J Psychiatr 2014; 12:118-24. [PMID: 25193507 DOI: 10.1016/j.ajp.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 07/23/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Major depression disorder (MDD) is the most frequent psychiatric complication after traumatic brain injury (TBI), with a prevalence of 14-77%. The aim of this study was to analyse the psychiatric sequelae of TBI, and to identify the neuropsychological and psychopathological correlates of post-TBI MDD in order to highlight their differences from those of primary MDD. METHODS This was a longitudinal, prospective, case-control study. Sixteen patients with closed brain injury, and a lesion revealed by computed tomography (CT), were recruited and were evaluated one (T1), three (T3) and six (T6) months after discharge from Neurosurgery Department; the controls were six patients with MDD. The psychiatric symptoms were evaluated using brief psychiatric rating scale (BPRS), Hamilton depression rating scale (HRSD), Beck depression inventory scale (BDI), Hamilton anxiety rating scale (HRSA), global assessment of functioning (GAF) and instrumental activity of daily living (IADL). Neuropsychological profiles were assessed by using neuropsychological tests, focused on memory and frontal-executive functioning. RESULTS At T1, MDD was observed in 10 cases (62.5%), a manic episode in 12.5%, and post-traumatic stress disorder in 6.5%. At T3 and T6, MDD was diagnosed in, respectively, eight (50%) and six cases (37.5%). Post TBI MDD had less severe depressive symptoms, showed greater social isolation and hostility and more cognitive deficits in comparison with the control group. CONCLUSIONS MDD is a frequent TBI complication. Patients with post-TBI MDD have a specific psychopathological profile characterised by a less severe depressive symptomatology and a neuropsychological pattern that is significantly associated with greater deficits in cognitive functions than those with primary MDD.
Collapse
Affiliation(s)
- M C Mauri
- Clinical Psychiatry Neuropsychopharmacology Unit, IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy.
| | - S Paletta
- Clinical Psychiatry Neuropsychopharmacology Unit, IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Colasanti
- Neuropsychopharmacology Unit, Division of Experimental Medicine, Imperial College London, London, UK
| | - G Miserocchi
- Clinical Neurosurgery, IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - A C Altamura
- Clinical Psychiatry Neuropsychopharmacology Unit, IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
38
|
Dell'Osso B, Cremaschi L, Palazzo MC, Spagnolin G, Cattaneo A, Grancini B, Maggi M, Altamura AC. Use of asenapine as add-on therapy in the treatment of bipolar disorder: a comprehensive review and case series. Expert Opin Drug Saf 2014; 13:1199-208. [PMID: 25084462 DOI: 10.1517/14740338.2014.938047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Several randomized controlled trials (RCTs), conducted in schizophrenic and bipolar patients, have documented the efficacy and tolerability of asenapine as monotherapy both for short- and long-term treatment. However, evidence on its augmentative use is more limited and related to the manic/mixed phase of bipolar disorder (BD). AREAS COVERED The present article reviews augmentative asenapine efficacy and safety/tolerability in the treatment of BD. It also includes some original cases of bipolar patients treated with add-on asenapine in the short- and long-term. EXPERT OPINION To date, only a single RCT with manic/mixed patients with partial response to mood-stabilizer monotherapy supports the efficacy and safety/tolerability of augmentative asenapine to lithium/valproate, both in acute and long-term treatment. Additionally, two case reports confirm the overall effectiveness of augmentative asenapine to clozapine and valproate. Our case series, consisting of 4 bipolar patients treated with adjunctive asenapine to mood stabilizers and atypical antipsychotics - with treatment duration ranging from 1 to 14 months - provided clinical results that are consistent with literature data. Taken as a whole, available evidence seems to support the efficacy and safety of adjunctive asenapine in bipolar patients, though additional studies with active comparators are requested to confirm the current body of evidence.
Collapse
Affiliation(s)
- Bernardo Dell'Osso
- Università degli Studi di Milano, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Dipartimento di Salute Mentale , Via Francesco Sforza 35, Milano , Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
INTRODUCTION Preliminary data indicate agomelatine as a promising molecule for both acute and long-term treatment of generalised anxiety disorder (GAD). AREAS COVERED The present review illustrates the pharmacokinetic properties of agomelatine and their implications for the management of GAD patients. A search of the main database sources (Medline, Isi Web of Knowledge and Medscape) was performed in order to obtain a complete and balanced evaluation of agomelatine pharmacokinetics for the treatment of GAD. The word 'agomelatine' was associated with 'pharmacokinetics', 'GAD', 'anxiety' and 'tolerability'. No restriction criteria were established in relation to methodology or year of publication. Only English-language articles were included. EXPERT OPINION Short half-life and 1-day administration make agomelatine an interesting molecule for GAD treatment. However, potential interactions with a number of compounds necessitate caution when prescribing and using agomelatine in patients with psychiatric (e.g., alcohol abuse) or medical comorbidities. Further data are necessary to define a precise risk/benefit ratio in special populations such as elderly patients suffering from GAD.
Collapse
Affiliation(s)
- Massimiliano Buoli
- University of Milan, Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milan , Italy
| | | | | |
Collapse
|
40
|
Altamura AC, Bertoldo A, Marotta G, Paoli RA, Caletti E, Dragogna F, Buoli M, Baglivo V, Mauri MC, Brambilla P. White matter metabolism differentiates schizophrenia and bipolar disorder: a preliminary PET study. Psychiatry Res 2013; 214:410-4. [PMID: 24144506 DOI: 10.1016/j.pscychresns.2013.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
Abstract
Fluorodeoxyglucose-F18 positron emission tomography studies (FDG-PET) have shown similar corticolimbic metabolic dysregulation in bipolar disorder and schizophrenia, with hypoactive prefrontal cortex coupled with hyperactive anterior limbic areas. However, it is not clear whether white matter metabolism connecting these regions is differently affected in the two disorders. Twenty-six patients with schizophrenia (mean age ± S.D.=30.23 ± 9.7 year-old; 19 males; mean weight ± S.D.=71 ± 3 kg) and 26 patients with bipolar disorder (mean age ± S.D.=48.73 ± 13 year-old; 18 males; mean weight ± S.D.=75 ± 15 kg) underwent an FDG-PET scan. Normalized datasets the two groups of patients were compared on a voxel-by-voxel basis using a two-sample t statistic test as implemented in SPM8, and adding age as covariate. Group differences were assessed applying a threshold of p<0.0005. White matter metabolic rates significantly differed between schizophrenia and bipolar disorder, whereas no differences were shown for cortical activity. This is the first FDG-PET, to our best knowledge, directly comparing subjects with schizophrenia to those with bipolar disorder. It reports decreased activity in the center of large fronto-temporal and cerebellar white matter tracts in patients with schizophrenia in respect to those with bipolar disorder. This feature may characterize and differentiate the regional brain metabolism of the two illnesses.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- Department of Neurosciences, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Rovera C, Curti R, Colombo EM, Zappa MA, Lattuada E, Mozzi E, Mauri MC, Roviaro G, Altamura AC. [Psychiatric features before and after intervention: a study of patients affected by severe obesity undergoing adjustable gastric banding]. Riv Psichiatr 2013; 48:393-9. [PMID: 24326752 DOI: 10.1708/1356.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM This study identifies psychological features and the evolution of psychiatric symptoms in a group of patients affected by obesity, who underwent adjustable gastric banding. MATERIALS AND METHODS In this group, other than clinical visit, test SCL-90 is made in preoperative time. In postoperative SCL-90, TAS and BES were carried out. Patients evaluated before and after bariatric surgery were 220 and 115, respectively. SCL-90 test made before bariatric surgery showed high values (>0.7) for cluster related to somatization, interpersonal sensitivity, paranoid ideation, depression and obsessive compulsive disorder. DISCUSSION Depression symptoms were more important in patients undergoing endogastric balloon placement (mean value of 0.9). Anxious symptoms showed a mean value of 0.73 in patients undergoing endogastric balloon placement as compared to a mean value of 0.52 in patients undergoing gastric banding. CONCLUSIONS Our findings show that in patients undergoing bariatric surgery, depressive symptoms are more common preoperatively and normalize at follow-up. This confirms that a possible cause of depression is obesity. The present study also shows that anxious symptoms are lower in obese patients.
Collapse
|
42
|
Mauri MC, Paletta S, Maffini M, Moliterno D, Altamura AC. Suicide attempts in schizophrenic patients: clinical variables. Asian J Psychiatr 2013; 6:421-7. [PMID: 24011691 DOI: 10.1016/j.ajp.2013.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/24/2013] [Accepted: 07/02/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Schizophrenia is associated with a significant risk of suicide: 40-50% of schizophrenic patients report suicidal ideation at some point in their lives, and 4-13% eventually commit suicide. In order to be able to predict and prevent suicide in schizophrenic patients, it is necessary to investigate and characterise suicide victims who meet the criteria for psychotic disorders and risk factors. METHODS The aim of this retrospective study was to verify the associations between suicide attempts (SAs) and the demographic and clinical variables of 106 patients who met the DSM-IV-TR criteria for schizophrenia. The patients were divided into two groups on the basis of the presence/absence of lifetime suicide attempts, and their main demographic and clinical characteristics were analysed and compared. RESULTS The patients with a history of SAs frequently had a duration of untreated psychosis (DUP) of ≥1 year (chi-squared test=9.984, df=1, p=0.0016). They also showed significant associations with the presence of a depressive dimension (chi-squared test=4.439, df=1, p=0.0351), hospitalisations before SAs (chi-squared test=25.515, df=1, p <0.001), and a family history of psychiatric disorders (chi-squared test=12.668, df=2, p=0.0018) or suicidal behaviours (chi-squared test=18.241, df=2, p=0.0001). Finally, they were more frequently prescribed typical antipsychotic agents. CONCLUSIONS The severity of psychiatric symptoms indicates a high risk of suicide in schizophrenic patients. Further prospective studies of larger samples should investigate the role of early interventions and atypical antipsychotic treatment in reducing the risk.
Collapse
Affiliation(s)
- M C Mauri
- Department of Neuroscience and Mental Health, University of Milan, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | | | | | | | | |
Collapse
|
43
|
Buoli M, Caldiroli A, Altamura AC. Psychotic versus non-psychotic major depressive disorder: a comparative naturalistic study. Asian J Psychiatr 2013; 6:333-7. [PMID: 23810143 DOI: 10.1016/j.ajp.2013.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/03/2013] [Accepted: 02/09/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Psychotic depressed patients were found to have more severe cognitive deficits, poorer treatment response and higher suicidal risk respect to non-psychotic depressives. Aim of the present research was to compare clinical variables and outcome between psychotic and non-psychotic major depressive patients. METHOD A sample of 36 major depressed patients was divided into two groups according to the presence of psychotic symptoms. Structured Clinical Interview for DSM (SCID-I) and Hamilton Depression Rating Scale (HAM-D) were administered to the patients at baseline by trained raters. One-way analysis of variance (ANOVAs) and chi-square tests were performed to compare the two groups. Binary logistic regression was performed to assess the risk of lack of response/remission in patients with psychotic symptoms and the risk of developing psychotic symptoms in major depressives with a family history of schizophrenia or bipolar disorder. RESULTS Psychotic major depressives presented more severe illness as showed by HAM-D baseline scores (F=17.20, p<0.001), a longer duration of hospitalization (F=7.64, p=0.009) and they were more frequently treated with clomipramine (χ(2)=16.22, p=0.027). Psychotic symptoms were predictive of lack of remission (OR=4.09, p=0.05) and family history of schizophrenia/psychotic bipolar disorder was associated with psychotic major depression (OR=10.81, p=0.04). CONCLUSIONS Patients with psychotic symptoms present a more severe course of illness as showed by long hospitalizations and lower rates of remission. Psychotic depressives show more frequently a family history of "major psychoses" suggesting a continuum in psychotic disorders and a genetic association of major psychotic depression with bipolar disorder and schizophrenia.
Collapse
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Italy.
| | | | | |
Collapse
|
44
|
Altamura AC, Dragogna F. Should the term 'antipsychotic' be changed to 'multidimensional stabiliser' in bipolar disorder? Towards a new denomination for 'atypical antipsychotics'. Aust N Z J Psychiatry 2013; 47:707-9. [PMID: 23728532 DOI: 10.1177/0004867413492572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Alfredo Carlo Altamura
- Department of Psychiatry, Mood Disorder Treatment Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | | |
Collapse
|
45
|
Abstract
Bipolar disorder is a chronic mental illness associated with high levels of somatic morbidity, comorbidity and mortality. Treatment guidelines for bipolar mania generally recommend initiating first-line therapy with a second-generation antipsychotic or mood stabiliser, either alone or in combination. Asenapine is a second-generation antipsychotic with a unique receptor binding profile, licensed for the treatment of manic episodes in adults with bipolar I disorder. 'Real-world' data are needed to complement evidence from clinical trials, in order to provide clinicians with pragmatic information regarding the likely risks and benefits of using a new agent in clinical practice. Evidence from real-world case reports demonstrates that - as in clinical trials - asenapine is effective in treating mania and mixed episodes associated with bipolar I disorder, whether used as monotherapy or in combination with a mood stabiliser. It has a rapid onset of antimanic effect and an early improvement is associated with treatment outcome. Asenapine also shows promise in controlling depressive symptoms and clinically challenging mixed states. Asenapine has a favourable tolerability profile, compared with other first-line agents, having a minimal impact on weight and metabolic parameters. Asenapine should be considered a first-line treatment option for adults with bipolar I disorder.
Collapse
Affiliation(s)
- Allan H Young
- Centre for Mental Health, Imperial College London, London, UK
| | | | | | | | | |
Collapse
|
46
|
Altamura AC, Moliterno D, Paletta S, Maffini M, Mauri MC, Bareggi S. Understanding the pharmacokinetics of anxiolytic drugs. Expert Opin Drug Metab Toxicol 2013; 9:423-40. [PMID: 23330992 DOI: 10.1517/17425255.2013.759209] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Anxiety disorders are considered the most common mental disorders and they can increase the risk for comorbid mood and substance use disorders, significantly contributing to the global burden of disease. For this reason, anxiolytics are the most prescribed psychoactive drugs, particularly in the Western world. AREAS COVERED This review aims to analyze pharmacokinetic profile, plasma level variations so as the metabolism, interactions and possible relation to clinical effect of several drugs which are used primarily as anxiolytics. The drugs analyzed include benzodiazepines, anticonvulsants (pregabalin, gabapentin), buspirone, β-blockers and antihistamines (hydroxyzine). Regarding the most frequently used anxiolytic benzodiazepines, data on alprazolam, bromazepam, chlordesmethyldiazepam, chlordiazepoxide, clotiazepam, diazepam, etizolam, lorazepam, oxazepam, prazepam and clonazepam have been detailed. EXPERT OPINION There is a need for a more balanced assessment of the benefits and risks associated with benzodiazepine use, particularly considering pharmacokinetic profile of the drugs to ensure that patients, who would truly benefit from these agents, are not denied appropriate treatment. An optimal pharmacological approach involving an integrative pharmacokinetic and pharmacodynamic optimization strategy would ensure better treatment and personalization of anxiety disorders. So it would be desirable for the development of new anxiolytic drug(s) that are more selective, fast acting and free from the unwanted effects associated with the traditional benzodiazepines as tolerance or dependence.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- University of Milan, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Department of Clinical Psychiatry, Via F. Sforza 35, 20122 Milan, Italy.
| | | | | | | | | | | |
Collapse
|
47
|
Buoli M, Caldiroli A, Caletti E, Paoli RA, Altamura AC. New approaches to the pharmacological management of generalized anxiety disorder. Expert Opin Pharmacother 2013; 14:175-84. [DOI: 10.1517/14656566.2013.759559] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
48
|
Altamura AC, De Gaspari IF, Rovera C, Colombo EM, Mauri MC, Fedele L. Safety of SSRIs during pregnancy: a controlled study. Hum Psychopharmacol 2013; 28:25-8. [PMID: 23166037 DOI: 10.1002/hup.2276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 10/04/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of our study was to analyze the efficacy and the safety of SSRIs during pregnancy. METHODS A group of 30 pregnant women affected by Major Depressive Disorder by SCID I interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and treated with selective serotonin reuptake inhibitor (SSRI) were included in the study. They were matched to a comparison group of 26 pregnant women. RESULTS There were no statistically significant differences in any of the pregnancy outcomes of interest between the treated women and comparison group. There was no statistically significant association in newborns of women treated with an SSRI and the control group in the first and fifth minute Apgar score, and no newborns were admitted to neonatal Intensive Care Units. CONCLUSIONS No definitive association between use of SSRIs during pregnancy and an increased risk of birth defects or other adverse outcomes could be found.
Collapse
Affiliation(s)
- A C Altamura
- Department of Psychiatry, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | |
Collapse
|
49
|
Rosa M, Franzini A, Giannicola G, Messina G, Altamura AC, Priori A. Hypothalamic oscillations in human pathological aggressiveness. Biol Psychiatry 2012; 72:e33-5. [PMID: 22789687 DOI: 10.1016/j.biopsych.2012.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 11/16/2022]
|
50
|
Buoli M, Caldiroli A, Panza G, Altamura AC. Prominent clinical dimension, duration of illness and treatment response in schizophrenia: a naturalistic study. Psychiatry Investig 2012; 9:354-60. [PMID: 23251199 PMCID: PMC3521111 DOI: 10.4306/pi.2012.9.4.354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/01/2012] [Accepted: 06/10/2012] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Preliminary data indicate that predominant positive symptoms are predictive of subsequent treatment response, while negative and cognitive symptoms are associated with poor outcome. Purpose of the present study was to investigate the relation between the predominant clinical dimension, duration of illness and acute antipsychotic response in a sample of schizophrenic inpatients. METHODS Fifty-one schizophrenic inpatients, receiving an antipsychotic mono-therapy, were dimensionally assessed at the admission in the Acute Psychiatric Unit of the University of Milan. Treatment response was selected as parameter of outcome and defined as a reduction >50% of baseline total The Positive and Negative Syndrome Scale (PANSS) score. Demographic and clinical variables between responders and non-responders were compared using one-way analysis of variance for continuous variables and χ(2) test for dichotomous ones. Binary logistic regression was performed to find if dimensional scores and duration of illness were associated with acute antipsychotic response. RESULTS A longer duration of illness was found in non-responders respect to responders (15.61 years vs. 8.28 years)(F=4.98, p=0.03). Higher scores on PANSS positive sub-scale (OR=1.3, p=0.03), lower scores on cognitive PANSS scores (OR=0.75, p=0.05) and shorter duration of illness (OR=0.93, p=0.04) were found to be predictive of acute antipsychotic response. CONCLUSION These preliminary results show that a long duration of illness as well as a more severe cognitive impairment is predictive of treatment non-response, indicating a worse outcome for chronic patients with predominant cognitive symptoms.
Collapse
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Panza
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|