Lung cancer in Argentina: a modelling study of disease and economic burden

OBJECTIVES

Lung cancer remains a significant global public health challenge and is still one of the leading causes of cancer-related death in Argentina. This study aims to assess the disease and economic burden of lung cancer in the country.

STUDY DESIGN

Burden of disease study.

METHODS

A mathematical model was developed to estimate the disease burden and direct medical cost attributable to lung cancer. Epidemiological parameters were obtained from local statistics, the Global Cancer Observatory, the Global Burden of Disease databases, and a literature review. Direct medical costs were estimated through micro-costing. Costs were expressed in US dollars (US$), April 2023 (1 US$ = 216.38 Argentine pesos). A second-order Monte Carlo simulation was performed to estimate the uncertainty.

RESULTS

Considering approximately 10,000 deaths, 12,000 incident cases, and 14,000 5-year prevalent cases, the economic burden of lung cancer in Argentina in 2023 was estimated to be US$ 556.20 million (396.96-718.20), approximately 1.4% of the total healthcare expenditure for the country. The cost increased with a higher stage of the disease, and the main driver was drug acquisition (80%). A total of 179,046 disability-adjusted life years could be attributable to lung cancer, representing 10% of the total cancer.

CONCLUSION

The disease and economic burden of lung cancer in Argentina implies a high cost for the health system and would represent 19% of the previously estimated economic burden for 29 cancers in Argentina.

Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study

BACKGROUND

Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide-related behaviours, and little is known about its effect with offender-patients.

AIMS

To evaluate DBT with a group of offender-patients in the Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014.

METHODS

Twenty-one male forensic psychiatric in-patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS-20).

RESULTS

Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS-11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores.

CONCLUSIONS

Italy has innovative forensic psychiatric facilities with a new recovery-rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full-scale randomised controlled trial should follow.

A novel SCL-90-R six-item factor identifies subjects at risk of early adverse outcomes in public mental health settings

To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure ("SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up.

Focus on aggressive behaviour in mental illness

Background

Aggression is a behaviour with evolutionary origins, but in today’s society it is often both destructive and maladaptive. Increase of aggressive behaviour has been observed in a number of serious mental illnesses, and it represents a clinical challenge for mental healthcare provider. These phenomena can lead to harmful behaviours, including violence, thus representing a serious public health concern. Aggression is often a reason for psychiatric hospitalization, and it often leads to prolonged hospital stays, suffering by patients and their victims, and increased stigmatization. Moreover, it has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use.

Materials and methods

In this review, based on a selective search of 2010-2016 pertinent literature on PubMed, we analyze and summarize information from original articles, reviews, and book chapters about aggression and psychiatric disorders, discussing neurobiological basis and therapy of aggressive behaviour.

Results

A great challenge has been revealed regarding the neurobiology of aggression, and an integration of this body of knowledge will ultimately improve clinical diagnostics and therapeutic interventions. The great heterogeneity of aggressive behaviour still hampers our understanding of its causal mechanisms. Still, over the past years, the identification of specific subtypes of aggression has released possibilities for new and individualized treatment approaches.

Conclusions

Neuroimaging studies may help to further elucidate the interrelationship between neurocognitive functioning, personality traits, and antisocial and violent behaviour. Recent studies point toward manipulable neurobehavioral targets and suggest that cognitive, pharmacological, neuromodulatory, and neurofeedback treatment approaches can be developed to ameliorate urgency and aggression in schizophrenia. These combined approaches could improve treatment efficacy. As current pharmacological and therapeutic interventions are effective but imperfect, new insights into the neurobiology of aggression will reveal novel avenues for treatment of this destructive and costly behaviour.

Aripiprazole once-monthly as treatment for psychosis in Turner syndrome: literature review and case report

Turner syndrome (TS) is a neurogenetic disorder characterized by partial or complete monosomy-X, usually resulting of a sporadic chromosomal nondisjunction. It is one of the most common sex chromosome abnormalities, affecting approximately 1 in 2,000 live born females. There are sporadic few case reports of concomitant TS with schizophrenia worldwide. No defined psychiatric condition has been traditionally related to TS, and it is not mentioned in DSM-IV. Although it is not associated with any psychiatric syndrome, several case reports in the literature describe a similar constellation of symptoms in TS that may represent a biologically-based entity. Aripiprazole once-monthly is a second generation antipsychotic recently developed. Its efficacy and non-inferiority to oral aripiprazole have been demonstrated in preventing relapse in patients with schizophrenia. Experience with oral aripiprazole and the current availability of the long-acting formulation suggest a potential benefit in a variety of clinical scenarios and therefore consideration as a treatment option in the treatment of schizophrenia and psychotic symptoms in several disease like TS.

[Pathophysiology of aggressive behavior: evaluation and management of pathological aggression]

This work aims to define the aggression in all its forms, with notes on management and rapid tranquilization. The pathological aggression is described as a non-homogeneous phenomenon, it is variable in according to social, psychological and biological agents. The distinction of violence between affective aggression and predatory aggression can be functional to the prediction of outcome of any treatment. In general, a pattern of predatory violence tend to match with patients unresponsive and not compliant to treatment, a low probability to predict future violence and, therefore, a difficulty in managing risk. The affective aggressor, however, shows increased probability of treatment response, with more predictability of violent actions in reaction to situations perceived as threatening and, therefore, greater management of future violence risk. Those who act affective violence tend to show a wide range of emotional and cognitive problems, while those who act with predatory patterns show greater inclination to aggression and antisocial behavior. Aggression that occurs in psychiatry mostly appears to be affective, therefore susceptible to modulation through treatments.

[Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service]

AIM

Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient.

METHODS

Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study.

RESULTS

Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study.

CONCLUSIONS

There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

A second trial of clozapine in a case of granulocytopenia

It is generally believed that agranulocytosis, a major problem with clozapine treatment, will tend to occur dose-dependently once it develops in an individual. Therefore, despite clinical progress obtained, the drug has to be discontinued and treatment shifts to another drug. We report on the case of a 29-year-old woman with DSM-IV undifferentiated schizophrenia who developed agranulocytosis after 5 years of 300 mg/day clozapine treatment. The drug was withdrawn and two trials with thioridazine and olanzapine were unsuccessful. Four months after clozapine suspension, we decided to make a further trial, reintroducing clozapine titrated up to 500 mg/day. The patient's symptoms improved and blood leukocytes remained within the normal range after eight months. Copyright 2000 John Wiley & Sons, Ltd.

Disruption of nocturnal melatonin rhythm and immunological involvement in ischaemic stroke patients

The aim of this study was to evaluate nocturnal and diurnal urinary melatonin excretion in a group of ischaemic stroke patients, and to verify if a possible impairment of this excretion could be linked with some changes of immunological and neuro-psychic status. We assessed 13 ischaemic stroke patients and five healthy controls for nocturnal urinary melatonin excretion, which was found to be impaired in stroke patients (patients, 0.05 +/- 0.01 ng/ml; controls, 30 +/- 3.0 ng/ml; P < 0.001). No differences were found between the groups with regard to diurnal excretion. Patients with impaired nocturnal melatonin excretion presented: a decreased cell-mediated immunity (assessed by a skin-test); a prevalence of anergic status (69% of patients were anergic compared with 0% of controls; P < 0.05); a slight (but not significant) enhancement of plasma cortisol levels; and some changes in lymphocyte subsets (an overall decrease in CD3 lymphocyte number). In almost all the ischaemic stroke patients there was an impairment of cortisol/melatonin ratio (a marker of depression) and an altered sleep rhythm with mood disorders. Our data suggest that ischaemic stroke patients had an impairment of nocturnal urinary melatonin excretion, which was associated with an impaired cell-mediated immunity and some changes of lymphocyte subsets. In addition, reduced melatonin excretion might be associated with neurological and psychical symptoms.

Unreliability of TRH test but not dexamethasone suppression test as a marker of depression in chronic vasculopathic patients

Thirteen vasculopathic nondepressed men, admitted to the hospital 2 weeks earlier because of stroke, 10 age- and weight-matched patients with major depression, and 10 age- and weight-matched normal controls were tested with TRH and on different occasion with the dexamethasone (DEX) suppression test (DST). Patients with stroke were tested again with TRH and DST after 1 year. All subjects were euthyroid. A blunted TSH response to TRH was observed in 77% of vasculopathic patients, 64% of depressed patients, and 27% of controls. Some depressed patients showed serum GH or cortisol increments in response to TRH. Nonsuppression to DEX was observed in 45% of depressed patients and 15% of vasculopathics but not in normal controls. These data indicate that, in contrast to cortisol nonsuppression to DEX, blunted TSH response to TRH has poor diagnostic value as a marker for depression after stroke and may merely represent the expression of neuroendocrine dysfunction associated with cerebral vasculopathy.

[Parma Stroke Data Bank: embolic stroke]

Cerebral infarction is one of the three main causes of death in most countries. It is very frequent and, since it is more often disabiliting rather than fatal, it is of high social impact. The correct classification of patients and the accurate diagnostic definition of the various subtypes of stroke is of great prognostic and therapeutic importance since cerebral infarction is not a single entity. In this study we report our findings concerning 244 patients with embolic infarction recorded in the Parma Stroke Data Bank hospital register. Clinical features were studied (risk factors, symptomatology of the onset, degree of severity within 3 days of the onset, post-stroke complications) as were instruments readings (TAC) and evolution (outcome, mortality, personal performance and environmental integration, both 4 weeks after the clinical onset and after one year).

[Parma stroke data bank: atherothrombotic and lacunar stroke]

In an epidemiological research about stroke, we studied 235 patients with atherothrombotic brain infarctions and 81 patients with lacunes. It was a longitudinal study concerning patients admitted to our Medical Division during the acute phase and followed up for one year after the onset. We report some anamnestic data, the frequency of positive brain CT scan, main risk factors, symptoms at the onset, severity degree of the stroke within the first 72 hours, complications during, and outcome after, the first four weeks, including personal performances and environmental fitness, mortality rate and frequency of relapses. We also report some of these data after one year from the acute episode.

Prevalence and prognostic value of peripheral arterial disease in stroke patients

As atherosclerosis is a multi-systemic disease, each patient presenting clinical manifestation of atherosclerosis such as a stroke or RIND should be, from a vascular point of view, globally evaluated. The availability of Doppler ultrasound technique enables us to discover the presence of Peripheral Artery Disease (PAD) which is not always overt in the patient's history. Furthermore the presence of PAD is associated with a poorer prognosis in stroke patients.