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Cavaleri D, Riboldi I, Crocamo C, Paglia G, Carrà G, Bartoli F. Evidence from preclinical and clinical metabolomics studies on the antidepressant effects of ketamine and esketamine. Neurosci Lett 2024; 831:137791. [PMID: 38670523 DOI: 10.1016/j.neulet.2024.137791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
The antidepressant effects of ketamine and esketamine are well-documented. Nonetheless, most of the underlying molecular mechanisms have to be uncovered yet. In the last decade, metabolomics has emerged as a useful means to investigate the metabolic phenotype associated with depression as well as changes induced by antidepressant treatments. This mini-review aims at summarizing the main findings from preclinical and clinical studies that used metabolomics to investigate the metabolic effects of subanesthetic, antidepressant doses of ketamine and esketamine and their relationship with clinical response. Both animal and human studies report alterations in several metabolic pathways - including the tricarboxylic acid cycle, glycolysis, the pentose phosphate pathway, lipid metabolism, amino acid metabolism, the kynurenine pathway, and the urea cycle - following the administration of ketamine or its enantiomers. Although more research is needed to clarify commonalities and differences in molecular mechanisms of action between the racemic compound and its enantiomers, these findings comprehensively support an influence of ketamine and esketamine on mitochondrial and cellular energy production, membrane homeostasis, neurotransmission, and signaling. Metabolomics may thus represent a promising strategy to clarify molecular mechanisms underlying treatment-resistant depression and related markers of clinical response to ketamine and esketamine. This body of preclinical and clinical evidence, if further substantiated, has the potential to guide clinicians towards personalized approaches, contributing to new paradigms in the clinical management of depression.
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Affiliation(s)
- Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Paglia
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy; Division of Psychiatry, University College London, 149 Tottenham Ct Rd, London W1T 7NF, United Kingdom
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy.
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Brittlebank A, De Picker L, Krysta K, Seker A, Riboldi I, Hanon C, Stercu GA, Chumakov E, Samochowiec J, Dom G, Casanova Dias M. Benchmarking Psychiatry in Europe and beyond: The European Board Exam of Psychiatry. Eur Psychiatry 2024:1-9. [PMID: 38654499 DOI: 10.1192/j.eurpsy.2024.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/26/2024] Open
Affiliation(s)
| | - Livia De Picker
- University Psychiatric Hospital Campus Duffel, Belgium; University of Antwerp, Belgium
| | - Krzysztof Krysta
- Department and Clinic of Rehabilitation Psychiatry, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-055Katowice, Poland
| | - Asilay Seker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cecile Hanon
- Regional Resource Center of old age Psychiatry, AP-HP. Centre - University of Paris, Psychiatry and addictology department, Corentin-Celton Hospital, Issy-les-Moulineaux, France
| | | | - Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, St Petersburg, Russia
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Geert Dom
- University of Antwerp, Belgium. Medical Director PC Multversum, Boechout, Belgium. European Psychiatric Association, President
| | - Marisa Casanova Dias
- South London and Maudsley NHS Foundation Trust, London, UK; National Centre for Mental Health, Cardiff University, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
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Riboldi I, Calabrese A, Piacenti S, Capogrosso CA, Paioni SL, Bartoli F, Carrà G, Armes J, Taylor C, Crocamo C. Understanding University Students' Perspectives towards Digital Tools for Mental Health Support: A Cross-country Study. Clin Pract Epidemiol Ment Health 2024; 20:e17450179271467. [PMID: 38660572 PMCID: PMC11037510 DOI: 10.2174/0117450179271467231231060255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 04/26/2024]
Abstract
Background Organisational and individual barriers often prevent university students from seeking mental health support. Digital technologies are recognised as effective in managing psychological distress and as a source of health-related information, thus representing useful options to address mental health needs in terms of accessibility and cost-effectiveness. However, university students' experiences and perspectives towards such interventions are little known. Objectives We thus aimed to expand the existing base of scientific knowledge, focusing on this special population. Methods Data were from the qualitative component of "the CAMPUS study", longitudinally assessing the mental health of students at the University of Milano-Bicocca (Italy) and the University of Surrey (UK). We conducted in-depth interviews and thematically analysed the transcripts using the framework approach. Results An explanatory model was derived from five themes identified across 33 interviews (15 for Italy, 18 for the UK). Students perceived that social media, apps, and podcasts could deliver relevant mental health content, ranging from primary to tertiary prevention. Wide availability and anonymity were perceived as advantages that make tools suitable for preventive interventions, to reduce mental health stigma, and as an extension of standard treatment. These goals can be hindered by disadvantages, namely lower efficacy compared to face-to-face contact, lack of personalisation, and problematic engagement. Individual and cultural specificities might influence awareness and perspectives on the use of digital technologies for mental health support. Conclusion Although considering some specific features, digital tools could be a useful instrument to support the mental health needs of students. Since personal contact remains crucial, digital tools should be integrated with face-to-face interventions through a multi-modal approach.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | | | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
| | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cath Taylor
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
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Bartoli F, Callovini T, Cavaleri D, Crocamo C, Riboldi I, Aguglia A, De Fazio P, Martinotti G, D'Agostino A, Ostuzzi G, Barbui C, Carrà G. Effect of long-acting injectable antipsychotics on 1-year hospitalization in bipolar disorder: a mirror-image study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1579-1586. [PMID: 36436121 DOI: 10.1007/s00406-022-01522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
Long-acting injectable (LAI) antipsychotics are often used for the long-term management also of bipolar disorder (BD). Nonetheless, evidence on their effect on pragmatic outcomes such as hospitalization risk in BD is inconsistent. We carried out a mirror-image study comparing rates and number of days of hospitalization, one year before and after the initiation of LAI treatment, in a sample of subjects with BD. Participants were selected from the STAR Network Depot Study, a pragmatic, observational, multicenter research involving a cohort of inpatients and outpatients consecutively started on LAI treatment. Variations in rates and in total number of days of hospitalization between the 12 months before and those after treatment initiation were analyzed. Among 461 individuals screened for eligibility, we included 71 adults with BD, initiated either on first- (FGA) or second-generation (SGA) LAIs. We found a significant decrease in terms of 12-month hospitalization rates (p < 0.001) and number of days (p < 0.001) after LAI initiation, without any effect by age, gender, alcohol/substance use disorders, and symptom severity. Subgroup analyses based on antipsychotic class, history of LAI treatment, and concomitant oral medications, confirmed the decreasing trend on both hospitalization rates and number of days. However, these reductions were not significant among participants who continued this treatment for less than 6 months. Comprehensively, this study supports the role of LAIs as effective maintenance treatment options for BD. Further research is needed to identify clinical characteristics of people with BD who would most benefit from long-acting formulations of antipsychotics.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti, Pescara, Chieti, Italy
| | | | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Riboldi I, Capogrosso CA, Piacenti S, Calabrese A, Lucini Paioni S, Bartoli F, Crocamo C, Carrà G, Armes J, Taylor C. Mental Health and COVID-19 in University Students: Findings from a Qualitative, Comparative Study in Italy and the UK. Int J Environ Res Public Health 2023; 20:4071. [PMID: 36901083 PMCID: PMC10001873 DOI: 10.3390/ijerph20054071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION COVID-19 restrictions introduced several changes in university academic and social experience. Self-isolation and online teaching have amplified students' mental health vulnerability. Thus, we aimed to explore feelings and perspectives about the impact of the pandemic on mental health, comparing students from Italy and the UK. METHODS Data were collected from the qualitative portion of "the CAMPUS study", longitudinally assessing mental health of students at the University of Milano-Bicocca (Italy) and the University of Surrey (UK). We conducted in-depth interviews and thematically analysed the transcripts. RESULTS The explanatory model was developed from four themes identified across 33 interviews: anxiety exacerbated by COVID-19; putative mechanisms leading to poor mental health; the most vulnerable subgroups; and coping strategies. Generalised and social anxiety resulted from COVID-19 restrictions by being associated with loneliness, excessive time online, unhealthy management of time and space and poor communication with the university. Freshers, international students, and people on the extremes of the introversion/extroversion spectrum, were identified as vulnerable, while effective coping strategies included taking advantage of free time, connection with family and mental health support. The impact of COVID-19 was mostly related to academic issues by students from Italy, whereas to the drastic loss of social connectedness by the UK sample. CONCLUSIONS Mental health support for students has an essential role, and measures that encourage communication and social connectedness are likely to be beneficial.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | | | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
| | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cath Taylor
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
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Cavaleri D, Bartoli F, Capogrosso CA, Guzzi P, Moretti F, Riboldi I, Misiak B, Kishi T, Rubin RT, Fuchs D, Crocamo C, Carrà G. Blood concentrations of neopterin and biopterin in subjects with depression: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110633. [PMID: 36089162 DOI: 10.1016/j.pnpbp.2022.110633] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 06/23/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Pteridines, such as neopterin, biopterin, and tetrahydrobiopterin (BH4), may be involved in depression pathophysiology owing to their links to immune-inflammatory response, oxidative and nitrosative stress, and monoaminergic transmission. Nonetheless, studies assessing pteridines in depression are inconsistent. We conducted a systematic review and meta-analysis of observational studies comparing blood pteridine concentrations between subjects with depression and healthy controls (HCs). METHODS We searched Embase, MEDLINE, and PsycInfo for articles indexed through November 2021. Study quality was appraised, evaluating age and gender comparability between groups, sample representativeness, and methods to assess depression. Random-effects meta-analyses were carried out, generating pooled standardized mean differences (SMDs). Heterogeneity across studies was estimated using the I2 statistic. RESULTS Twenty-four studies, involving 3075 subjects, were included. Individuals with depression showed blood neopterin concentrations higher than HCs (k = 19; SMD = 0.36; p < 0.001) with moderate heterogeneity across studies (I2 = 58.2%). No moderating role of age, gender, or type of blood sample was found. Sensitivity analyses showed no impact of inconsistency and quality of studies on findings. Neopterin concentrations were higher among individuals with major depressive disorder compared to HCs (SMD = 0.44; p < 0.001). This held true also when considering only drug-free subjects (SMD = 0.68; p = 0.003). No differences in biopterin concentrations were found between subjects with depression and HCs (k = 5; SMD = -0.35; p = 0.086), though this result was limited by inconsistency of findings (I2 = 77.9%) and quality of studies. Finally, no sufficient data were available for a meta-analysis on BH4. CONCLUSIONS As a whole, our work partly supports the hypothesis of an imbalance of pteridine metabolism in depression.
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Affiliation(s)
- Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy.
| | - Chiara A Capogrosso
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Pierluca Guzzi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Robert T Rubin
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States; Community Memorial Health System, Ventura County Medical Center, 147 N Brent St, Ventura, CA 93003, United States
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocentre, Medical University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy; Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, United Kingdom
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Bartoli F, Cavaleri D, Nasti C, Palpella D, Guzzi P, Riboldi I, Crocamo C, Pappa S, Carrà G. Long-acting injectable antipsychotics for the treatment of bipolar disorder: evidence from mirror-image studies. Ther Adv Psychopharmacol 2023; 13:20451253231163682. [PMID: 36994116 PMCID: PMC10041584 DOI: 10.1177/20451253231163682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
Clinical trials and real-world data have shown that long-acting injectable antipsychotics (LAIs) might be an effective therapeutic option also for people with bipolar disorder (BD). However, complementing evidence from mirror-image studies investigating LAIs in BD is scattered and has not been systematically evaluated so far. We thus performed a review of observational mirror-image studies testing the effectiveness of LAI treatment on clinical outcomes in people with BD. Embase, MEDLINE, and PsycInfo electronic databases were systematically searched (via Ovid) up to November 2022. We included six mirror-image studies that compared relevant clinical outcomes between the 12-months after (post-treatment period) and the 12-months before (pre-treatment period) the initiation of a LAI treatment in adults with BD. We found that LAI treatment is associated with a significant reduction in days spent in hospital and number of hospitalizations. Moreover, LAI treatment seems to be associated with a significant decrease in the proportion of individuals with at least one hospital admission, even though data on this outcome were reported by just two studies. In addition, studies consistently estimated a significant reduction of hypo-/manic relapses after LAI treatment initiation, while the effect of LAIs for depressive episodes is less clear. Finally, LAI treatment initiation was associated with a lower number of emergency department visits in the year after LAI initiation. The findings of this review seem to suggest that the use of LAIs is an effective strategy to improve major clinical outcomes in people with BD. Nonetheless, additional research, based on standardized assessments of prevalent polarity and relapses, is needed to identify the clinical characteristics of individuals with BD who are most likely to benefit from a LAI treatment.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Pierluca Guzzi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sofia Pappa
- Division of Brain Sciences, Imperial College London, London, UK; West London NHS Trust, London, UK
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Bartoli F, Callovini T, Cavaleri D, Cioni RM, Bachi B, Calabrese A, Moretti F, Canestro A, Morreale M, Nasti C, Palpella D, Piacenti S, Nacinovich R, Riboldi I, Crocamo C, Carrà G. Clinical correlates of comorbid attention deficit hyperactivity disorder in adults suffering from bipolar disorder: A meta-analysis. Aust N Z J Psychiatry 2023; 57:34-48. [PMID: 35786010 DOI: 10.1177/00048674221106669] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 12/24/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder is a frequent comorbid condition in adults with bipolar disorder. We performed a meta-analysis aimed at assessing sociodemographic and clinical correlates of attention deficit hyperactivity disorder in bipolar disorder. METHOD We searched main electronic databases up to June 2021. Random-effects meta-analyses, with relevant meta-regression and quality-based sensitivity analyses, were carried out to estimate the association between attention deficit hyperactivity disorder and putative correlates, grading the quality of evidence. RESULTS We included 43 studies, based on 38 independent samples. Attention deficit hyperactivity disorder participants were more likely to be males (odds ratio = 1.46; p < 0.001) and unemployed (odds ratio = 1.45; p = 0.045), and less likely to be married (odds ratio = 0.62; p = 0.014). They had an earlier onset of bipolar disorder (standardized mean difference = -0.36; p < 0.001); more mood episodes (standardized mean difference = 0.35; p = 0.007), particularly depressive (standardized mean difference = 0.30; p = 0.011) and mixed (standardized mean difference = 0.30; p = 0.031) ones; higher odds of using antidepressants (odds ratio = 1.80; p = 0.024) and attempted suicides (odds ratio = 1.83; p < 0.001) and lower odds of psychotic features (odds ratio = 0.63; p = 0.010). Moreover, they were more likely to have generalized anxiety disorder (odds ratio = 1.50; p = 0.019), panic disorder (odds ratio = 1.89; p < 0.001), social phobia (odds ratio = 1.61; p = 0.017), eating disorders (odds ratio = 1.91; p = 0.007), antisocial personality disorder (odds ratio = 3.59; p = 0.004) and substance (odds ratio = 2.29; p < 0.001) or alcohol (odds ratio = 2.28; p < 0.001) use disorders. Quality of the evidence was generally low or very low for the majority of correlates, except for bipolar disorder onset and alcohol/substance use disorders (high), and suicide attempts (moderate). CONCLUSION Comorbid bipolar disorder/attention deficit hyperactivity disorder may have some distinctive clinical features including an earlier onset of bipolar disorder and higher comorbid alcohol/substance use disorder rates. Further research is needed to identify additional clinical characteristics of this comorbidity.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Aurelia Canestro
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Morreale
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Renata Nacinovich
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, UK
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Riboldi I, Cavaleri D, Capogrosso CA, Crocamo C, Bartoli F, Carrà G. Practical Guidance for the Use of Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia. Psychol Res Behav Manag 2022; 15:3915-3929. [PMID: 36605176 PMCID: PMC9809355 DOI: 10.2147/prbm.s371991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a severe mental illness causing a high degree of disability. First- and second-generation antipsychotics (FGAs and SGAs) represent key resources for its acute and long-term management. Since a poor adherence to oral treatments may negatively impact the course of the disorder, long-acting injectable antipsychotics (LAIs) are often used to reduce clinical relapses. Notwithstanding their potential beneficial features, LAIs use in clinical practice remains somewhat hampered by the limited amount of relevant systematic information. This review thus aims at providing a clinical, practical guidance for the use of LAIs in the treatment of schizophrenia. We synthetized main information on indications, dosage, and administration of LAIs approved by the US Food and Drug Administration (FDA) and/or in EU countries, as well as evidence from the most recent systematic reviews and meta-analyses. Currently available information, though heterogeneous, shows that LAIs can prevent relapses and rehospitalizations, improving clinical outcomes and favouring sustained remission among people with schizophrenia. The use of SGA LAIs is supported by more robust evidence than FGA LAIs. Along with their positive impact on the prevention of treatment discontinuation, some LAIs might also enhance individual global functioning and quality of life, without additional adverse events or health-care costs, as compared with oral antipsychotics. Although which LAIs can be considered a first-choice option, as well as their superiority over oral antipsychotics, remain unclear issues, this review offers a comprehensive overview of information available on the use of LAIs for people with schizophrenia, providing clinicians with practical guidance in terms of efficacy and acceptability of single agents. Literature gaps and future research needs are also described.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,Correspondence: Ilaria Riboldi, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, 20900, Italy, Tel +39 0257998647, Email
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara A Capogrosso
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,Division of Psychiatry, University College London, London, UK
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10
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Frankova I, Scheeres K, Menculini G, Cikrikcili U, Matei IC, Fellinger M, Riboldi I, Uzer-Kremers L, Küey L. Forcibly displaced persons and mental health: A survey of the experiences of Europe-wide psychiatry trainees during their training. Transcult Psychiatry 2022; 60:167-175. [PMID: 36344237 DOI: 10.1177/13634615221135421] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/09/2022]
Abstract
Many European countries have seen increasing refugee populations and asylum applications over the past decade. Forcibly displaced persons (FDPs) are known to be at higher risk of developing mental disorders and are in need of specific care. Thus, specific training for mental health professionals is recommended by international health organizations. The aim of this exploratory study was to assess the experience of clinical work with FDPs among psychiatric trainees in Europe and Central Asia as well as their interest and specific training received on this topic. An online questionnaire was designed by the Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees (EFPT) and was distributed via email through local networks among European trainees from 47 countries between March 2017 and April 2019. Answers of 342 psychiatric trainees from 15 countries were included in the survey analysis. A majority of trainees (71%) had had contact with FDPs in the last year of their clinical work. Although three-quarters expressed a strong interest in the mental health of FDPs, only 35% felt confident in assessing and treating them. Specific training was provided to 25% of trainees; of this subset, only a quarter felt this training prepared them adequately. Skills training on transcultural competencies, post-traumatic stress disorder, and trauma management was regarded as essential to caring for refugees with confidence. Although psychiatric trainees are motivated to improve their skills in treating FDPs, a lack of adequate specific training has been identified. The development of practical skills training is essential. International online training courses could help meet this pressing need.
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Affiliation(s)
- Iryna Frankova
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, 123498Bogomolets National Medical University, Ukraine.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Karl Scheeres
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, England
| | - Giulia Menculini
- Department of Psychiatry, 9309University of Perugia, Italy.,Italian Society of Psychiatry (SIP), Young Section-SIP Giovani, Italy
| | - Uğur Cikrikcili
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) - Magdeburg, Germany
| | - Ioan-Costin Matei
- Clinica Nutrimed, Romania.,Global Mental Health MSc Student, University of Glasgow, UK
| | - Matthäus Fellinger
- Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, 27271Medical University of Vienna, Austria
| | - Ilaria Riboldi
- Italian Society of Psychiatry (SIP), Young Section-SIP Giovani, Italy.,60233Department of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Laura Uzer-Kremers
- Department of Psychiatry and Addictology, Medical University of Amiens, France
| | - Levent Küey
- Psychiatry, Private practice, Istanbul, Turkey
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11
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Carrà G, Bartoli F, Capogrosso CA, Cioni RM, Moretti F, Piacenti S, Riboldi I, Crocamo C, Bebbington PE. Innovations in community-based mental health care: an overview of meta-analyses. Int Rev Psychiatry 2022; 34:770-782. [PMID: 36786120 DOI: 10.1080/09540261.2022.2113043] [Citation(s) in RCA: 1] [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] [Indexed: 10/14/2022]
Abstract
In the last four decades, mental health services for people with Severe Mental Illness (SMI) have seen asylums replaced by a balanced model of Community Mental Healthcare (CMH). Innovative approaches and strategies in the field of CMH have been extensively researched. However, this research has been hampered by issues limiting their capacity to inform clinicians and policymakers. We conducted an overview of meta-analyses of the effectiveness of innovative CMH models focussing on clinical and psychosocial outcomes in comparisons with standard care in adults with SMI. Based on the 12 eligible studies, we appraised, synthesised and graded the resulting evidence. There was moderate quality evidence that case management, Early Intervention Services (EIS) and caregiver-directed interventions were superior to standard care in reducing hospital admission. In relation to psychosocial outcomes, EIS showed high quality evidence of a small effect on global functioning. There was moderate quality evidence for a similar effect of Intensive Case Management, and for a large effect of family intervention. For quality of life, both EIS and self-management education had a small effect, with moderate quality. The level of research about effective CMH models is therefore substantial. However, several gaps related to innovative CMH not yet covered in meta-analytic synthesis, need to be filled.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara A Capogrosso
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Riccardo M Cioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Riboldi I, Crocamo C, Callovini T, Capogrosso CA, Piacenti S, Calabrese A, Lucini Paioni S, Moretti F, Bartoli F, Carrà G. Testing the Impact of Depressive and Anxiety Features on the Association between Attention-Deficit/Hyperactivity Disorder Symptoms and Academic Performance among University Students: A Mediation Analysis. Brain Sci 2022; 12:brainsci12091155. [PMID: 36138891 PMCID: PMC9496751 DOI: 10.3390/brainsci12091155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 12/03/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is associated with poor academic performance also among university students. This relationship may be made more complex by comorbid conditions. The aim of this study was to evaluate the mediating role of anxiety and depressive symptoms in the relationship between ADHD and academic performance. Data were drawn from the CAMPUS study (registration number: 0058642/21), an ongoing survey on university students’ mental health. Using a logit model, mediation analyses were carried out to test whether the relationship between ADHD symptoms (assessed by ASRS-5) and academic performance might be mediated by depressive (assessed by PHQ-9) and anxiety (assessed by GAD-7) symptoms. Our results showed that worse academic performance is associated with ADHD symptoms (p < 0.001). However, about 24% of the overall association between ADHD symptoms and academic performance was mediated by depressive symptoms (indirect effect: 0.065, 95%CI 0.022; 0.100), whereas the contribution of anxiety symptoms to the model was not significant. Along with the association between ADHD symptoms and poor academic performance, our findings highlight the key mediating role of depressive symptoms, which may be targeted with tailored support, ultimately improving both the academic performance and the well-being of university students with ADHD.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-02-5799-8647
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | | | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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13
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Carrà G, Crocamo C, Bartoli F, Riboldi I, Sampogna G, Luciano M, Albert U, Carmassi C, Cirulli F, Dell’Osso B, Menculini G, Nanni MG, Pompili M, Sani G, Volpe U, Fiorillo A. Were anxiety, depression and psychological distress associated with local mortality rates during COVID-19 outbreak in Italy? Findings from the COMET study. J Psychiatr Res 2022; 152:242-249. [PMID: 35753244 PMCID: PMC9212315 DOI: 10.1016/j.jpsychires.2022.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/18/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The mental health of the Italian population declined at the onset of the COVID-19 pandemic. However, nationwide population prevalence estimates may not effectively reproduce the heterogeneity in distress responses to the pandemic. In particular, contextual determinants specific to COVID-19 pandemic need to be considered. We thus aimed to explore the association between local COVID-19 mortality rates and mental health response among the general population. METHODS We capitalised on data (N = 17,628) from a large, cross-sectional, national survey, the COMET study, run between March and May 2020. While psychological distress was measured by General Health Questionnaire-12 (GHQ-12), the Depression, Anxiety and Stress Scale-21 Items (DASS-21) was used to assess relevant domains. In addition, a Covid-19 mortality ratio was built to compare single regional mortality rates to the national estimate and official statistics were used to control for other area-level determinants. RESULTS Adjusted ordered regression analyses showed an association between mortality ratio and moderate (OR = 1.10, 95%CI 1.03-1.18) and severe (OR = 1.11, 95%CI 1.03-1.21) DASS-21 anxiety levels. No effects of mortality ratio on GHQ-12 scores and DASS-21 depression and stress levels, uniformly high across the country, were estimated. CONCLUSIONS Although we could not find any association between regional COVID-19 mortality ratio and depression or psychological distress, anxiety levels were significantly increased among subjects from areas with the highest mortality rates. Local mortality rate seems a meaningful driver for anxiety among the general population. Considering the potentially long-lasting scenario, local public health authorities should provide neighbouring communities with preventive interventions reducing psychological isolation and anxiety levels.
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Affiliation(s)
- Giuseppe Carrà
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy,Division of Psychiatry, University College London, London, UK
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina – ASUGI, Trieste, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco and Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milano, Italy
| | | | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, University Cattolica del Sacro Cuore, Rome, Italy,Department of Psychiatry, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Umberto Volpe
- Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
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14
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Bartoli F, Callovini T, Calabrese A, Cioni RM, Riboldi I, Crocamo C, Carrà G. Disentangling the Association between ADHD and Alcohol Use Disorder in Individuals Suffering from Bipolar Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2021; 12:brainsci12010038. [PMID: 35053783 PMCID: PMC8773515 DOI: 10.3390/brainsci12010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Attention Deficit-Hyperactivity disorder (ADHD) may influence rates of Alcohol Use Disorder (AUD) among individuals suffering from Bipolar Disorder (BD). The aim of this systematic review and meta-analysis was to estimate the strength and consistency of the potential association between ADHD and AUD in BD. We searched main electronic databases for studies indexed up to November 2020. We included observational studies investigating the association between ADHD and AUD among individuals with BD. The association between ADHD and AUD was estimated using odds ratios (ORs) with 95% Confidence Intervals (CIs). Eleven studies, involving 2734 individuals with BD (516 with ADHD), were included in the meta-analysis. Individuals with both BD and ADHD had higher rates of AUD as compared with subjects with BD only (34.0% vs. 18.3%). The estimated OR of AUD for ADHD was 2.50 (95% CI: 1.91 to 3.27; I2 = 13.0%). Study-level characteristics did not influence the effect size. No risk of publication bias was estimated. Despite some limitations, this meta-analysis estimated an association between ADHD and AUD among individuals suffering from BD. At least a portion of the high rates of AUD in BD may, thereby, be related to comorbid ADHD. Longitudinal studies are needed to clarify the nature of this relationship.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
- Correspondence: ; Tel.: +39-02-5799-8644
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Riccardo M. Cioni
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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15
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Bartoli F, Cavaleri D, Bachi B, Moretti F, Riboldi I, Crocamo C, Carrà G. Repurposed drugs as adjunctive treatments for mania and bipolar depression: A meta-review and critical appraisal of meta-analyses of randomized placebo-controlled trials. J Psychiatr Res 2021; 143:230-238. [PMID: 34509090 DOI: 10.1016/j.jpsychires.2021.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/08/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
Several drugs previously tested in clinical trials and approved for different indications have been repurposed for bipolar disorder. We carried out a systematic meta-review of meta-analyses of randomized placebo-controlled trials investigating repurposed drugs as adjunctive treatments for mania and bipolar depression. We performed a critical appraisal using 'A MeaSurement Tool to Assess systematic Reviews' Version 2 (AMSTAR 2). We synthesized results on efficacy, tolerability, and safety, assessing evidence quality according to the 'Grading of Recommendations, Assessment, Development and Evaluations' (GRADE) approach. Our systematic search identified nine eligible studies investigating 12 drugs, four for mania and eight for bipolar depression. The quality of reporting was heterogeneous according to AMSTAR 2. In mania, allopurinol (for symptoms reduction and remission at 4-8 weeks) and tamoxifen (for response and symptoms reduction at 4-6 weeks) showed higher efficacy than placebo, with low and very low quality of evidence, respectively. Concerning bipolar depression, modafinil/armodafinil (for response, remission, and symptoms reduction at 6-8 weeks) and pramipexole (for response and symptoms reduction at 6 weeks) were superior to placebo, despite the low quality of evidence. Results on the efficacy of celecoxib and N-acetylcysteine were of low quality and limited to certain outcomes. Overall, the lack of evidence of high and moderate quality does not allow us to draw firm conclusions on the clinical utility of repurposed drugs as adjunctive treatments for mania and bipolar depression, highlighting the need for additional research.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy.
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy; Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN, United Kingdom
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16
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Bartoli F, Riboldi I, Bachi B, Calabrese A, Moretti F, Crocamo C, Carrà G. Efficacy of Cannabidiol for Δ-9-Tetrahydrocannabinol-Induced Psychotic Symptoms, Schizophrenia, and Cannabis Use Disorders: A Narrative Review. J Clin Med 2021; 10:jcm10061303. [PMID: 33810033 PMCID: PMC8005219 DOI: 10.3390/jcm10061303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/17/2023] Open
Abstract
Although cannabis’ major psychoactive component, Δ-9-tetrahydrocannabinol (THC), has been linked to both earlier onset and poorer outcomes of psychotic disorders, Cannabidiol (CBD) seems to have different pharmacological mechanisms and potential therapeutic properties. However, no clinical study has investigated CBD for the treatment of co-occurring psychotic and cannabis use disorders so far, even though its utility seems grounded in a plausible biological basis. The aim of this work is thus to provide an overview of available clinical studies evaluating the efficacy of CBD for psychotic symptoms induced by THC, schizophrenia, and cannabis use disorders. After searching for relevant studies in PubMed, Cochrane Library, and ClinicalTrials.gov, we included 10 clinical studies. Available evidence suggests that CBD may attenuate both psychotic-like symptoms induced by THC in healthy volunteers and positive symptoms in individuals with schizophrenia. In addition, preliminary data on the efficacy of CBD for cannabis use disorders show mixed findings. Evidence from ongoing clinical studies will provide insight into the possible role of CBD for treating psychotic and cannabis use disorders.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
- Correspondence: (F.B.); (G.C.); Tel.: +39-025-799-8644 (F.B.); +39-025-799-8645 (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
- Correspondence: (F.B.); (G.C.); Tel.: +39-025-799-8644 (F.B.); +39-025-799-8645 (G.C.)
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17
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Pinzón-Espinosa J, Valdés-Florido MJ, Riboldi I, Baysak E, Vieta E. The COVID-19 Pandemic and Mental Health of Refugees, Asylum Seekers, and Migrants. J Affect Disord 2021; 280:407-408. [PMID: 33227670 DOI: 10.1016/j.jad.2020.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Justo Pinzón-Espinosa
- Department of Mental Health, Parc Taulí University Hospital, Sabadell, Spain; Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, Spain; Department of Medicine, School of Medicine, University of Barcelona, Catalonia, Spain.
| | | | - Ilaria Riboldi
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan 20153, Italy
| | - Erensu Baysak
- Department of Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, Spain; Department of Medicine, School of Medicine, University of Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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Imperatori C, Massullo C, Carbone GA, Farina B, Colmegna F, Riboldi I, Giacomo ED, Clerici M, Dakanalis A. Electroencephalographic (EEG) alterations in young women with high subclinical eating pathology levels: a quantitative EEG study. Eat Weight Disord 2020; 25:1631-1642. [PMID: 31667777 DOI: 10.1007/s40519-019-00801-w] [Citation(s) in RCA: 2] [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: 07/19/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To explore electroencephalographic (EEG) alterations in young women with different eating disorder (ED) psychopathology levels. METHODS Thirty-seven young women completed general and ED psychopathology (i.e., the ED Examination Questionnaire; EDE-Q) measures. EEG power spectra data were investigated in two conditions: (a) 5 min of resting state (RS) and (b) 5 min of RS after a single taste of a milkshake (ML-RS). EEG analyses were performed using exact Low-Resolution Electromagnetic Tomography software (eLORETA). RESULTS Cluster analysis performed on the EDE-Q responses revealed a group of 17 women with high levels of ED pathology falling into the subclinical (i.e., sub-threshold) EDs category and a group of 20 women with low levels of ED pathology (controls). In the RS conditions, no significant modifications were observed between groups. Compared to controls, women with subclinical EDs showed an increase in theta activity in the parieto-occipital areas in the ML-RS condition. After controlling for body mass index and general psychopathology, theta activity in these brain structures was positively associated with EDE-Q global and subscale (restraint, shape and weight concern) scores. CONCLUSIONS Our results may reflect the neurophysiological substrate of ED psychopathology core features like shape/weight concerns. Previous brain imaging and qEEG studies with full-syndrome ED patients also underscored the involvement of parieto-occipital areas in ED pathophysiology. These studies also found brain alterations in the RS condition, not observed here. This is notable given that full-syndrome and subclinical EDs are considered as different manifestations of the same disease along a severity spectrum. LEVEL OF EVIDENCE Level V, cross-sectional, electroencephalographic, descriptive study.
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Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Chiara Massullo
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Giuseppe Alessio Carbone
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Fabrizia Colmegna
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Ester Di Giacomo
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Massimo Clerici
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
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Bartoli F, Cavaleri D, Moretti F, Bachi B, Calabrese A, Callovini T, Cioni RM, Riboldi I, Nacinovich R, Crocamo C, Carrà G. Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study. Medicina (Kaunas) 2020; 56:medicina56110613. [PMID: 33203127 PMCID: PMC7696058 DOI: 10.3390/medicina56110613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: Readmissions of youths hospitalized for a severe mental disorder are common events and bear a remarkable human, social, and economic burden. The current study aimed at evaluating predictors of 1-year rehospitalization in a sample of adolescents and young adults with severe mental disorders. Materials and Methods: Data for ≤25-year-old inpatients with a severe mental disorder and consecutively admitted between 1 January 2016 and 30 June 2019 were collected. Subjects were retrospectively assessed over a follow-up period of one year after the index discharge to track readmissions—i.e., the primary outcome variable. Standard descriptive statistics were used. The association between variables and 1-year rehospitalization was estimated using the univariate Cox proportional hazards regression model. We then carried out a multivariable Cox regression model, also estimating the covariate-adjusted survivor function. Hazard ratios (HRs) with related 95% confidence intervals (95% CIs) were provided. Results: The final sample included 125 individuals. The multivariable Cox regression model estimated that co-occurring substance use disorders (HR = 2.14; 95% CI: 1.08 to 4.26; p = 0.029) and being admitted for a suicide attempt (HR = 2.49; 95% CI: 1.13 to 5.49; p = 0.024) were both significant predictors of 1-year rehospitalization. Conclusions: Our study showed that comorbid substance use disorders and being admitted for a suicide attempt were predictors of early readmission in youths with severe mental disorders. Although their generalizability is limited, our findings could contribute to improve the quality of young patients’ mental health care by identifying vulnerable subjects who may benefit from tailored interventions to prevent rehospitalizations.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Correspondence: ; Tel.: +39-02-5799-8353
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Riccardo M. Cioni
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Renata Nacinovich
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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Bartoli F, Crocamo C, Bava M, Castagna G, Di Brita C, Riboldi I, Trotta G, Verrengia E, Clerici M, Carrà G. Testing the association of serum uric acid levels with behavioral and clinical characteristics in subjects with major affective disorders: A cross-sectional study. Psychiatry Res 2018; 269:118-123. [PMID: 30145291 DOI: 10.1016/j.psychres.2018.08.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/04/2018] [Revised: 05/21/2018] [Accepted: 08/13/2018] [Indexed: 02/01/2023]
Abstract
Previous research has hypothesized a role for serum uric acid as a marker of mental disorders and related behaviors, possibly due to its link with purinergic transmission and antioxidant activity. We tested the association of serum uric acid levels with specific behavioral and clinical characteristics in 99 individuals suffering from major affective disorders. Subjects were assessed and interviewed using the Kessler Psychological Distress Scale, the Columbia-Suicide Severity Rating Scale, the Modified Overt Aggression Scale, and the Barratt Impulsiveness Scale. We found that psychological distress and suicidal ideation severity were associated with lower uric acid serum levels. On the other hand, verbal aggression and history of violence were associated with higher levels of serum uric acid. However, according to linear regression analyses, there were no behavioral and clinical characteristics independently associated with serum uric acid. Serum uric acid levels were influenced by creatinine and BMI, as well as, possibly, by white blood cells count and gender. Despite some limitations, these results suggest that no behavioral / clinical features are associated with variations of serum uric acid, which rather seem attributable to specific biochemical and metabolic parameters. Nevertheless, the role of purinergic system in different mental disorders and behavioral abnormalities, deserves further research.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy..
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Mattia Bava
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Gloria Castagna
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Carmen Di Brita
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giulia Trotta
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Enrica Verrengia
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy.; Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
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Carrà G, Bartoli F, Riboldi I, Trotta G, Crocamo C. Poverty matters: Cannabis use among people with serious mental illness: Findings from the United States survey on drug use and health, 2015. Int J Soc Psychiatry 2018; 64:656-659. [PMID: 30132359 DOI: 10.1177/0020764018795213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/17/2022]
Abstract
BACKGROUND: Little is known about the influence of contextual characteristics on comorbid substance use and serious mental illness (SMI). AIMS: To explore the role of poverty on comorbid SMI and cannabis use. METHODS: We used data from the 2015 National Survey on Drug Use and Health, considering those in poverty, with income under 100% of the US poverty threshold. RESULTS: People in poverty were more likely to suffer from concurrent SMI and cannabis use (3.07%, 95% confidence interval (CI):1.84%; 5.07%), even controlling for gender, age, tobacco and alcohol use (odds ratio (OR) = 2.77, 95% CI: 1.27; 6.03, p = .010). CONCLUSION: The magnitude of the association between SMI and cannabis use is influenced by poverty status. More research on potential mediators like income inequality and impoverished social capital is needed.
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Affiliation(s)
- Giuseppe Carrà
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,2 Division of Psychiatry, University College London, London, UK
| | - Francesco Bartoli
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giulia Trotta
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Cristina Crocamo
- 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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Bartoli F, Clerici M, Di Brita C, Riboldi I, Crocamo C, Carrà G. Effect of clinical response to active drugs and placebo on antipsychotics and mood stabilizers relative efficacy for bipolar depression and mania: A meta-regression analysis. J Psychopharmacol 2018; 32:416-422. [PMID: 29338576 DOI: 10.1177/0269881117749851] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Randomised placebo-controlled trials investigating treatments for bipolar disorder have been hampered by wide variations of active drugs and placebo clinical response rates. It is important to estimate whether the active drug or placebo response has a greater influence in determining the relative efficacy of drugs for psychosis (antipsychotics) and relapse prevention (mood stabilisers) for bipolar depression and mania. METHODS We identified 53 randomised, placebo-controlled trials assessing antipsychotic or mood stabiliser monotherapy ('active drugs') for bipolar depression or mania. We carried out random-effects meta-regressions, estimating the influence of active drugs and placebo response rates on treatment relative efficacy. RESULTS Meta-regressions showed that treatment relative efficacy for bipolar mania was influenced by the magnitude of clinical response to active drugs ( p=0.002), but not to placebo ( p=0.60). On the other hand, treatment relative efficacy for bipolar depression was influenced by response to placebo ( p=0.047), but not to active drugs ( p=0.98). CONCLUSIONS Despite several limitations, our unexpected findings showed that antipsychotics / mood stabilisers relative efficacy for bipolar depression seems unrelated to active drugs response rates, depending only on clinical response to placebo. Future research should explore strategies to reduce placebo-related issues in randomised, placebo-controlled trials for bipolar depression.
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Affiliation(s)
- Francesco Bartoli
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Carmen Di Brita
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ilaria Riboldi
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Cristina Crocamo
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Carrà
- 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,2 Division of Psychiatry, University College London, UK
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Bartoli F, Riboldi I, Crocamo C, Di Brita C, Clerici M, Carrà G. Ketamine as a rapid-acting agent for suicidal ideation: A meta-analysis. Neurosci Biobehav Rev 2017; 77:232-236. [DOI: 10.1016/j.neubiorev.2017.03.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 11/16/2022]
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