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Civardi SC, Besana F, Carnevale Miacca G, Mazzoni F, Arienti V, Politi P, Brondino N, Olivola M. Risk factors for suicidal attempts in a sample of outpatients with treatment-resistant depression: an observational study. Front Psychiatry 2024; 15:1371139. [PMID: 38585482 PMCID: PMC10995380 DOI: 10.3389/fpsyt.2024.1371139] [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] [Received: 01/15/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Treatment-resistant depression (TRD) is commonly defined as the failure of at least two trials with antidepressant drugs, given at the right dose and for an appropriate duration. TRD is associated with increased mortality, compared to patients with a simple major depressive episode. This increased rate was mainly attributed to death from external causes, including suicide and accidents. The aim of our study is to identify socio-demographic and psychopathological variables associated with suicidal attempts in a sample of outpatients with TRD. Material and methods We performed a monocentric observational study with a retrospective design including a sample of 63 subjects with TRD referred to an Italian outpatient mental health centre. We collected socio-demographic and psychopathological data from interviews and clinical records. Results 77.8% of the sample (N=49) were females, the mean age was 49.2 (15.9). 33.3% (N=21) of patients had attempted suicide. 54% (N=34) of patients had a psychiatric comorbidity. Among the collected variables, substance use (p=0.031), psychiatric comorbidities (p=0.049) and high scores of HAM-D (p=0.011) were associated with the occurrence of suicide attempts. In the regression model, substance use (OR 6.779), psychiatric comorbidities (OR 3.788) and HAM-D scores (OR 1.057) were predictive of suicide attempts. When controlling for gender, only substance use (OR 6.114) and HAM-D scores (OR 1.057) maintained association with suicide attempts. Conclusion The integrated treatment of comorbidities and substance abuse, which involves different mental health services, is fundamental in achieving the recovery of these patients. Our study supports the importance of performing a careful clinical evaluation of patients with TRD in order to identify factors associated with increased risk of suicide attempts.
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Affiliation(s)
| | - Filippo Besana
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | - Filippo Mazzoni
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Miriam Olivola
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
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Lanza A, Olivola M, Peschi G, Brondino N, Politi P. HCV prevalence and treatment outcomes among drug users in an outpatient center for drug addiction in Northern Italy. Ann Ist Super Sanita 2023; 59:108-113. [PMID: 37337985 DOI: 10.4415/ann_23_02_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION We aimed at evaluating hepatitis C virus (HCV) prevalence and treatment referral outcomes in a large population of drug users in Northern Italy. MATERIAL AND METHODS Each participant underwent a quick capillary blood test. Positive participants underwent HCV RNA quantification. HCV RNA positive subjects were referred to treatment and evaluated immediately at the end of treatment and at 3 and 6 months after treatment. RESULTS Of the 636 participants tested, 244 were positive. Intravenous drug use was more frequent among subjects who tested positive for HCV antibodies (99%). Among subjects who tested positive, 68% were HCV-RNA positive while 32% were negative. Among people referred to treatment, nearly 30% did not show up while 70% completed the treatment with success. Over 99% of people who started direct-acting antiviral agent (DAA) have a sustained response. DISCUSSION We observed a significant higher prevalence of HCV positive subjects among people who inject drugs (99%) and we observed a high success rate for HCV treatment engagement. CONCLUSIONS Rapid testing for HCV represents a potential tool for HCV screening among high-risk groups.
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Affiliation(s)
- Assunta Lanza
- Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Miriam Olivola
- Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | | | - Natascia Brondino
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Pavia, Italy
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Olivola M, Bassetti N, Parente S, Arienti V, Civardi SC, Topa PA, Brondino N. Cognitive Effects of Lurasidone and Cariprazine: A Mini Systematic Review. Curr Neuropharmacol 2023; 21:2431-2446. [PMID: 37519001 PMCID: PMC10616918 DOI: 10.2174/1570159x21666230727140843] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 08/01/2023] Open
Abstract
Cognitive deficits are associated with schizophrenia and show a progressive worsening, often being unresponsive to treatment. New antipsychotic molecules acting as antagonist at the serotoninergic 5-hydroxytryptamine receptor 7 (e.g. lurasidone) or partial agonists at dopamine D3 receptor (e.g. cariprazine) could have an impact on cognition in this patient group. The aim of the systematic review is to explore the efficacy of lurasidone and cariprazine in improving cognition in both animal models and human studies. The following terms: (lurasidone AND cognit*) OR (cariprazine AND cognit*) were searched in Web of Science from inception to December 2021. We included all studies that assessed changes in cognitive function after treatment with cariprazine or lurasidone. Of 201 selected articles, 36 were included. Twenty-four articles used animal models (rats, mice and marmosets), five evaluating the effects of cariprazine and 19 the effects of lurasidone. Twelve articles were clinical studies (cariprazine n = 2; lurasidone n = 10). In both animal and human studies lurasidone showed a greater efficacy on cognitive performance compared to placebo, quetiapine, ziprasidone or treatmentas- usual. Cariprazine was superior to other antipsychotics in improving cognitive functions in both animal and human studies. The cognitive effect of lurasidone could be explained by its potent antagonism at the 5-HT7 receptors combined with partial agonism at 5-HT1A receptors. The pro-cognitive effect of cariprazine is probably explained by its very high affinity for D3 receptors. Head-to-head studies comparing lurasidone and cariprazine are needed to establish the "first-choice" treatment for cognitive dysfunction associated with schizophrenia.
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Affiliation(s)
- Miriam Olivola
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
- Department of Mental Health and Addiction, ASST Pavia, Pavia, Italy
| | - Nicola Bassetti
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
| | - Serena Parente
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
| | - Serena Chiara Civardi
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
| | | | - Natascia Brondino
- Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, 27100, Italy
- Department of Mental Health and Addiction, ASST Pavia, Pavia, Italy
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Croatto G, Vancampfort D, Miola A, Olivola M, Fiedorowicz JG, Firth J, Alexinschi O, Gaina MA, Makkai V, Soares FC, Cavaliere L, Vianello G, Stubbs B, Fusar-Poli P, Carvalho AF, Vieta E, Cortese S, Shin JI, Correll CU, Solmi M. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials. Mol Psychiatry 2023; 28:369-390. [PMID: 36138129 PMCID: PMC9493151 DOI: 10.1038/s41380-022-01770-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. METHODS Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). RESULTS Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). CONCLUSIONS Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.
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Affiliation(s)
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven University, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Alessandro Miola
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | | | - Marcel A Gaina
- Institute of Psychiatry "Socola", Iasi, Romania
- Psychiatry, Department of Medicine III, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | | | | | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King's College London, London, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Psychosis Studies, King's College London, London, UK.
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
- Department of Psychiatry, University of Ottawa, Ontario, Canada.
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Fagiolini A, Olivola M, Lavatelli L, Bellomo A, Lobaccaro C, Falsetto N, Micillo M, Cuomo A. Treatment persistence in patients with schizophrenia treated with lurasidone in Italian clinical practice. Ann Gen Psychiatry 2022; 21:49. [PMID: 36527022 PMCID: PMC9756598 DOI: 10.1186/s12991-022-00425-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND RATIONALE Treatment persistence combines clinician and patient judgment of efficacy, tolerability and safety into a comprehensive measure of effectiveness and is defined as the act of continuing a treatment over time. Studies have reported poor treatment persistence to antipsychotic medications in patients with schizophrenia. This study evaluated treatment persistence to lurasidone (LUR) in patients with schizophrenia in a real-world Italian setting. METHODS This was a retrospective observational study of patients with schizophrenia who started treatment with LUR ≥ 6 months before inclusion. Following informed consent, data were collected starting from the index date (start of LUR treatment) at all visits occurring as per clinical practice. The primary endpoint was treatment persistence during the first 6 months, defined as the time between index date and all-cause discontinuation. Patients treated with LUR > 180 days were considered persistent. As secondary endpoint, treatment persistence was evaluated for a period of ≥ 18 months. RESULTS Forty-five patients were enrolled and 41 (91.11%) completed the study. Forty-one patients (91.11%) were included in the eligible population as they initiated LUR treatment ≥ 6 months before data collection. Patients were 43.0 ± 15.89 years old and 61% were female. Twenty-two patients (53.66%) started LUR treatment in a hospital setting and 19 (46.34%) in an outpatient setting. Based on Clinical Global Impression-Severity scale (CGI-S) at LUR initiation, 12 patients (29.27%) were severely ill, 17.07% markedly ill, 19.51% moderately ill, 2.44% mildly ill and 4.88% borderline mentally ill. Thirty-two patients (78.05%) were treatment persistent for ≥ 180 days. Among the 19 patients observed for ≥ 18 months, 11 (57.89%) were persistent for ≥ 18 months. Among the 22 study patients observed for < 18 months, 12 (54.54%) were persistent. An improvement in schizophrenia severity according to CGI-S was observed at inclusion (following LUR therapy) compared to the index date. Six patients (14.63%) experienced at least one adverse drug reaction: akathisia (7.32%), extrapyramidal disorder (4.88%), hyperprolactinemia (2.44%), restlessness (2.44%), and galactorrhea (2.44%). None were serious. CONCLUSIONS Persistence to LUR in patients with schizophrenia was relatively high: 78% and 58% of patients were still on LUR after 6 and 18 months of treatment, respectively. This may reflect LUR's relatively favorable balance between efficacy and tolerability, as well as favorable patient satisfaction and acceptance.
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Affiliation(s)
- Andrea Fagiolini
- Università Di Siena, V.Le Mario Bracci, 16, 53100, Siena (SI), Italy.
| | - Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia and Servizio Psichiatrico Di Diagnosi E Cura ASST Pavia, IRCCS Policlinico San Matteo, Viale Repubblica 34, 27100, Pavia, Italy
| | - Lisa Lavatelli
- Psichiatria 1 ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Antonello Bellomo
- University of Foggia, Viale Luigi Pinto, 1, 71122, Foggia, MI, Italy
| | | | | | - Marco Micillo
- Angelini Pharma S.P.A, Viale Amelia70, 00181, Rome, Italy
| | - Alessandro Cuomo
- University of Siena, V.Le Mario Bracci, 16, 53100, Siena, SI, Italy
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Martinotti G, Vita A, Fagiolini A, Maina G, Bertolino A, Dell'Osso B, Siracusano A, Clerici M, Bellomo A, Sani G, d'Andrea G, Chiaie RD, Conca A, Barlati S, Di Lorenzo G, De Fazio P, De Filippis S, Nicolò G, Rosso G, Valchera A, Nucifora D, Di Mauro S, Bassetti R, Martiadis V, Olivola M, Belletti S, Andriola I, Di Nicola M, Pettorruso M, McIntyre RS, di Giannantonio M. Real-world experience of esketamine use to manage treatment-resistant depression: A multicentric study on safety and effectiveness (REAL-ESK study). J Affect Disord 2022; 319:646-654. [PMID: 36167246 DOI: 10.1016/j.jad.2022.09.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 06/29/2022] [Revised: 08/28/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment-resistant Depression (TRD) represents a widespread disorder with significant direct and indirect healthcare costs. esketamine, the S-enantiomer of ketamine, has been recently approved for TRD, but real-world studies are needed to prove its efficacy in naturalistic settings. OBJECTIVES Evaluate the effectiveness and safety of esketamine nasal spray in a clinical sample of patients with TRD from several Italian mental health services. METHODS REAL-ESK study is an observational, retrospective and multicentric study comprising a total of 116 TRD patients treated with esketamine nasal spray. Anamnestic data and psychometric assessment (MADRS, HAMD-21, HAM-A) were collected from medical records at baseline (T0), one month (T1) and three month (T2) follow-ups. RESULTS A significant reduction of depressive symptoms was found at T1 and T2 compared to T0. A dramatic increase in clinical response (64.2 %) and remission rates (40.6 %) was detected at T2 compared to T1. No unexpected safety concerns were observed, side effects rates were comparable to those reported in RCTs. No differences in efficacy have been found among patients with and without psychiatric comorbidities. LIMITATIONS The open design of the study and the absence of a placebo or active comparator group are limitations. The study lacks an inter-rater reliability evaluation of the assessments among the different centres. Side effects evaluation did not involve any specific scale. CONCLUSIONS Our findings support the safety and tolerability of esketamine in a real-world TRD sample. The later response and the non-inferiority in effectiveness in patients with comorbidities represent novel and interesting findings.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy; Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Italy
| | - Andrea Fagiolini
- School of Medicine, Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, 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
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Clerici
- Dipartimento di Medicina e Chirurgia, Università degli studi Milano Bicocca, Italy; Dipartimento di Salute Mentale e Dipendenze ASST Monza, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giacomo d'Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy.
| | - Roberto Delle Chiaie
- Department of Neuroscience and Mental Health-Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Andreas Conca
- Psychiatric Service of the Health District of Bozen, Bozen-Bolzano, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Nicolò
- Department of Mental Health and Addiction, ASL Roma 5, Rome, Italy
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy
| | | | | | | | - Roberta Bassetti
- SPDC Frosinone - ASL, Frosinone, Italy; Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | | | - Miriam Olivola
- Department of Brain and Behavioural Science, University of Pavia, Italy
| | - Sandro Belletti
- Mental Heath Department, Azienda Unità Sanitaria Locale (AUSL) Umbria 2, Italy
| | | | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Massimo di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy
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Applewhite B, Olivola M, Tweed C, Wesemann U, Himmerich H. Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review. BMJ Mil Health 2022:e002135. [PMID: 35675995 DOI: 10.1136/bmjmilitary-2022-002135] [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: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with "body dysmorphic disorder," "muscle dysmorphia," "body image," "performance and image enhancing drugs," "anabolic steroid," military personnel," "soldiers," "navy," "air force," "army" and "armed forces" as search terms. RESULTS A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours. CONCLUSIONS BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.
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Affiliation(s)
- Briana Applewhite
- Department of Psychological Medicine, King's College London, London, UK
| | - M Olivola
- Department of Brain and Behavioural Science, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - C Tweed
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Naval Medicine, Royal Navy, Gosport, UK
| | - U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - H Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
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Civardi S, Bassetti N, Arienti V, Besana F, Politi P, Brondino N, Olivola M. Efficacy and tolerability of brexpiprazole in patients with psychotic and mood disorders: a pilot study. Eur Psychiatry 2022. [PMCID: PMC9567215 DOI: 10.1192/j.eurpsy.2022.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Brexpiprazole is a novel antipsychotic drug. It exerts antagonistic activity at the serotonin 5HT2A, 5HT2B, 5HT7 and noradrenaline alpha 1b/2c receptors; it also acts as partial agonist of serotonin 5HT1 and dopamine D2, D3 receptors. Brexpiprazole is approved for the treatment of schizophrenia and as an add-on therapy for major depression. Objectives This pilot study aims at exploring efficacy and tolerability of Brexpiprazole in a small sample of patients diagnosed with either a psychotic or a mood disorder. Methods This observational study was conducted at our Acute Psychiatric Inpatient Unit. We included 7 patients (5 males, 2 females) hospitalized between 2020 and 2021, diagnosed with schizophrenia spectrum disorders or mood disorders with psychotic symptoms confirmed by Mini International Neuropsychiatric Interview. Patients who participated signed an informed consent. Information concerning diagnosis, demographic characteristics (age, sex, education, marital status) and pharmacological therapy were collected examining clinical records. The average lenght of hospitalization was 13.4 days. Psychopathology was assessed by means of the PANSS and the severity of the illness was evaluated with CGI severity scale (CGI-S), both on admission and discharge. We also administered the UKU scale to evaluate the tolerability profile. Results ![]()
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Results can be seen in figures 1, 2, 3 Conclusions Our study found a significant improvement in both positive and negative symptoms, with good tolerability. Limitations of our study are: small sample size and limited period of observation. These premises suggest that further research is needed in order to elucidate the exact mechanisms underlying Brexpiprazole’s action and the possible implication in mood disorders. Disclosure No significant relationships.
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Olivola M, Arienti V, Bassetti N, Civardi S, Brondino N. Use of intranasal esketamine in a girl with treatment-resistant depression and autism spectrum disorders: a case report. EXCLI J 2022; 21:540-543. [PMID: 35651653 PMCID: PMC9150017 DOI: 10.17179/excli2022-4694] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
Major depression is a common comorbidity in autism spectrum disorder (ASD), often difficult to identify and to treat. Autistic subjects are more at risk for suicidal thoughts and behaviors compared to typically developing peers. Unfortunately, ASD individuals are more frequently treatment-resistant and often show side-effects which reduce efficacy. Intranasal esketamine has been recently approved as an add-on medication for treatment-resistant depression (TRD), but it has never been used in ASD with comorbid major depression. Of note, a pilot study of intranasal ketamine has shown no effect on social withdrawal in ASD without depression. The present case report describes the first girl with ASD and comorbid TRD treated with intranasal esketamine.
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Affiliation(s)
- Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,ASST Pavia, Pavia, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,ASST Pavia, Pavia, Italy
| | - Nicola Bassetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,ASST Pavia, Pavia, Italy
| | - Serena Civardi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,ASST Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,ASST Pavia, Pavia, Italy,*To whom correspondence should be addressed: Natascia Brondino, Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; Tel: +39 0382987246, E-mail:
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10
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Olivola M, Civardi S, Damiani S, Cipriani N, Silva A, Donadeo A, Politi P, Brondino N. Effectiveness and safety of intravenous valproate in agitation: a systematic review. Psychopharmacology (Berl) 2022; 239:339-350. [PMID: 34783884 DOI: 10.1007/s00213-021-06009-0] [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] [Received: 12/14/2020] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE The use of intravenous valproate is not approved for clinical practice in psychiatry. Literature data pointed out for a potential usefulness of this route of administration for valproate, but there is no actual consensus. OBJECTIVES The aim of the present systematic review is to assess the effectiveness of intravenous valproate in agitation as well as general safety. METHODS A systematic review of studies evaluating the use of intravenous valproate in agitation was conducted. Additionally, safety was evaluated in all randomized trials involving the use of intravenous valproate in all medical conditions (epilepsy, migraine and psychiatric conditions). RESULTS For the systematic review on effectiveness in agitation, the search yielded 965 articles overall. After removing duplicates, 9411 articles were screened by title and abstract, and 39 of these were evaluated at a full-text level. Six studies were considered eligible for qualitative synthesis: one RCT and case report (n = 3), followed by cohort studies (n = 2). For the systematic review on safety, twenty-two RCTs were considered eligible for quantitative synthesis. CONCLUSION Intravenous valproate seems efficacious in reducing agitation in psychiatric patients; it generally appears safe compared to other neuroleptics or antiepileptics. However, the evidence is still not strong as it relies mainly on open-label studies or case series.
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Affiliation(s)
- Miriam Olivola
- ASST Pavia, Pavia, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Serena Civardi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Nicolo Cipriani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Silva
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alberto Donadeo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- ASST Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Brondino
- ASST Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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11
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Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY, Carvalho AF, Seeman MV, Correll CU, Fusar-Poli P. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 2022; 27:281-295. [PMID: 34079068 PMCID: PMC8960395 DOI: 10.1038/s41380-021-01161-7] [Citation(s) in RCA: 716] [Impact Index Per Article: 358.0] [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: 03/06/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
Abstract
Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11-34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7-16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9-25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14-29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15-23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17-48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20-41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20-34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20-33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21-46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.
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Affiliation(s)
- Marco Solmi
- grid.5608.b0000 0004 1757 3470Neurosciences Department, University of Padua, Padua, Italy ,grid.5608.b0000 0004 1757 3470Neuroscience Centre, University of Padua, Padua, Italy ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Joaquim Radua
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.10403.360000000091771775Imaging Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain ,grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
| | - Miriam Olivola
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Enrico Croce
- grid.8484.00000 0004 1757 2064Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Livia Soardo
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.4795.f0000 0001 2157 7667Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Jae Il Shin
- grid.15444.300000 0004 0470 5454Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - James B. Kirkbride
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Peter Jones
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, England ,CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
| | - Jae Han Kim
- grid.15444.300000 0004 0470 5454Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Yeob Kim
- grid.15444.300000 0004 0470 5454Yonsei University College of Medicine, Seoul, South Korea
| | - Andrè F. Carvalho
- grid.414257.10000 0004 0540 0062IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Mary V. Seeman
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Christoph U. Correll
- grid.440243.50000 0004 0453 5950Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA ,grid.250903.d0000 0000 9566 0634Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY USA ,grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK. .,National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK.
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Donadeo A, Politi P, Silva A, Civardi S, Farinella E, Brondino N, Olivola M, Sommi F, Damiani S. Correlation profiles between interoception and exteroception in psychotic patients versus healthy controls. Eur Psychiatry 2021. [PMCID: PMC9475798 DOI: 10.1192/j.eurpsy.2021.1430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Individual abilities to perceive internal and external sensations are defined respectively as interoception and exteroception: the dysregulation of these functions can explain many psychotic symptoms. (Ardizzi et al. 2016) Objectives We evaluated the differences in the interoceptive and exteroceptive perception between 39 patients with psychosis and 250 healthy controls using self-administered questionnaires. The association between interoception and exteroception in the two groups was also tested. Methods The tests we used are AASP (Adolescent / Adult Sensory Profile) and MAIA (Multidimensional Assessment of Interoceptive Awareness). Differences were measured with t-tests, associations with spearman’s correlation. Results Significant differences emerged between the two samples in the AASP total score and in its Low registration (LR) and Sensory Avoiding (SA) sub-scales and in the MAIA total score and in all its sub-scales except “Not Worrying” (Fig.1). Different patterns of associations between AASP and MAIA were observed: psychotic patients showed negative correlations between MAIA and AASP in the LR and Sensation Seeking (SS) sub-scales and in the auditory (AU) and tactile (TO) sensory channels. Healthy controls, positive correlations emerged between MAIA and AASP in the Sensation Seeking (SK) sub-scale and in the “perception of movement” (MO) sub-score (Fig.2)(Fig.3).![]() ![]() ![]() Conclusions Higher scores of psychotic patients in AASP and MAIA reveal both a disregulated sensory related behavior and a hightened awareness towards internal stimuli. The negative correlation between the two scales in psychotic subjects highlights the importance of the interaction between internal and external perception in determining the global subjective experience.
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13
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Keeler J, Lambert E, Olivola M, Owen J, Xia J, Thuret S, Himmerich H, Cardi V, Treasure J. Lower pattern recognition memory scores in anorexia nervosa. J Eat Disord 2021; 9:49. [PMID: 33865451 PMCID: PMC8052530 DOI: 10.1186/s40337-021-00406-8] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is extensive evidence for volumetric reductions in the hippocampus in patients with anorexia nervosa (AN), however the impact on function is unclear. Pattern separation and recognition are hippocampus-dependent forms of learning thought to underlie stimulus discrimination. METHODS The present study used the Mnemonic Similarity Task to investigate pattern separation and recognition for the first time in patients with AN (N = 46) and healthy controls (N = 56). An Analysis of Covariance examined between-group differences, controlling for age, antidepressant use and method of task delivery (remote vs. in person). RESULTS When controlling for covariates, pattern recognition memory scores were lower in the AN group with a medium effect size (d = 0.51). In contrast, there was a small effect whereby patients with AN had a greater pattern separation score than controls (d = 0.34), albeit this difference was not significant at the p = 0.05 threshold (p = 0.133). Furthermore, pattern separation and recognition memory abilities were not related to age, body mass index, eating disorder psychopathology or trait anxiety levels. CONCLUSIONS This preliminary study provides initial evidence for an imbalance in pattern separation and recognition abilities in AN, a hippocampus-dependent cognitive ability. Further studies should endeavour to investigate pattern separation and recognition performance further in AN, as well as investigate other hippocampus-dependent functions.
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Affiliation(s)
- Johanna Keeler
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Ellen Lambert
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Miriam Olivola
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Judith Owen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Jingjing Xia
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hubertus Himmerich
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Valentina Cardi
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
- Department of General Psychology, University of Padova, Padova, Italy
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
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Bassetti N, Parente S, Topa P, Brondino N, Damiani S, Politi P, Olivola M. Distress and burnout among psychiatrists during the COVID-19 pandemic. Eur Psychiatry 2021. [PMCID: PMC9471673 DOI: 10.1192/j.eurpsy.2021.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction COVID-19 is an infectious disease caused by SARS-CoV-2. The WHO on March 11, 2020, has declared the novel coronavirus outbreak a global pandemic. Several studies found an association between the COVID-19 pandemic and psychiatric symptoms, such as distress, anxiety, fear of infection, depression and insomnia in the general population. Therefore, psychiatrists have been professionally overloaded, trying to manage the psychosocial impact of the pandemic and suffering its effects in person. Objectives To evaluate the disease perceptions, distress and burnout among psychiatrists from the Department of Mental Health and Addictions of Pavia in three different times, which correspond to the three main phases of the pandemic management in Italy: T0 is the first peak of the infections and the lock-down, from March to June; T1 is the reduction of the infections and the reopening, from June to October; T2 is the second wave of infections with a new progressive closure, the current one. Methods We used three questionnaires: the BIPQ (Brief Illness Perception Questionnaire), the PSS-10 (Perceived Stress Scale-10), the PED (Profile of emotional distress). We also used a survey (6 items) in T0, T1 and T2 to evaluate exposure, perception, quality of life and burnout. Results ![]()
table 1,2,3. BIPQ: no one was exposed. Conclusions The increase of individual, who seeking help for mental health, impact on the perception of stress and on the emotional distress, even though psychiatrists have an adequate perception of COVID-19.
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Silva A, Politi P, Brondino N, Olivola M. Efficacy of IV immunoglobulins on depressive symptoms and self-injury: A case report. Eur Psychiatry 2021. [PMCID: PMC9480233 DOI: 10.1192/j.eurpsy.2021.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Some studies in literature highlight the correlation between immune-mediated inflammatory processes and psychiatric pathologies. However, there are few studies about the efficacy of IV immunoglobulins in psychiatric features (1). (1) ZUNSZAIN, Patricia A.; HEPGUL, Nilay; PARIANTE, Carmine M. Inflammation and depression. In: Behavioral neurobiology of depression and its treatment. Springer, Berlin, Heidelberg, 2012. p. 135-151. Objectives Case report: a 39 year patient diagnosed with borderline personality disorder and myasthenia was hospitalized for self-injury ideation, acting out and depressive episode treated with acid valproic, aripiprazole, gabapentin; flare-up of myasthenia that needed treatment. Methods Clinical and test evaluation was performed in three stages: before (t0), immediately after (t1) and 3 weeks after (t2) the administration of the IgEV without other treatment modifications. We have used: - Inventory of Statements About Self-Injury (ISAS) - Barrat Impulsiveness Scale, Version 11 (BIS-11) - Hamilton Anxiety Rating Scale (HAM-A) - Montgomery-Asberg Depression Rating Scale (MADRS) - Alexian Brothers Urge to Selfe-Injure Scale (ABUSI) Results The patient has a score of 79 at BIS-11. She used to have a huge number of acting aout as we see on ISAS (Fig.1).![]() ![]() Conclusions We observed a reduction in non-suicidal self-injurious ideation, the suspension of acting-out, a complete remission of depressive symptoms with mild persistence of anxious symptoms immediately after the administration of immunoglobulins, and the remission continue until one month after the administration (Fig.2). Disclosure No significant relationships.
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Ferretti F, Gualtieri G, Bossini L, Olivola M, Del Matto L, Desantis S, Fagiolini A, Pozza A, Coluccia A. Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender. Perspect Psychiatr Care 2021; 57:761-769. [PMID: 32853435 DOI: 10.1111/ppc.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/02/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Posttraumatic stress disorder (PTSD) includes different symptoms: re-experiencing, avoidance of reminders and numbing, and hyperarousal. Although questionnaires are widely used, clinician-administered interviews provide a more comprehensive exploration of symptoms. Few studies examined the convergence between clinician-rated and patient-reported general severity and symptoms, with mixed findings. We explored the association between clinician-rated and patient-reported general severity and symptoms and the moderator role of gender in PTSD patients referred to a specialized outpatient service. DESIGN AND METHODS The Clinician-Administered PTSD Scale and Davidson Trauma Scale were administered to 56 patients. FINDINGS Patients classified by clinicians as with higher avoidance/numbing symptoms and women classified with higher hyperarousal symptoms reported higher general severity. PRACTICE IMPLICATIONS The assessment of the patients reporting high severity should focus on hyperarousal, particularly for women.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Letizia Bossini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Miriam Olivola
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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Ferretti F, Pozza A, Bossini L, Desantis S, Olivola M, Del Matto L, Gualtieri G, Gusinu R, Bezzini D, Fagiolini A, Coluccia A. Post-traumatic stress disorder in Italy: a comprehensive evaluation of all the ICD comorbidities and gender-related differences. BMC Res Notes 2019; 12:747. [PMID: 31730479 PMCID: PMC6858635 DOI: 10.1186/s13104-019-4792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/11/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives The association between post-traumatic stress disorder (PTSD) and medical comorbidities is controversial since most studies focused on specific comorbidity and victim types. In Italy, data on this issue are scarce. A comprehensive evaluation of all the ICD medical categories co-occurring in PTSD may orient assessment and treatment during clinical and forensic practice. This is the first study evaluating all the ICD physical comorbidities and gender-related differences in Italian PTSD patients. Eighty-four PTSD patients (36 females, 48 males) were included. The Clinician-Administered PTSD Scale, Mini International Neuropsychiatric Interview and Davidson Trauma Scale were administered. Results Most patients had a PTSD consequent to an accident and half of them presented extreme symptom severity. No gender differences emerged on symptom severity/duration and age at the event. Metabolic (39.29%), circulatory (20.24%) and musculoskeletal systems/connective tissue diseases (17.86%) were the most frequent comorbidities. Metabolic/circulatory diseases were more frequent among males (p = 0.019 and p = 0.027, respectively) while females more frequently showed neoplasms (p = 0.039). Physical comorbidities represent a serious complication in PTSD patients and are more prevalent than in the Italian population. While gender is not associated with symptom presentation, it seems to play a key role in specific comorbidities including metabolic, circulatory and neoplastic diseases.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Letizia Bossini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Miriam Olivola
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Giacomo Gualtieri
- Health Service Management Board, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Roberto Gusinu
- Health Service Management Board, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy
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Pozza A, Bossini L, Ferretti F, Olivola M, Del Matto L, Desantis S, Fagiolini A, Coluccia A. The Effects of Terrorist Attacks on Symptom Clusters of PTSD: a Comparison with Victims of Other Traumatic Events. Psychiatr Q 2019; 90:587-599. [PMID: 31187353 DOI: 10.1007/s11126-019-09650-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the Post-Traumatic Stress Disorder (PTSD) literature, no study assessed differences in symptom clusters among victims of terrorist attacks (TA) as compared with victims of other traumatic events. Due to the intentional nature of the harm infliction, TA may be expected to produce more severe symptoms, particularly avoidance, since this cluster was found to be a severity marker and a maintenance factor of the disorder. As several patients delay treatment-seeking, duration of untreated illness (DUI) is another problem potentially influencing PTSD severity. The current study explored differences in PTSD symptom clusters as a function of the traumatic event type (TA compared with other events), DUI, and sex. One hundred-eight patients with primary PTSD were administered The Clinician Administered PTSD Scale. Mean DUI was approximately 12 years, irrespective of the event type. Patients who had experienced TA had significantly more severe Avoidance/Numbing symptoms and general PTSD severity than those who had experienced other events. No significant effects emerged for DUI and sex on all clusters. Timely recognition and intervention on PTSD may include community psychoeducation programs about its symptoms. Tailored intervention on TA-related PTSD may focus on Avoidance/Numbing by including medication and psychotherapeutic approaches for this symptom cluster.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy
| | - Letizia Bossini
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy.
| | - Miriam Olivola
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy
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Ferretti F, Pozza A, Bossini L, Del Matto L, Desantis S, Olivola M, Gualtieri G, Coluccia A, Fagiolini A. A comparison of physical comorbidities in patients with posttraumatic stress disorder developed after a terrorist attack or other traumatic event. J Neurosci Res 2019; 97:543-553. [PMID: 30623488 DOI: 10.1002/jnr.24373] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
No study investigated whether the presence of specific medical comorbidities is associated with the type of traumatic event, in particular with terrorist attack (TA). In a group of subjects with posttraumatic stress disorder (PTSD), the current study investigated the association between the types of traumatic event (TA vs. other traumatic event [OTE]) and medical comorbidities, controlling for sex and PTSD duration. The Mini International Neuropsychiatric Interview, the Clinician-Administered PTSD Scale, and the Davidson Trauma Scale were administered to 84 subjects diagnosed with PTSD. Thirty-nine were victims of TA and 45 victims of OTE. TA was associated with higher prevalence of neoplasms (β = 2.60, p = 0.02). Females were more protected than males from circulatory system comorbidities (β = 1.47, p = 0.04), while PTSD duration was associated with higher prevalence of such comorbidities (β = 0.005, p = 0.01). Females showed a higher prevalence of neoplasms than males (β = 2.50, p = 0.02). Female sex was protective against metabolic syndrome (β = -1.79, p = 0.02). Patients with PTSD due to TA and female patients should be considered for their higher prevalence of neoplasms, while male patients and those with higher symptom duration should be monitored for circulatory disease and metabolic syndrome. Symptom duration might be associated with circulatory and metabolic disease. Implications for tailored and timely psychopharmacological and psychotherapeutic intervention for PTSD are discussed focusing on these specific medical comorbidities.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Letizia Bossini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Miriam Olivola
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Giacomo Gualtieri
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
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Bossini L, Ilaria C, Koukouna D, Caterini C, Olivola M, Fagiolini A. PTSD in victims of terroristic attacks – a comparison with the impact of other traumatic events on patients’ lives. Psychiatr Pol 2016; 50:907-921. [DOI: 10.12740/pp/65742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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