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McCrone P, Young AH, Zahn R, Eberhard J, Wasserman D, Brambilla P, Balazs J, Caldas-de-Almeida J, Ulrichsen A, Carli V, Antunes A, Schiena G, Quoidbach V, Boyer P, Strawbridge R. Economic impact of reducing treatment gaps in depression. Eur Psychiatry 2023; 66:e57. [PMID: 37309907 PMCID: PMC10486252 DOI: 10.1192/j.eurpsy.2023.2415] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent across Europe. While evidence-based treatments exist, many people with MDD have their condition undetected and/or untreated. This study aimed to assess the cost-effectiveness of reducing treatment gaps using a modeling approach. METHODS A decision-tree model covering a 27-month time horizon was used. This followed a care pathway where MDD could be detected or not, and where different forms of treatment could be provided. Expected costs pertaining to Germany, Hungary, Italy, Portugal, Sweden, and the UK were calculated and quality-adjusted life years (QALYs) were estimated. The incremental costs per QALY of reducing detection and treatment gaps were estimated. RESULTS The expected costs with a detection gap of 69% and treatment gap of 50% were €1236 in Germany, €476 in Hungary, €1413 in Italy, €938 in Portugal, €2093 in Sweden, and €1496 in the UK. The incremental costs per QALY of reducing the detection gap to 50% ranged from €2429 in Hungary to €10,686 in Sweden. The figures for reducing the treatment gap to 25% ranged from €3146 in Hungary to €13,843 in Sweden. CONCLUSIONS Reducing detection and treatment gaps, and maintaining current patterns of care, is likely to increase healthcare costs in the short term. However, outcomes are improved, and reducing these gaps to 50 and 25%, respectively, appears to be a cost-effective use of resources.
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Affiliation(s)
- Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Judit Balazs
- Department of Developmental & Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Oslo New University College, Oslo, Norway
| | - Jose Caldas-de-Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Vigna E, Carli V, Hadlaczky G, Wasserman D. Exposure to body odours combined with the effect of mindfulness treatment in patients with depressive and social anxiety symptoms - A preliminary study. Eur Psychiatry 2022. [PMCID: PMC9567934 DOI: 10.1192/j.eurpsy.2022.1899] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction To understand the way chemistry influences human communication is important since the reaction to chemosignals has many implications for science and society. For instance, previous research showed a connection between olfaction and affective psychiatric disorders. Olfactory processing may be impaired in subject presenting depression symptoms (DEP). Furthermore, a heightened sensitivity to social odours has been shown in subject with social anxiety symptoms (SAD). This may be due to the partial overlap of brain areas which are involved in olfactory processing and the pathophysiology of these disorders. Yet, more detailed research on the olfactory processing is required. Objectives POTION is an EU funded project within the Horizon2020 initiative that aims to understand the nature of chemosignals in humans and their sphere of influence on social interaction. Within this project, we conducted a preliminary exploratory study examining whether the odours may be utilized to support positive outcomes of psychological therapy. It evaluates the catalyst effect of the odour conditions on the effectiveness of mindfulness meditation for SAD and DEP. Methods Thirty subjects per patient group (total=60) are randomly allocated to one exposure group (happy or fearful human body odour or clean air) and follow the intervention while being exposed to the odour. Psychological outcome is measured before and after the intervention through the State-Trait Anxiety Inventory and the Profile of Mood State questionnaires. Analysis of variance is performed to assess outcome differences between groups. Results Preliminary results on a subsample of 32 patients show a trend of deeper reduction of anxiety symptoms at post-treatment among odour-exposed groups compared to clean air (F(1,17)=11.08, p=0.004). Conclusions Final results on the complete sample will be available and presented at the time of the congress. Disclosure No significant relationships.
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Petros N, Hadlaczky G, Carletto S, Martínez S, Meyer B, Ostacoli L, Ottaviano M, Scilingo E, Carli V. Sociodemographic characteristics associated with an eHealth system designed to reduce depressive symptoms among patients with breast or prostate cancer: a prospective study. Eur Psychiatry 2022. [PMCID: PMC9566384 DOI: 10.1192/j.eurpsy.2022.452] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Electronic health (eHealth) interventions integrate different elements of care in treating and preventing mental ill-health in patients with somatic illnesses. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help in improving the usability of these e-health interventions. Objectives This study aimed to identify sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND e-health system, comprised of a mobile application and a sensorized shirt, developed to reduce co-morbid depressive symptoms in patients with breast or prostate cancer. Methods The study included 129 patients with a diagnosis of breast or prostate cancer who received the NEVERMIND system. Sociodemographic data were collected at baseline. Usability outcomes included the System Usability Scale (SUS), the Mobile Application Rating Scale: user version (uMARS), and a usage index. Results The analysis was based on 108 patients (68 breast cancer and 40 prostate cancer patients) who used the NEVERMIND system. The overall mean SUS score at 12-weeks was 73.4 with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8, and females scored the app higher than males (β coefficient= 0.16; p=.03, 95% CI 0.02 - 0.3). Females had significant lower usage (β coefficient= -0.13; p=.04, 95% CI -0.25 to -0.01) after adjusting for other covariates. Conclusions There was a higher favourability of the mobile application among females compared to males. However, males had significantly higher usage of the NEVERMIND system. The NEVERMIND system does not suffer from ‘digital divide’ where certain sociodemographic characteristics are more associated with higher usability. Disclosure No significant relationships.
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Charlier P, Malaurie J, Wasserman D, Carli V, Sarchiapone M, Dagenais-Everell C, Herve C. The EPA guidance on suicide treatment and prevention needs to be adjusted to fight the epidemics of suicide at the North Pole area and other autochthonous communities. Eur Psychiatry 2017; 41:129-131. [PMID: 28152433 DOI: 10.1016/j.eurpsy.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022] Open
Abstract
More and more, youth suicide in the Inuit community is gaining importance, with a frequency in Greenland rising from 14.4 (1960-64) to 110.4 per 100,000 person-years (2010-11). The huge cultural/educational changes during the last 20 years and the role of globalization, especially of the occidental influence on this community may be at the origin of such an "epidemics" of suicide in this cultural region. Recently, a political organization representing the Inuit community in Canada (ITK for Inuit Tapiriit Kanatami) launched a National Inuit Suicide Prevention Strategy (NISP) based on the specificities of this community in comparison to the occidental civilization. In fact, not only the Canadian Inuit community is concerned by this epidemics of suicide, but also many other autochthonous groups. In this context, the European Psychiatric Association (EPA) guidance on suicide treatment and prevention needs to be adjusted to autochthonous individuals' needs.
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Affiliation(s)
- P Charlier
- UVSQ/EA 4569, Paris-Descartes University, 78180 Paris, France; CASH & IPES, 92000 Nanterre, France.
| | | | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill (NASP), Karolinska Institute, Stockholm, Sweden
| | - V Carli
- National Centre for Suicide Research and Prevention of Mental Ill (NASP), Karolinska Institute, Stockholm, Sweden
| | - M Sarchiapone
- Medicine and health Science Department, University of Molise, Via De Santis, 86100 Campobasso, Italy
| | - C Dagenais-Everell
- UVSQ/EA 4569, Paris-Descartes University, 78180 Paris, France; McGill University, Montreal, Canada
| | - C Herve
- UVSQ/EA 4569, Paris-Descartes University, 78180 Paris, France; CASH & IPES, 92000 Nanterre, France
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Gorodetsky E, Carli V, Sarchiapone M, Roy A, Goldman D, Enoch MA. Predictors for self-directed aggression in Italian prisoners include externalizing behaviors, childhood trauma and the serotonin transporter gene polymorphism 5-HTTLPR. Genes Brain Behav 2016; 15:465-73. [PMID: 27062586 DOI: 10.1111/gbb.12293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/24/2016] [Accepted: 04/04/2016] [Indexed: 12/16/2022]
Abstract
Suicidal behavior and self-mutilation can be regarded as the expression of self-directed aggression and both are common in prison populations. We investigated the influence of externalizing behaviors, depressive symptoms, childhood trauma, 5-HTTLPR variants on self-directed aggression (N = 145) in a group of 702 male Italian prisoners. Participants were comprehensively evaluated, including for psychiatric disorders, impulsive traits, lifetime aggressive behavior [Brown-Goodwin Lifetime History of Aggression (BGHA)], hostility, violent behavior during incarceration, depressive symptomatology [Hamilton Depression Rating Scale (HDRS)], childhood trauma [Childhood Trauma Questionnaire (CTQ)]. Logistic regression analysis showed false discovery rate corrected independent main effects of externalizing behaviors: BGHA (P = 0.001), violent behavior in jail (P = 0.007), extraversion (P = 0.015); HDRS (P = 0.0004), Axis I disorders (P = 0.015), CTQ (P = 0.004) and 5-HTTLPR genotype (P = 0.02). Carriers of 5-HTTLPR high (LA LA ), intermediate (LA LG , SLA ) activity variants were more likely to have exhibited self-directed aggression relative to the low activity (LG LG , SLG , SS) variant: high/low: odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.27-4.68, P = 0.007; intermediate/low: OR = 1.96, 95% CI 1.09-3.68, P = 0.025. The CTQ main effect was driven by physical abuse. There was no interactive effect of 5-HTTLPR and CTQ. Secondary logistic regression analyses in (1) all suicide attempters (N = 88) and (2) all self-mutilators (N = 104), compared with controls showed that in both groups, childhood trauma (P = 0.008-0.01), depression (P = 0.0004-0.001) were strong predictors. BGHA, violent behavior in jail predicted self-mutilation (P = 0.002) but not suicide attempts (P = 0.1). This study was able to distinguish differing influences on self-directed aggression between groups of closely related predictor variables within the externalizing behavioral domain. 5-HTTLPR had an independent, variant dosage effect.
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Affiliation(s)
- E Gorodetsky
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD, USA
| | - V Carli
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - M Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Institute of Health for Migration and Poverty, Rome, Italy
| | - A Roy
- Veterans Affairs Medical Center, Psychiatry Service, East Orange, NJ, USA
| | - D Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD, USA
| | - M-A Enoch
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD, USA
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Fleischmann A, Arensman E, Berman A, Carli V, De Leo D, Hadlaczky G, Howlader S, Vijayakumar L, Wasserman D, Saxena S. Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Glob Ment Health (Camb) 2016; 3:e5. [PMID: 28596874 PMCID: PMC5314741 DOI: 10.1017/gmh.2015.27] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 01/07/2023] Open
Abstract
Globally, over 800 000 people died by suicide in 2012 and there are indications that for each adult who died of suicide there were likely to be many more attempting suicide. There are many millions of people every year who are affected by suicide and suicide attempts, taking into consideration the family members, friends, work colleagues and communities, who are bereaved by suicide. In the WHO Mental Health Action Plan 2013-2020, Member States committed themselves to work towards the global target of reducing the suicide rate in countries by 10% by 2020. Hence, the first-ever WHO report on suicide prevention, Preventing suicide: a global imperative, published in September 2014, is a timely call to take action using effective evidence-based interventions. Their relevance for low- and middle-income countries is discussed in this paper, highlighting restricting access to means, responsible media reporting, introducing mental health and alcohol policies, early identification and treatment, training of health workers, and follow-up care and community support following a suicide attempt.
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Affiliation(s)
- A. Fleischmann
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - E. Arensman
- Department of Epidemiology and Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - A. Berman
- American Association of Suicidology, USA
| | - V. Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - D. De Leo
- Australian Institute for Suicide Research and Prevention, Brisbane, Australia
| | - G. Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Howlader
- University of Melbourne, Melbourne, Australia
| | | | - D. Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Burón P, Jimenez-Trevino L, Saiz PA, García-Portilla MP, Corcoran P, Carli V, Fekete S, Hadlaczky G, Hegerl U, Michel K, Sarchiapone M, Temnik S, Värnick A, Verbanck P, Wasserman D, Schmidtke A, Bobes J. Reasons for Attempted Suicide in Europe: Prevalence, Associated Factors, and Risk of Repetition. Arch Suicide Res 2016; 20:45-58. [PMID: 26726966 DOI: 10.1080/13811118.2015.1004481] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.
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Barzilay S, Feldman D, Snir A, Apter A, Carli V, Hoven CW, Wasserman C, Sarchiapone M, Wasserman D. The interpersonal theory of suicide and adolescent suicidal behavior. J Affect Disord 2015; 183:68-74. [PMID: 26001665 DOI: 10.1016/j.jad.2015.04.047] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Joiner's interpersonal theory of suicide (IPTS) proposes that suicide results from the combination of a perception of burdening others, social alienation, and the capability for self-harm. The theory gained some empirical support, however the overall model has yet to be tested. This study aimed to test the main predictions of IPTS in a large community sample of Israeli adolescents. METHOD 1196 Israeli Jewish and Arab high-school pupils participating in the SEYLE project completed a self-report questionnaire measuring perceived burdensomeness, thwarted belongingness, health risk behaviors, and non-suicidal self-injury (risk variables), and suicidal ideation and suicide attempts (outcome measures). The data were tested in cross-sectional regression models. RESULTS Consistent with IPTS, perceived burdensomeness was found to interact with thwarted belongingness, predicting suicidal ideation. Depression mediated most of the effect of thwarted belongingness and perceived burdensomeness on suicidal ideation. Acquired capability for self-harm, as measured by health risk behaviors and direct non-suicidal self-injurious behaviors, predicted suicide attempt. However, this mechanism operated independently from ideation rather than in interaction with it, at variance with IPTS-based predictions. LIMITATIONS The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs. CONCLUSION The findings support some of the IPTS predictions but not all, and imply two separate pathways for suicidal behavior in adolescents: one related to internalizing psychopathology and the other to self-harm behaviors. This conceptualization has clinical implications for the differential identification of adolescents at risk for suicidal behavior and for the development of prevention strategies.
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Affiliation(s)
- S Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel.
| | - D Feldman
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - A Snir
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - A Apter
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V Carli
- National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - C W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - C Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Health Sciences, University of Molise, Campobasso, Italy
| | - M Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy "d'Annunzio University" Foundation, Chieti, Italy
| | - D Wasserman
- National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Banzer R, Haring C, Buchheim A, Oehler S, Carli V, Hoven C, Wasserman C, Sarchiapone M, Kaess M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Kahn J, Postuvan V, Värnik A, Wasserman D. Risk Factors and Comorbidities for Occasional and Daily Smoking in European Adolescents: Results of the Seyle Project. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30404-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Cotter P, Corcoran P, McCarthy J, O'Suilleabháin F, Carli V, Hoven C, Wasserman C, Sarchiapone M, Wasserman D, Keeley H. Victimisation and psychosocial difficulties associated with sexual orientation concerns: a school-based study of adolescents. Ir Med J 2014; 107:310-313. [PMID: 25551899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined victimisation, substance misuse, relationships, sexual activity, mental health difficulties and suicidal behaviour among adolescents with sexual orientation concerns in comparison to those without such concerns. 1112 Irish students (mean age 14 yrs) in 17 mixed-gender secondary schools completed a self-report questionnaire with standardised scales and measures of psychosocial difficulties. 58 students (5%) reported having concerns regarding their sexual orientation. Compared with their peers, they had higher levels of mental health difficulties and a markedly-increased prevalence of attempted suicide (29% vs. 2%), physical assault (40% vs. 8%), sexual assault (16%vs. 1%) and substance misuse. Almost all those (90%) with sexual orientation concerns reported having had sex compared to just 4% of their peers. These results highlight the significant difficulties associated with sexual orientation concerns in adolescents in Ireland. Early and targeted interventions are essential to address their needs.
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Affiliation(s)
- P Cotter
- National Suicide Research Foundation, University College Cork
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Gorodetsky E, Bevilacqua L, Carli V, Sarchiapone M, Roy A, Goldman D, Enoch MA. The interactive effect of MAOA-LPR genotype and childhood physical neglect on aggressive behaviors in Italian male prisoners. Genes Brain Behav 2014; 13:543-9. [PMID: 24805005 DOI: 10.1111/gbb.12140] [Citation(s) in RCA: 27] [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] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/25/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Abstract
Aggressive disorders are moderately heritable; therefore, identification of genetic influences is important. The X-linked MAOA gene, encoding the MAOA enzyme, has a functional 30 bp repeat polymorphism in the promoter region (MAOA-LPR) that has been shown to influence aggression. Childhood trauma is a known risk factor for numerous psychopathologies in adulthood including aggressive behaviors. We investigated the interactive effect of MAOA-LPR genotype and a history of childhood trauma in predicting aggressive behaviors in a prisoner population. A total of 692 male prisoners were genotyped for MAOA-LPR with genotypes grouped into high and low transcriptional activity. Participant evaluations included measures of aggression (Brown-Goodwin Lifetime History of Aggression, BGHA), hostility (Buss-Durkee Hostility Inventory), impulsivity (Barratt Impulsiveness Scale), violence directed toward self and others, and childhood trauma [Childhood Trauma Questionnaire (CTQ)]. MAOA-LPR interacted with CTQ physical neglect (PN), the most common (47%) form of childhood trauma in this sample, to predict BGHA aggression (P = 0.002). Within the group not exposed to PN, carriers of the MAOA-LPR high-activity variant were more aggressive: (tR = 2.47, P < 0.014). We observed a crossover effect in that the increase in aggression scores with PN was greater in low-activity individuals (tR = 5.55, P < 0.0001) than in high-activity individuals (tR = 4.18, P < 0.0001). These findings suggest that childhood trauma and the functional MAOA-LPR polymorphism may interact to specifically increase risk for over aggressive behavior but not impulsivity or hostility. The MAOA-LPR low-activity variant may be protective against the development of aggressive behavior under low stress conditions, at least in this prisoner population.
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Affiliation(s)
- E Gorodetsky
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD, USA
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Carli V, Hadlaczky G, Hökby S, Sarchiapone M, Wasserman D. EPA-1480 – Suicide prevention by internet and media based mental health promotion (supreme). Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Nemes B, Cozman D, Carli V, Sarchiapone M, Hoven C, Wasserman C, Wasserman D. EPA-0695 - Family disintegration due to workforce migration and suicidal behavior in adolescents. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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D'Aulerio M, Carli V, Iosue M, Basilico F, Recchia L, Apter A, Balazs J, Bobes J, Brunner R, Cosman D, Kahn J, Postuvan V, Saiz P, Varnik A, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. EPA-1110 - Association between truancy and suicidality among european young. preliminary data from an italian sample. we-stay project. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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D'Aulerio M, Carli V, Iosue M, Basilico F, Angela Maria D, Recchia L, Balazs J, Germanavicius A, Waller T, Masip C, Varnik A, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. EPA-1120 - Objective and methodologies of supreme.project for youth suicide prevention through internet and media. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bernini G, Carrara D, Bacca A, Carli V, Virdis A, Rugani I, Duranti E, Ghiadoni L, Bernini M, Taddei S. Effect of acute and chronic vitamin D administration on systemic renin angiotensin system in essential hypertensives and controls. J Endocrinol Invest 2013; 36:216-20. [PMID: 23645099 DOI: 10.1007/bf03347275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To investigate the systemic renin-angiotensin system (RAS) in essential hypertensives (EH) and controls (C) after short- and long-term vitamin D receptor activation. DESIGN Ten consecutive EH (under controlled low-salt diet) and 10 C underwent calcitriol administration (0.25 μg bid) for 1 week (Group A). Eighteen consecutive EH under angiotensin II receptor antagonist therapy received a single oral dose of 300,000 IU of cholecalciferol and were followed up for 8 weeks (Group B). METHODS In basal conditions and at the end of the study (1 week in Group A and 8 weeks in Group B), plasma renin activity (PRA), plasma active renin, aldosterone, and angiotensin II were evaluated, as well as blood pressure, plasma 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D], and PTH. RESULTS In Group A, plasma 25(OH)D levels in EH and C were below the normal range, although lower levels were found in the former. No association between basal plasma 25(OH)D or 1,25(OH)2D levels and blood pressure values or RAS components was observed either in the whole group or in the two subgroups. Calcitriol administration did not affect any RAS parameter either in EH or in C. In Group B, cholecalciferol significantly increased 25(OH)D and 1,25(OH)2D levels without interfering with the angiotensin II receptor antagonist-induced increase in RAS components. No correlation was found between plasma 25(OH)D or 1,25(OH)2D levels and blood pressure values or RAS parameters before and after cholecalciferol administration. CONCLUSIONS The present data suggest that, in our experimental conditions, vitamin D receptor activation is unable to influence systemic RAS activity.
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Affiliation(s)
- G Bernini
- Department of Internal Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
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Brunner R, Kaess M, Parzer P, Fischer G, Resch F, Carli V, Hoven C, Wasserman C, Sarchiapone M, Wasserman D. 3038 – Characteristics of non-suicidal self-injury and suicide attempts among adolescents in europe: results from the european research consortium seyle. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)77531-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Carli V, Wasserman C, Sarchiapone M, Hoven C, Wasserman D. 2577 – Prevalence of risk behaviours and psychopathology among european youth. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)77247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Durkee T, Kaess M, Carli V, Sarchiapone M, Wasserman C, Hoven C, Wasserman D. 1672 – Pathological internet use among european adolescents: psychopathology and self-destructive behaviors. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76661-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Carli V, Durkee T, Wasserman D, Hadlaczky G, Despalins R, Kramarz E, Wasserman C, Sarchiapone M, Hoven CW, Brunner R, Kaess M. The association between pathological internet use and comorbid psychopathology: a systematic review. Psychopathology 2013; 46:1-13. [PMID: 22854219 DOI: 10.1159/000337971] [Citation(s) in RCA: 335] [Impact Index Per Article: 30.5] [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: 07/26/2011] [Accepted: 02/25/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pathological Internet use (PIU) has been conceptualized as an impulse-control disorder that shares characteristics with behavioral addiction. Research has indicated a potential link between PIU and psychopathology; however, the significance of the correlation remains ambiguous. The primary objective of this systematic review was to identify and evaluate studies performed on the correlation between PIU and comorbid psychopathology; the secondary aims were to map the geographical distribution of studies, present a current synthesis of the evidence, and assess the quality of available research. SAMPLING AND METHODS An electronic literature search was conducted using the following databases: MEDLINE, PsycARTICLES, PsychINFO, Global Health, and Web of Science. PIU and known synonyms were included in the search. Data were extracted based on PIU and psychopathology, including depression, anxiety, symptoms of attention deficit and hyperactivity disorder (ADHD), obsessive-compulsive symptoms, social phobia and hostility/aggression. Effect sizes for the correlations observed were identified from either the respective publication or calculated using Cohen's d or R(2). The potential effect of publication bias was assessed using a funnel plot model and evaluated by Egger's test based on a linear regression. RESULTS The majority of research was conducted in Asia and comprised cross-sectional designs. Only one prospective study was identified. Twenty articles met the preset inclusion and exclusion criteria; 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessive-compulsive symptoms, and 66% with hostility/aggression. No study reported associations between PIU and social phobia. The majority of studies reported a higher rate of PIU among males than females. The relative risks ranged from an OR of 1.02 to an OR of 11.66. The strongest correlations were observed between PIU and depression; the weakest was hostility/aggression. CONCLUSIONS Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Associations were reported to be higher among males in all age groups. Limitations included heterogeneity in the definition and diagnosis of PIU. More studies with prospective designs in Western countries are critically needed.
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Affiliation(s)
- V Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at Karolinska Institutet, Stockholm, Sweden
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D’aulerio M, Carli V, Iosue M, Basilico F, De Marco A, Recchia L, Balazs J, Germanavicius A, Hamilton R, Masip C, Mschin N, Varnik A, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. 1849 – Young and suicide prevention programs through internet and media: supreme. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Nemes B, Cozman D, Wasserman D, Carli V, Sarchiapone M, Wasserman C, Hoven C. 1639 – Social intolerance and risk-taking behaviors in european adolescents. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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D’Aulerio M, Carli V, Iosue M, Basilico F, Recchia L, Apter A, Balazs J, Bobes J, Brunner R, Cosman D, Kahn J, Postuvan V, Saiz P, Varnik A, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. 1827 – Prevalence of risk behaviours among european young. preliminary data from an italian sample we-stay project. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Carli V, Mandelli L, Zaninotto L, Roy A, Recchia L, Stoppia L, Gatta V, Sarchiapone M, Serretti A. A protective genetic variant for adverse environments? The role of childhood traumas and serotonin transporter gene on resilience and depressive severity in a high-risk population. Eur Psychiatry 2012; 26:471-8. [PMID: 21684723 DOI: 10.1016/j.eurpsy.2011.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 01/19/2011] [Revised: 04/22/2011] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Genetic aspects may influence the effect of early adverse events on psychological well being in adulthood. In particular, a common polymorphism within the serotonin transporter gene (5-HTTLPR short/long) has been associated to the risk for stress-induced psychopathology. In the present study we investigated the role of childhood traumas and 5-HTTLPR on measures of psychological resilience and depression in a sample of individuals at a high risk for psychological distress (763 male prisoners). The 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. In particular, among subjects exposed to severe childhood trauma only, the long-allele was associated to lower resilience scores and increased current depressive severity as compared to short/short homozygous. Sex specific effects, difference in type and duration of stressors and the specific composition of the sample may explain discrepancy with many studies reporting the short-allele as a vulnerability factor for reactivity to stress. We here speculated that in males the long-allele may confer lower resilience and therefore higher vulnerability for depressive symptoms in subjects exposed to early stress and currently living in stressful environments.
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Affiliation(s)
- V Carli
- Department of Health Sciences, University of Molise, Campobasso, Italy
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26
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Bernini G, Bacca A, Carli V, Carrara D, Materazzi G, Berti P, Miccoli P, Pisano R, Tantardini V, Bernini M, Taddei S. Cardiovascular changes in patients with primary aldosteronism after surgical or medical treatment. J Endocrinol Invest 2012; 35:274-80. [PMID: 21422805 DOI: 10.3275/7611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Data on the cardiovascular middle-term follow-up of patients with primary aldosteronism (PA) are scanty. AIM To detect the cardiovascular effects of surgery in patients with aldosterone (ALD)-producing adenoma (APA) and of pharmacotherapy in those with bilateral adrenal hyperplasia (BAH), a prospective study involving 60 consecutive patients with PA was performed. MATERIAL/ METHODS: Clinical, biochemical, and cardiovascular assessment was obtained before and after (31.5±4.4 months) surgery or proper medical treatment (32.1±5.0 months) in 19 and 41 patients, respectively. RESULTS As expected, plasma ALD normalized in all operated patients, while in the other group it did not change. Systolic and diastolic blood pressure decreased (p<0.001) after both treatments. However, absolute and percentage reduction was significantly more pronounced (p<0.01) in operated than in non-operated patients. Left ventricular (LV) mass showed significant reduction after surgery (LV mass g/m(2), p<0.0007; LV mass g/m(2.7), p<0.01), but no change after medical treatment, so that the differences between absolute and percentage values at follow- up were statistically significant (p<0.01) between groups. Basal LV mass/m(2.7) was positively associated with age (p<0.009), body mass index (p<0.0008), drug number (p<0.03), and ALD/plasma renin activity ratio (p<0.01). Allocating the patients according to plasma ALD and cardiac parameters, patients who presented ALD reduction during the study also had a decrement in cardiac mass (p<0.04). CONCLUSIONS Our data indicate that in patients with PA the removal of ALD excess by surgery in APA is effective in reducing blood pressure and in improving cardiac parameters, while anti-hypertensive therapy in BAH shows less positive impact on cardiovascular system.
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Affiliation(s)
- G Bernini
- Department of Internal Medicine, University of Pisa, Pisa, Italy.
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Basilico F, Carli V, Iosue M, D’Aulerio M, Di Domenico A, Recchia L, Sarchiapone M. P-1410 - Internet and the media for the prevention of suicide among european youngs. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75577-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Carli V. W08-01 - The supreme project: objectives and methodology. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sarchiapone M, Wasserman C, Carli V, Hoven C, Wasserman D. AS24-01 - Suicide and affective disorders in adolescents, preliminary results from the seyle project. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74020-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Balazs J, Miklósi M, Keresztény Á, Apter A, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Kahn JP, Postuvan V, Resch F, Varnik A, Sarchiapone M, Hoven C, Wasserman C, Carli V, Wasserman D. P-259 - Prevalence of adolescent depression in Europe. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74426-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Wasserman D, Rihmer Z, Rujescu D, Sarchiapone M, Sokolowski M, Titelman D, Zalsman G, Zemishlany Z, Carli V. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur Psychiatry 2011; 27:129-41. [PMID: 22137775 DOI: 10.1016/j.eurpsy.2011.06.003] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [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: 04/11/2011] [Revised: 06/07/2011] [Accepted: 06/13/2011] [Indexed: 10/14/2022] Open
Abstract
UNLABELLED Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. SUICIDAL CRISIS: Acute intervention should start immediately in order to keep the patient alive. DIAGNOSIS An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. TREATMENT Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT TEAM: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. FAMILY: The suicidal person independently of age should always be motivated to involve family in the treatment. SOCIAL SUPPORT: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. SAFETY A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. TRAINING OF PERSONNEL: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.
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Affiliation(s)
- D Wasserman
- The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
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Carli V, Mandelli L, Zaninotto L, Gatta V, Stuppia L, Serretti A, Sarchiapone M. GXE interaction as a protective factor: 5HTTR and bad environment. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73866-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Early traumatic experiences have been consistently associated with a higher risk to develop psychopathological symptoms in adulthood. Resilience, a trait reflecting tolerance of negative affect, positive acceptance of change and an action-oriented approach to problem solving, has been hypothesized to be a protective factor against stressors. Genetic aspects have been also hypothesized influencing resilience to stress and risk to develop psychopathological symptoms in response to both early and recent adverse events. In particular, a common polymorphism within the gene coding for serotonin transporter (5-HTTLPR s/l) has been consistently associated to the risk to develop depressive-anxious symptoms in response to stressful life events. In the present study we aimed to investigate the role of childhood traumas and 5-HTTLPR on measures of resilience and depression in a sample of individuals at a high risk for psychological distress.A large sample of male prisoners was investigated (n = 1516). 5-HTTLPR genotype was available for 762 individuals. Overall, childhood traumas were significantly correlated to poor resilience and more severe depressive symptoms. 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. Contrary to expectations, s/s individuals exposed to a high number of early traumas had a current higher resilience and less depressive symptoms than l-allele carriers. Present data did not confirm the 5-HTTLPR s-allele as the genetic risk variant for psychopathology in individuals exposed to stressors.
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Bernini M, Bacca A, Casto G, Carli V, Cupisti A, Carrara D, Farnesi I, Barsotti G, Naccarato AG, Bernini G. A case of pheochromocytoma presenting as secondary hyperaldosteronism, hyperparathyroidism, diabetes and proteinuric renal disease. Nephrol Dial Transplant 2011; 26:1104-7. [DOI: 10.1093/ndt/gfq747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carli V, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. W02-02 - Saving and empowering young lives in Europe (SEYLE): a European project for mental health promotion among European adolescents. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Martinotti G, Carli V, Tedeschi D, Di Giannantonio M, Roy A, Janiri L, Sarchiapone M. Mono- and polysubstance dependent subjects differ on social factors, childhood trauma, personality, suicidal behaviour, and comorbid Axis I diagnoses. Addict Behav 2009; 34:790-3. [PMID: 19446962 DOI: 10.1016/j.addbeh.2009.04.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/08/2009] [Accepted: 04/21/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND The study aimed to examine the clinical correlates of polysubstance dependence. SUBJECTS AND METHODS Seven hundred and fifty two substance-dependent subjects were interviewed with the Mini-International Neuropsychiatric Interview, the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA), and the Hamilton Depression Rating Scale (HDRS). Subjects completed the Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), and Barratt Impulsivity Scale (BIS). Subjects found to have polysubstance dependence were compared with subjects with monosubstance dependence. RESULTS Polysubstance dependence was found in 48.3% of the subjects. Subjects with polysubstance dependence were significantly younger, more were separated/divorced and unemployed, and they had significantly higher CTQ scores for childhood emotional and physical neglect, higher EPQ psychoticism scores, higher BGLHA aggression scores, and higher BIS impulsivity scores. Significantly more of the polysubstance dependent subjects had attempted suicide, self-mutilated, and exhibited aggressive behavior. Significantly more monosubstance dependent subjects had an Axis I psychiatric disorder and they had higher HDRS depression scores. CONCLUSIONS Polysubstance dependence is common among the groups studied and may be associated with certain socio-demographic, developmental, and personality factors.
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Affiliation(s)
- G Martinotti
- Institute of Psychiatry, Catholic University Medical School, Rome, Italy.
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Sarchiapone M, Jovanović N, Roy A, Podlesek A, Carli V, Amore M, Mancini M, Marušič A. Relations of psychological characteristics to suicide behaviour: Results from a large sample of male prisoners. Personality and Individual Differences 2009. [DOI: 10.1016/j.paid.2009.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zarrilli F, Angiolillo A, Castaldo G, Chiariotti L, Keller S, Sacchetti S, Marusic A, Zagar T, Carli V, Roy A, Sarchiapone M. Brain derived neurotrophic factor (BDNF) genetic polymorphism (Val66Met) in suicide: a study of 512 cases. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:599-600. [PMID: 18759323 DOI: 10.1002/ajmg.b.30849] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sarchiapone M, Marusic A, Carli V, Cuomo C. Risk factors and vulnerability to suicidal behavior. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Uccellini D, Grampa G, La Spina I, Nasuelli D, Neromante I, Politini L, Reverberi F, Porazzi D, Carli V, Camardese G. Mirtazapine in the treatment of essential tremor: an open-label, observer-blind study. Neuropsychiatr Dis Treat 2006; 2:95-100. [PMID: 19412450 PMCID: PMC2671731] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Essential tremor (ET) is the most common movement disorder in the adult population. At present ET treatment shows limited efficacy, particularly in patients with severe and disabling symptoms. This study evaluates the clinical efficacy of mirtazapine in an untreated ET patient population. MATERIALS AND METHODS 30 ET patients (female/male = 19/11; average age = 71.4 +/- 8.3 years) were examined by clinical criteria, electromyographic (EMG), and apomorphine tests to study the cortical silent period. The patients were all treated with mirtazapine 30 mg daily. RESULTS Mirtazapine proved to be a good control agent for tremor symptomatology in 23/27 patients (85%) who completed 1 month of treatment, with a marked reduction of tremor; the benefit was maintained during the 12-month follow-up. No significant variation in EMG parameters was observed aside from two prevalent and distinct frequencies of tremors (5-6 Hz and 7-8 Hz) and a group of selected patients whose cortical silent period (SP) was markedly reduced. There were no clinical differences between the two subgroups. All apomorphine-tested patients showed an SP with no significant modifications. CONCLUSIONS Mirtazapine proved to be an efficacious drug treatment for tremor symptoms in patients suffering from ET. It had limited side effects and excellent overall tolerability, could be used as daily monotherapy, and did not interfere with any of the many other medications being taken simultaneously by the patients.
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Affiliation(s)
- Davide Uccellini
- UO di Neurologia, AO "Ospedale di Circolo di Busto A", Busto Arsizio Varese, Italy.
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Fuoco R, Giannarelli S, Onor M, Ceccarini A, Carli V. Optimized cleanup methods of organic extracts for the determination of organic pollutants in biological samples. Microchem J 2005. [DOI: 10.1016/j.microc.2004.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sarchiapone M, Amore M, De Risio S, Carli V, Faia V, Poterzio F, Balista C, Camardese G, Ferrari G. Mirtazapine in the treatment of panic disorder: an open-label trial. Int Clin Psychopharmacol 2003; 18:35-8. [PMID: 12490773 DOI: 10.1097/00004850-200301000-00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this open label trial was to evaluate mirtazapine tolerability and effectiveness in controlling symptomatology of patients with panic disorder. Forty-five patients with panic disorder, with or without agoraphobia, 11 of them with a comorbid diagnosis of major depression, were included. Patients were assessed with a structured psychiatric interview and their symptomatology evaluated with specific psychometric scales. Three study participants dropped out due to adverse events. Mirtazapine was administered at an established dose of 30 mg daily for 3 months. Patients were assessed at weeks 2 and 4, and then at monthly intervals. All psychometric measures showed statistically significant reductions in total scores at the rated time points, with a pronounced decline in number and intensity of panic attacks and anticipatory anxiety throughout the study. Mirtazapine was well tolerated as signified by the low discontinuation rate (6.3%), and all patients showed a significant symptomatic improvement. The improvement did not appear to be linked to the concurrent presence of a depressive illness.
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Affiliation(s)
- M Sarchiapone
- Institute of Psychiatry, Catholic University of Sacred Heart, Rome, Italy
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Sarchiapone M, Camardese G, Carli V, Barbarino E, De Risio S. S09.01 Treatment protocol of suicidal behavior in a day hospital setting. Eur Psychiatry 2000. [DOI: 10.1016/s0924-9338(00)93965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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