1
|
Ferrara M, Basaldella M, Vacca F, Woods SW, Walsh BC, Cannon TD, Srihari VH, Grassi L. The Italian adaptation of the Mini-SIPS, a tool for early detection of individuals at clinical high risk and first episode of psychosis: A preliminary study of implementation in an Italian FEP program. Early Interv Psychiatry 2024. [PMID: 38769052 DOI: 10.1111/eip.13548] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/26/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
AIMS The study aims are to present the Italian adaptation of the Abbreviated Clinical Structured Interview for DSM-5 Attenuated Psychosis Syndrome (Mini-SIPS) and illustrate its implementation in a clinical setting. METHODS The Mini-SIPS was developed from the original extended version as a tool designed to identify, within the clinical high risk (CHR) framework, the DSM-5 Attenuated Psychosis Syndrome (APS) and to be implemented in clinical settings. The Mini-SIPS was translated in Italian by a Yale-certified SIPS trainer, then back-translated in English by a trained psychologist, then approved by the Mini-SIPS authors. Since September 2021, the adapted Italian version of the Mini-SIPS has been implemented at the First Episode Psychosis (FEP) Program in Ferrara, Italy. RESULTS The Italian version of Mini-SIPS was successfully administered to 15 individuals subsequently referred to the First Episode Psychosis service in Ferrara. Within this sample, the tool has proven to be both an effective and efficient tool for the identification of CHR and FEP, and a valid instrument to help with the differential diagnosis. It also performed as a valuable guide for retrieving information about psychiatric history, to date the onset of APS and/or full-blown psychosis, to track the progression from CHR to psychosis or to symptoms resolution and to describe patients' pathways to care. CONCLUSION The Mini-SIPS is an efficient and easy-to-use interview to identify the early stages of psychosis and established psychosis in clinical contexts. The Italian adaptation of this interview could be effectively implemented in other Italian FEP Programs as a screening and monitoring tool. Formal validation of the instrument is needed to assessed validity and reliability in the diagnosis of the CHR and FEP.
Collapse
Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Health Authority (AUSL), Ferrara, Italy
- Department of Psychiatry, Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marta Basaldella
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Francesca Vacca
- Department of Mental Health and Pathological Addictions, Modena Health Authority (AUSL), Modena, Italy
| | - Scott W Woods
- Department of Psychology, Yale University, New Haven, USA
| | | | | | - Vinod H Srihari
- Department of Mental Health and Pathological Addictions, Modena Health Authority (AUSL), Modena, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Health Authority (AUSL), Ferrara, Italy
| |
Collapse
|
2
|
Nicholls-Mindlin J, Hazan H, Zhou B, Li F, Ferrara M, Levine N, Riley S, Karmani S, Mathis WS, Keshavan MS, Srihari V. The Anomalous Effect of COVID-19 Pandemic Restrictions on the Duration of Untreated Psychosis (DUP). medRxiv 2024:2024.05.09.24306737. [PMID: 38766117 PMCID: PMC11100924 DOI: 10.1101/2024.05.09.24306737] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
We investigated the impact of COVID-19 restrictions on the duration of untreated psychosis (DUP). First-episode psychosis admissions (n=101) to STEP Clinic in Connecticut showed DUP reduction (p=.0015) in the pandemic, with the median reducing from 208 days during the pre-pandemic to 56 days in the early pandemic period and subsequently increasing to 154 days (p=.0281). Time from psychosis onset to anti-psychotic prescription decreased significantly in the pandemic (p=.0183), with the median falling from 117 to 35 days. This cohort study demonstrates an association between greater pandemic restrictions and marked DUP reduction and provides insights for future early detection efforts.
Collapse
|
3
|
Venkataraman S, Hazan H, Li F, Ferrara M, Harper A, Ma J, Shah J, Musket C, Levine N, Keshavan MS, Srihari V. Role of Early Psychosis Detection in the Relationship Between Personal Income and Duration of Untreated Psychosis. Psychiatr Serv 2024; 75:427-433. [PMID: 38204369 DOI: 10.1176/appi.ps.20230239] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Prolonged duration of untreated psychosis (DUP) predicts poor outcomes of first-episode psychosis (FEP) and is often linked to low socioeconomic status (SES). The authors sought to determine whether patients' personal income, used as a proxy for SES, predicts length of DUP and whether personal income influences the effect of an early psychosis detection campaign-called Mindmap-on DUP reduction. METHODS Data were drawn from a trial that compared the effectiveness of early detection in reducing DUP across the catchment area of an FEP service (N=147 participants) compared with an FEP service with no early detection (N=75 participants). Hierarchical regression was used to determine whether personal income predicted DUP when analyses controlled for effects of age, race, and exposure to early psychosis detection. A group × personal income interaction term was used to assess whether the DUP difference between the early detection and control groups differed by personal income. RESULTS Lower personal income was significantly associated with younger age, fewer years of education, Black race, and longer DUP. Personal income predicted DUP beyond the effects of age, race, and early psychosis detection. Although Mindmap significantly reduced DUP across all income levels, this effect was smaller for participants reporting lower personal income. CONCLUSIONS Patients' personal income may be an important indicator of disparity in access to specialty care clinics across a wide range of settings. Early detection efforts should measure and target personal income and other SES indicators to improve access for all individuals who may benefit from FEP services.
Collapse
Affiliation(s)
- Shruthi Venkataraman
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Hadar Hazan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Fangyong Li
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Maria Ferrara
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Annie Harper
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jessica Ma
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jai Shah
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Christie Musket
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Nina Levine
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Matcheri S Keshavan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Vinod Srihari
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| |
Collapse
|
4
|
Vuolanto P, Almeida AN, Anderson A, Auvinen P, Beja A, Bracke P, Cardano M, Ceuterick M, Correia T, De Vito E, Delaruelle K, Delicado A, Esposito M, Ferrara M, Gariglio L, Guerreiro C, Marhánková JH, Hilário AP, Hobson-West P, Iorio J, Järvinen KM, Koivu A, Kotherová Z, Kuusipalo A, Lermytte E, Mendonça J, Morais R, Numerato D, Polak P, Rudek T, Sbaragli S, Scavarda A, Silva K, da Silva PA, Sivelä J, Moura ES, Świątkiewicz-mośny M, Tipaldo G, Wagner A. Trust matters: The Addressing Vaccine Hesitancy in Europe Study. Scand J Public Health 2024; 52:379-390. [PMID: 38346923 PMCID: PMC11067405 DOI: 10.1177/14034948231223791] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 05/04/2024]
Abstract
This article presents the design of a seven-country study focusing on childhood vaccines, Addressing Vaccine Hesitancy in Europe (VAX-TRUST), developed during the COVID-19 pandemic. The study consists of (a) situation analysis of vaccine hesitancy (examination of individual, socio-demographic and macro-level factors of vaccine hesitancy and analysis of media coverage on vaccines and vaccination and (b) participant observation and in-depth interviews of healthcare professionals and vaccine-hesitant parents. These analyses were used to design interventions aimed at increasing awareness on the complexity of vaccine hesitancy among healthcare professionals involved in discussing childhood vaccines with parents. We present the selection of countries and regions, the conceptual basis of the study, details of the data collection and the process of designing and evaluating the interventions, as well as the potential impact of the study. Laying out our research design serves as an example of how to translate complex public health issues into social scientific study and methods.
Collapse
Affiliation(s)
- Pia Vuolanto
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | | | | | - Petra Auvinen
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - André Beja
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - Piet Bracke
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Mario Cardano
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Melissa Ceuterick
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Tiago Correia
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - Elisabetta De Vito
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Katrijn Delaruelle
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Ana Delicado
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Maurizio Esposito
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Maria Ferrara
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Luigi Gariglio
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Cátia Guerreiro
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | | | | | - Pru Hobson-West
- University of Nottingham, School of Sociology and Social Policy, UK
| | - Juliana Iorio
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Katri-Maria Järvinen
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Annariina Koivu
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Zuzana Kotherová
- Charles University, Faculty of Social Sciences, the Czech Republic
| | - Aapo Kuusipalo
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Esther Lermytte
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Joana Mendonça
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Rita Morais
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Dino Numerato
- Charles University, Faculty of Social Sciences, the Czech Republic
| | - Paulina Polak
- Jagiellonian University, Institute of Sociology, Poland
| | - Tadeusz Rudek
- Jagiellonian University, Institute of Sociology, Poland
| | - Sara Sbaragli
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Alice Scavarda
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Katielle Silva
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | | | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Cultural, Behavioural and Media Insights Center, Finland
| | - Eva Soares Moura
- Charles University, Faculty of Social Sciences, the Czech Republic
| | | | - Giuseppe Tipaldo
- University of Turin, Department of Cultures, Politics and Society, Italy
| | | |
Collapse
|
5
|
Szmulewicz AG, Martínez-Alés G, Logan R, Ferrara M, Kelly C, Fredrikson D, Gago J, Conderino S, Díaz-Caneja CM, Galvañ J, Thorpe L, Srihari V, Yatham L, Sarpal DK, Shinn AK, Arango C, Öngür D, Hernán MA, Fep-Causal Collaboration OBOT. Antipsychotic drugs in first-episode psychosis: A target trial emulation in the FEP-CAUSAL Collaboration. Am J Epidemiol 2024:kwae029. [PMID: 38576166 DOI: 10.1093/aje/kwae029] [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: 05/04/2023] [Revised: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
Good adherence to antipsychotic therapy helps prevent relapses in First Episode Psychosis (FEP). We used data from the FEP-CAUSAL Collaboration, an international consortium of observational cohorts to emulate a target trial comparing antipsychotics with treatment discontinuation as the primary outcome. Other outcomes included all-cause hospitalization. We benchmarked our results to estimates from EUFEST, a randomized trial conducted in the 2000s. We included 1097 patients with a psychotic disorder and less than 2 years since psychosis onset. Inverse probability weighting was used to control for confounding. The estimated 12-month risks of discontinuation for aripiprazole, first-generation agents, olanzapine, paliperidone, quetiapine, and risperidone (95% CI) were: 61.5% (52.5-70.6), 73.5% (60.5-84.9), 76.8% (67.2-85.3), 58.4% (40.4-77.4), 76.5% (62.1-88.5), and 74.4% (67.0-81.2) respectively. Compared with aripiprazole, the 12-month risk differences (95% CI) were -15.3% (-30.0, 0.0) for olanzapine, -12.8% (-25.7, -1.0) for risperidone, and 3.0% (-21.5, 30.8) for paliperidone. The 12-month risks of hospitalization were similar between agents. Our estimates support use of aripiprazole and paliperidone as first-line therapies for FEP. Benchmarking yielded similar results for discontinuation and absolute risks of hospitalization as in the original trial, suggesting that data from the FEP-CAUSAL Collaboration data sufficed to approximately remove confounding for these clinical questions.
Collapse
Affiliation(s)
| | | | - Roger Logan
- CAUSALab, Department of Epidemiology, Harvard TH Chan School of Public Health
| | - Maria Ferrara
- USA Department of Psychiatry, Yale School of Medicine, USA
| | - Christian Kelly
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Juan Gago
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Sarah Conderino
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Joaquín Galvañ
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Lorna Thorpe
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Vinod Srihari
- USA Department of Psychiatry, Yale School of Medicine, USA
| | | | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ann K Shinn
- McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry
- Harvard Medical School, Boston, MA, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dost Öngür
- McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry
- Harvard Medical School, Boston, MA, USA
| | - Miguel A Hernán
- CAUSALab, Department of Epidemiology, Harvard TH Chan School of Public Health
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
| | | |
Collapse
|
6
|
Wierenga LM, Ruigrok A, Aksnes ER, Barth C, Beck D, Burke S, Crestol A, van Drunen L, Ferrara M, Galea LAM, Goddings AL, Hausmann M, Homanen I, Klinge I, de Lange AM, Geelhoed-Ouwerkerk L, van der Miesen A, Proppert R, Rieble C, Tamnes CK, Bos MGN. Recommendations for a Better Understanding of Sex and Gender in the Neuroscience of Mental Health. Biol Psychiatry Glob Open Sci 2024; 4:100283. [PMID: 38312851 PMCID: PMC10837069 DOI: 10.1016/j.bpsgos.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 02/06/2024] Open
Abstract
There are prominent sex/gender differences in the prevalence, expression, and life span course of mental health and neurodiverse conditions. However, the underlying sex- and gender-related mechanisms and their interactions are still not fully understood. This lack of knowledge has harmful consequences for those with mental health problems. Therefore, we set up a cocreation session in a 1-week workshop with a multidisciplinary team of 25 researchers, clinicians, and policy makers to identify the main barriers in sex and gender research in the neuroscience of mental health. Based on this work, here we provide recommendations for methodologies, translational research, and stakeholder involvement. These include guidelines for recording, reporting, analysis beyond binary groups, and open science. Improved understanding of sex- and gender-related mechanisms in neuroscience may benefit public health because this is an important step toward precision medicine and may function as an archetype for studying diversity.
Collapse
Affiliation(s)
- Lara Marise Wierenga
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Amber Ruigrok
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Eira Ranheim Aksnes
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dani Beck
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sarah Burke
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arielle Crestol
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lina van Drunen
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Liisa Ann Margaret Galea
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Lise Goddings
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Markus Hausmann
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Inka Homanen
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Ineke Klinge
- Dutch Society for Gender & Health, the Netherlands
- Gendered Innovations at European Commission, Brussels, Belgium
| | - Ann-Marie de Lange
- Laboratory for Research in Neuroimaging, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Lineke Geelhoed-Ouwerkerk
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Anna van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ricarda Proppert
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Carlotta Rieble
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Christian Krog Tamnes
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Marieke Geerte Nynke Bos
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| |
Collapse
|
7
|
Benrimoh D, Dlugunovych V, Wright AC, Phalen P, Funaro MC, Ferrara M, Powers AR, Woods SW, Guloksuz S, Yung AR, Srihari V, Shah J. Correction: On the proportion of patients who experience a prodrome prior to psychosis onset: a systematic review and meta-analysis. Mol Psychiatry 2024:10.1038/s41380-024-02481-0. [PMID: 38351175 DOI: 10.1038/s41380-024-02481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- David Benrimoh
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, Stanford University, Stanford, CA, USA.
| | | | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Sinan Guloksuz
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology Maastricht University Medical Center, Maastricht, Netherlands
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Australia
| | - Vinod Srihari
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Jai Shah
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada
| |
Collapse
|
8
|
Toffanin T, Cattarinussi G, Ghiotto N, Lussignoli M, Pavan C, Pieri L, Schiff S, Finatti F, Romagnolo F, Folesani F, Nanni MG, Caruso R, Zerbinati L, Belvederi Murri M, Ferrara M, Pigato G, Grassi L, Sambataro F. Effects of electroconvulsive therapy on cortical thickness in depression: a systematic review. Acta Neuropsychiatr 2024:1-15. [PMID: 38343196 DOI: 10.1017/neu.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is one of the most studied and validated available treatments for severe or treatment-resistant depression. However, little is known about the neural mechanisms underlying ECT. This systematic review aims to critically review all structural magnetic resonance imaging studies investigating longitudinal cortical thickness (CT) changes after ECT in patients with unipolar or bipolar depression. METHODS We performed a search on PubMed, Medline, and Embase to identify all available studies published before April 20, 2023. A total of 10 studies were included. RESULTS The investigations showed widespread increases in CT after ECT in depressed patients, involving mainly the temporal, insular, and frontal regions. In five studies, CT increases in a non-overlapping set of brain areas correlated with the clinical efficacy of ECT. The small sample size, heterogeneity in terms of populations, comorbidities, and ECT protocols, and the lack of a control group in some investigations limit the generalisability of the results. CONCLUSIONS Our findings support the idea that ECT can increase CT in patients with unipolar and bipolar depression. It remains unclear whether these changes are related to the clinical response. Future larger studies with longer follow-up are warranted to thoroughly address the potential role of CT as a biomarker of clinical response after ECT.
Collapse
Affiliation(s)
- Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Niccolò Ghiotto
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Chiara Pavan
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Luca Pieri
- Department of Medicine, University of Padova, Padua, Italy
| | - Sami Schiff
- Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Finatti
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Francesca Romagnolo
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giorgio Pigato
- Department of Psychiatry, Padova University Hospital, Padua, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| |
Collapse
|
9
|
Ferrara M, Zaffarami G, Simonelli G, Domenicano I, Vecchioni L, Toffanin T, Folesani F, Zotos S, Scrignoli C, Bertelli R, Carozza P, Grassi L. Dimensions and predictors of clinical and personal recovery in first-episode psychoses: Results from a cross-sectional study. Early Interv Psychiatry 2024. [PMID: 38318707 DOI: 10.1111/eip.13513] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION First episode psychosis (FEP) services ensure higher recovery rates compared to usual care. The aim of this study was to investigate the different dimensions of recovery and its predictors. METHODS This cross-sectional study recruited within those admitted to the Ferrara FEP service since 2012 that at the time of analysis were still receiving psychiatric care. At admission, demographic, social and clinical information were collected. In September 2022, patients were assessed with the Health of the Nation Outcome Scale to evaluate clinical/functional recovery, the Recovery Assessment Scale to evaluate personal recovery, and the G12 item of the Positive and Negative Syndrome Scale to evaluate insight. Patients in recovery were compared to those not in recovery by bivariate analyses. Adjusted logistic regressions were performed to investigate predictors of recovery. RESULTS Within 141 admitted, and 105 still receiving care, 54 patients completed the assessment. Most (51.9%) were in clinical/functional, 61.1% in personal recovery, and 38.8% both. Psychiatric hospitalization positively predicted clinical/functional recovery, whereas being prescribed oral antipsychotics was a negative predictor. Personal recovery was predicted by male sex and showed a negative association with overall severity of symptomatology. Those in personal recovery were more likely to have been prescribed long-acting antipsychotics, but this was not significant in the multivariable analysis. Poor insight negatively predicted clinical/functional recovery but had no impact on personal recovery. CONCLUSION Our findings confirm that clinical/functional and personal recovery are semi-independent dimensions and not always overlap. Further research is needed to promote interventions targeted at all recovery dimensions.
Collapse
Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Giulia Zaffarami
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Gabriele Simonelli
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Ludovica Vecchioni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Spyridon Zotos
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Chiara Scrignoli
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Raffaella Bertelli
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Paola Carozza
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| |
Collapse
|
10
|
Benrimoh D, Dlugunovych V, Wright AC, Phalen P, Funaro MC, Ferrara M, Powers AR, Woods SW, Guloksuz S, Yung AR, Srihari V, Shah J. On the proportion of patients who experience a prodrome prior to psychosis onset: A systematic review and meta-analysis. Mol Psychiatry 2024:10.1038/s41380-024-02415-w. [PMID: 38302562 DOI: 10.1038/s41380-024-02415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Preventing or delaying the onset of psychosis requires identification of those at risk for developing psychosis. For predictive purposes, the prodrome - a constellation of symptoms which may occur before the onset of psychosis - has been increasingly recognized as having utility. However, it is unclear what proportion of patients experience a prodrome or how this varies based on the multiple definitions used. METHODS We conducted a systematic review and meta-analysis of studies of patients with psychosis with the objective of determining the proportion of patients who experienced a prodrome prior to psychosis onset. Inclusion criteria included a consistent prodrome definition and reporting the proportion of patients who experienced a prodrome. We excluded studies of only patients with a prodrome or solely substance-induced psychosis, qualitative studies without prevalence data, conference abstracts, and case reports/case series. We searched Ovid MEDLINE, Embase (Ovid), APA PsycInfo (Ovid), Web of Science Core Collection (Clarivate), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, APA PsycBooks (Ovid), ProQuest Dissertation & Thesis, on March 3, 2021. Studies were assessed for quality using the Critical Appraisal Checklist for Prevalence Studies. Narrative synthesis and proportion meta-analysis were used to estimate prodrome prevalence. I2 and predictive interval were used to assess heterogeneity. Subgroup analyses were used to probe sources of heterogeneity. (PROSPERO ID: CRD42021239797). RESULTS Seventy-one articles were included, representing 13,774 patients. Studies varied significantly in terms of methodology and prodrome definition used. The random effects proportion meta-analysis estimate for prodrome prevalence was 78.3% (95% CI = 72.8-83.2); heterogeneity was high (I2 97.98% [95% CI = 97.71-98.22]); and the prediction interval was wide (95% PI = 0.411-0.936). There were no meaningful differences in prevalence between grouped prodrome definitions, and subgroup analyses failed to reveal a consistent source of heterogeneity. CONCLUSIONS This is the first meta-analysis on the prevalence of a prodrome prior to the onset of first episode psychosis. The majority of patients (78.3%) were found to have experienced a prodrome prior to psychosis onset. However, findings are highly heterogenous across study and no definitive source of heterogeneity was found despite extensive subgroup analyses. As most studies were retrospective in nature, recall bias likely affects these results. While the large majority of patients with psychosis experience a prodrome in some form, it is unclear if the remainder of patients experience no prodrome, or if ascertainment methods employed in the studies were not sensitive to their experiences. Given widespread investment in indicated prevention of psychosis through prospective identification and intervention during the prodrome, a resolution of this question as well as a consensus definition of the prodrome is much needed in order to effectively direct and organize services, and may be accomplished through novel, densely sampled and phenotyped prospective cohort studies that aim for representative sampling across multiple settings.
Collapse
Affiliation(s)
- David Benrimoh
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, Stanford University, Stanford, CA, USA.
| | | | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Sinan Guloksuz
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology Maastricht University Medical Center, Maastricht, Netherlands
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Australia
| | - Vinod Srihari
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Jai Shah
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada
| |
Collapse
|
11
|
Hazan H, Ferrara M, Riley S, Li F, Zhou B, Kline E, Gibbs-Dean T, Karmani S, Tayfur SN, Tek C, Keshavan M, Srihari V. The impact of early detection (ED) campaigns on care presentations: Beyond DUP reduction. Schizophr Res 2024; 264:457-461. [PMID: 38266513 PMCID: PMC10923115 DOI: 10.1016/j.schres.2024.01.022] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/13/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
We examined the effects of an early detection (ED) campaign (Mindmap), that successfully shortened the duration of untreated psychosis (DUP), on patient presentation profiles at two receiving coordinated specialty care (CSC) services. Data were collected between 2015 and 2019 during a test of ED delivered at one CSC (STEP, n = 147) compared to usual detection at another CSC (PREP, n = 63). Regression models were used to test the effects of ED and DUP on presentation. Before the launch of ED, there were no differences in presentation between STEP and PREP. However, the ED changed the profile of presentations to STEP such that patients were admitted with better negative and total symptoms scores, but worse GAF current and GAF social and with a greater decline in function over the prior year (GAF-Δ). Site-by-time interaction effects were not significant. During the campaign years, STEP vs. PREP recruited patients with better negative and total symptoms, GAF role, and pre-morbid adjustment scores but with worse positive symptoms, GAF current, and GAF-Δ. Nonetheless, mediation analysis revealed that DUP reduction accounted for very little (<8 %) of these differences in presentation. Early detection campaigns while successfully reducing access delays, can have salutary effects on presentation independent of DUP reduction.
Collapse
Affiliation(s)
- Hadar Hazan
- Yale Medical School, United States of America.
| | | | - Sarah Riley
- Yale Medical School, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences, United States of America
| | - Bin Zhou
- Yale Center for Analytical Sciences, United States of America
| | | | | | | | | | - Cenk Tek
- Yale Medical School, United States of America
| | | | | |
Collapse
|
12
|
Ferrara M, Curtarello EMA, Gentili E, Domenicano I, Vecchioni L, Zese R, Alberti M, Franchini G, Sorio C, Benini L, Little J, Carozza P, Dazzan P, Grassi L. Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry. Arch Womens Ment Health 2024; 27:11-20. [PMID: 37730924 DOI: 10.1007/s00737-023-01371-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia-spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (27.7%) or personality disorder (24.3%) in men and depression (24%) and delusional disorder (30.1%) in women. After the index date, long-acting antipsychotics and clozapine were more frequently prescribed to men (46.5% vs. 36.3%; 13.2% vs. 9.4%, p < 0.05) and mood stabilizers and antidepressants to women (24.3% vs. 21.1%; 50.1% vs. 35.5%; p < 0.05). Women had fewer involuntary admissions (10.1% vs. 13.6%) and were more likely to be discharged as the time under care increased (p = 0.009). After adjusting for covariates, sex was not a significant predictor of discharge. Our study confirmed that sex differences exist in clinical and sociodemographic characteristics of outpatients with SSD and that gender considerations might influence the rapidity of diagnosis and medications prescribed. These findings highlight the need to implement a women-tailored approach in specialist care programs for psychoses.
Collapse
Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | | | - Elisabetta Gentili
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Ludovica Vecchioni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Riccardo Zese
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Marco Alberti
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Giorgia Franchini
- Department of Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Sorio
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Lorenzo Benini
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Julian Little
- School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paola Carozza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC), London, UK
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| |
Collapse
|
13
|
Lo Moro G, Ferrara M, Langiano E, Accortanzo D, Cappelletti T, De Angelis A, Esposito M, Prinzivalli A, Sannella A, Sbaragli S, Vuolanto P, Siliquini R, De Vito E. Countering vaccine hesitancy: a systematic review of interventions to strengthen healthcare professionals' action. Eur J Public Health 2023; 33:905-915. [PMID: 37581903 PMCID: PMC10567238 DOI: 10.1093/eurpub/ckad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is relevant for healthcare professionals (HCPs) who face challenges in building trusting relationships with patients. Accordingly, the VAX-TRUST project has been developed to improve experiences of HCPs and patients dealing with vaccinations. To support VAX-TRUST, this work aimed to identify latest interventions targeted at HCPs to address hesitancy and increase vaccine uptake. METHODS A systematic review was conducted according to PRISMA by searching PubMed, Scopus and Embase. The protocol was registered on PROSPERO. Articles were eligible if evaluated interventions directly targeted at HCPs/healthcare students. The search was run on 26 January 2022. Articles published in 2016 or after were included. RESULTS A total of 17 492 records were identified; 139 articles were selected. Most articles were set in USA (n = 110). Over half had a pre-post design without a control group (n = 78). A total of 41 articles focused on single-component interventions, 60 on multi-component interventions involving only HCPs and/or students and 38 on multi-component interventions involving also other professionals. Main components were in-person education (n = 76), synchronous (n = 10) and asynchronous (n = 23) online learning, educational materials (n = 26), performance assessment and feedback (n = 33), electronic record changes (n = 30), role play/simulation (n = 21) and online games/apps (n = 5). Educational sessions were mainly about scientific update or communication. Outcomes of interventions were grouped in: vaccination rates (n = 69), knowledge (n = 32), attitudes (n = 26), confidence in counselling (n = 30) and acceptability (n = 16). CONCLUSIONS Apps, gaming, role play/simulations could represent innovative interventions. This review highlighted the need of delving into communication strategies and using more robust evaluations, longer follow-up and standardized measurements.
Collapse
Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Maria Ferrara
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Elisa Langiano
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Davide Accortanzo
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Toni Cappelletti
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Aldo De Angelis
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Maurizio Esposito
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | | | - Alessandra Sannella
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Sara Sbaragli
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Pia Vuolanto
- Research Centre for Knowledge, Science, Technology and Innovation Studies of Tampere University, Tampere, Finland
| | - Roberta Siliquini
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
- AOU City of Health and Science of Turin, Turin, Italy
| | - Elisabetta De Vito
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| |
Collapse
|
14
|
Ferrara M, Guloksuz S, Hazan H, Li F, Tek C, Sykes LY, Riley S, Keshavan M, Srihari VH. The effect of duration of untreated psychosis (DUP) on the risk for hospitalization after admission to a first episode service. Schizophr Res 2023; 260:198-204. [PMID: 37688984 DOI: 10.1016/j.schres.2023.08.005] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/11/2023]
Abstract
Engagement with a first episode-psychosis service (FES) reduces the risk of psychiatric hospitalization. However, the role of the duration of untreated psychosis (DUP) in impacting this outcome is disputed. This study aimed to examine whether DUP was an effect modifier of the post-FES reduction of risk of hospitalization, and to explore associations between patients' characteristics and hospitalization post-FES. Individuals aged 16-35 with recent onset (< 3 years) of non-affective psychosis, admitted to the Program for Specialized Treatment Early in Psychosis (STEP), a FES serving the Greater New Haven area, Connecticut, between 2014 and 2019 were included (N = 189). Medical records were queried from 2013 through 2020 for number and duration of psychiatric hospitalizations. Poisson regression models were used to estimate incidence rate ratios for hospitalization rates across all explanatory variables. Negative binomial regression was used to compare the length of stay (LOS) before vs after STEP enrollment. STEP admission was associated with a significant 90 % reduction in the frequency and duration of hospitalizations. This effect was moderated by DUP: with 30-day prolongations in components of DUP (supply, demand, and total) there was less reduction in hospitalizations and LOS after FES enrollment (p < .0001). Only DUP supply (time from first antipsychotic use to STEP admission) differentiated those who were hospitalized during the first year after STEP enrollment from those who were not (median: 35 vs. 15 weeks, p = .003). To fully harness the positive impact of FES on hospitalization, a detailed effort should be pursued to reduce all DUP components.
Collapse
Affiliation(s)
- Maria Ferrara
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America; University of Ferrara, Department of Neuroscience and Rehabilitation, Ferrara, Italy.
| | - Sinan Guloksuz
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hadar Hazan
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), Yale School of Public Health, New Haven, CT, United States of America
| | - Cenk Tek
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Laura Yoviene Sykes
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Sarah Riley
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Vinod H Srihari
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| |
Collapse
|
15
|
Zicarelli F, Tudisco R, Lotito D, Musco N, Iommelli P, Ferrara M, Calabrò S, Infascelli F, Lombardi P. Forage:Concentrate Ratio Effects on In Vivo Digestibility and In Vitro Degradability of Horse's Diet. Animals (Basel) 2023; 13:2589. [PMID: 37627380 PMCID: PMC10452004 DOI: 10.3390/ani13162589] [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: 07/17/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Determination of digestibility represents the first step for the evaluation of the net energy content of feed for livestock animals. The aim of this study was to evaluate the in vivo digestibility and in vitro degradability of five diets characterized by different forage/concentrate ratios (F:C) in horses. The in vitro degradability was determined by the Gas Production Technique (GPT), using as an inoculum source the feces of the same subjects used for the in vivo test. Five diets consisting of poliphyte hay, straw and grains of barley and oats with a different F:C ratio [90/10 (Diet 1); 78/22 (Diet 2); 68/32 (Diet 3); 60/40 (Diet 4); 50/50 (Diet 5) were formulated and administered in succession, starting with Diet 1. In the in vivo results, no significant differences emerged, despite the different F:C content. In in vitro fermentation, four diets out of the five (2, 3, 4, 5) presented a similar trend of the curve of gas production, showing good activity of the fecal micro population during the first hours of incubation. An important correlation between gas and Volatile Fatty Acid (VFA) were found, suggesting that the processes linked to the micro population deriving from the horse's caecum follow metabolic pathways whose products can be modeled in the same way as for the rumen. The GPT could represent the correct method for studying the nutritional characteristics of feed for horses, using feces as the source of inoculum, even if further investigations must be performed to improve the technique.
Collapse
Affiliation(s)
| | | | | | - Nadia Musco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Napoli, Italy; (F.Z.); (P.I.); (M.F.); (F.I.); (P.L.)
| | | | | | | | | | | |
Collapse
|
16
|
Ferrara M, Gentili E, Belvederi Murri M, Zese R, Alberti M, Franchini G, Domenicano I, Folesani F, Sorio C, Benini L, Carozza P, Little J, Grassi L. Establishment of a Public Mental Health Database for Research Purposes in the Ferrara Province: Development and Preliminary Evaluation Study. JMIR Med Inform 2023; 11:e45523. [PMID: 37584563 PMCID: PMC10461404 DOI: 10.2196/45523] [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: 01/05/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 08/17/2023] Open
Abstract
Background The immediate use of data exported from electronic health records (EHRs) for research is often limited by the necessity to transform data elements into an actual data set. Objective This paper describes the methodology for establishing a data set that originated from an EHR registry that included clinical, health service, and sociodemographic information. Methods The Extract, Transform, Load process was applied to raw data collected at the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, from 1925 to February 18, 2021, to build the new, anonymized Ferrara-Psychiatry (FEPSY) database. Information collected before the first EHR was implemented (ie, in 1991) was excluded. An unsupervised cluster analysis was performed to identify patient subgroups to support the proof of concept. Results The FEPSY database included 3,861,432 records on 46,222 patients. Since 1991, each year, a median of 1404 (IQR 1117.5-1757.7) patients had newly accessed care, and a median of 7300 (IQR 6109.5-9397.5) patients were actively receiving care. Among 38,022 patients with a mental disorder, 2 clusters were identified; the first predominantly included male patients who were aged 25 to 34 years at first presentation and were living with their parents, and the second predominantly included female patients who were aged 35 to 44 years and were living with their own families. Conclusions The process for building the FEPSY database proved to be robust and replicable with similar health care data, even when they were not originally conceived for research purposes. The FEPSY database will enable future in-depth analyses regarding the epidemiology and social determinants of mental disorders, access to mental health care, and resource utilization.
Collapse
Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | | | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Riccardo Zese
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Alberti
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Giorgia Franchini
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Cristina Sorio
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Lorenzo Benini
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| |
Collapse
|
17
|
Vastolo A, Gizzarelli M, Ruggiero A, Alterisio MC, Calabrò S, Ferrara M, Cutrignelli MI. Effect of diet on postprandial glycemic and insulin responses in healthy dogs. Front Vet Sci 2023; 10:1201611. [PMID: 37533455 PMCID: PMC10391544 DOI: 10.3389/fvets.2023.1201611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Dog owners have gradually changed their approach, paying more attention to the nutrition and health of their animals. Various pet foods with different ingredients and nutritional characteristics are available on the market. The present study aimed to evaluate the administration of three diets, namely, two grain-free (GF1 and GF2) and one grain-based (CB), with different sources of carbohydrates that can influence the glycemic and insulin postprandial responses in healthy dogs. Materials Fifteen healthy dogs were dived in three groups and alternatively fed each diet for 50 days. Blood samples were collected at beginning of each feeding period. Glycemia and insulin were measured before and after 120, 240 and 360 minutes diet administration to evaluate postprandial responses. Results GF2 diet showed the highest level of albumin and mean insulin concentration (p < 0.001). Furthermore, the GF1 diet caused the smallest (p < 0.001) glucose and insulin area under the curve (AUC) and the lowest (p < 0.05) glucose nadir. Otherwise, GF1 showed the highest (p < 0.01) insulin time to peak. The GF2 diet showed the highest level of albumin while reporting the lowest amount of fructosamine (p < 0.05). The diet GF2 registered the highest (p < 0.001) level of insulin zenith. The cereal-based (CB) diet reported the highest amount of fructosamine (p < 0.05). The CB diet had the highest levels of glucose and the highest (p < 0.001) glucose and insulin mean concentrations. Diet CB reported the lowest (p < 0.001) insulin nadir. Discussion Diets with different carbohydrate sources and chemical compositions could modulate the glycemic response in healthy dogs. Bearing in mind that glycemic/insulin postprandial responses influence energy availability and that different dogs have specific lifestyles, it may be preferable to also consider these aspects when choosing a maintenance diet for animals.
Collapse
|
18
|
Di Girolamo L, Ferrara M, Trevisan G, Longo BM, Allice T, Burdino E, Alladio F, Fantino S, Di Perri G, Calcagno A, Bonora S. Transient plasma viral rebound after SARS-CoV-2 vaccination in an exceptional HIV-1 elite controller woman. Virol J 2023; 20:123. [PMID: 37312093 DOI: 10.1186/s12985-023-02086-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Elite controllers are able to control viral replication without antiretroviral therapy. Exceptional elite controllers do not show disease progression for more than 25 years. Different mechanisms have been proposed and several elements of both innate and adaptive immunity are implicated. Vaccines are immune stimulating agents that can promote HIV-RNA transcription; transient plasma HIV-RNA detectability has been described within 7-14 days after different vaccinations. The most reliable mechanism involved in virosuppressed people living with HIV is a generalized inflammatory response that activates bystander cells harboring latent HIV. So far no data about viral load increase in elite controllers after SARS-CoV-2 vaccination are reported in literature. CASE PRESENTATION We report the case of a 65-year-old woman of European ancestry, diagnosed with HIV-1/HCV co-infection more than 25 years ago. Since then, HIV-RNA remained undetectable and she never received ARV therapy. In 2021 she was vaccinated with mRNA-BNT162b2 vaccine (Pfizer-BioNTech®). She was administered with three doses in June, July and October 2021, respectively. The last available viral load was undetectable in March 2021. We observed an increase of VL at 32 cp/ml and 124 cp/mL, two and seven months after the second vaccine dose, respectively. During monthly follow-up, HIV-RNA gradually and spontaneously dropped becoming undetectable without ARV intervention. COVID-19 serology was positive with IgG 535 BAU/mL, showing response to vaccination. We measured total HIV-DNA at different time-points and we found it detectable both at the time of the higher plasma HIV-RNA (30 cp/10^6 PBMCs) and when it was undetectable (13 cp/10^6 PBMCs), in reduction. CONCLUSIONS This case is the first report, to our knowledge, describing a rebound of plasma HIV-RNA in an elite controller after three doses of mRNA-BNT162b2 vaccine for SARS-CoV-2. Concomitantly with a spontaneous reduction of plasma HIV-RNA ten months after the third dose of mRNA-BNT162b2 vaccine (Pfizer-BioNTech®) without antiretroviral therapy intervention, we observed a reduction of total HIV-DNA in peripheral mononuclear cells. The potential role of vaccinations in altering HIV reservoir, even in elite controllers when plasma HIV-RNA is undetectable, could be a valuable aspect to take into account for the future HIV eradication interventions.
Collapse
Affiliation(s)
- L Di Girolamo
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - M Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy.
| | - G Trevisan
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - B M Longo
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - T Allice
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital ASL Città di Torino, Turin, Italy
| | - E Burdino
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital ASL Città di Torino, Turin, Italy
| | - F Alladio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - S Fantino
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Corso Svizzera 164, Turin, 10149, Italy
| |
Collapse
|
19
|
Scollo P, Pecorino B, Scibilia G, Guardalà VFM, Ferrara M, Mereu L, D'Agate MG. Scollo's symmetric lateral levator myorrhaphy (SLLM) for correction of rectocele in six steps. Tech Coloproctol 2023; 27:497-498. [PMID: 36333612 DOI: 10.1007/s10151-022-02726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Affiliation(s)
- P Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy
| | - B Pecorino
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy.
| | - G Scibilia
- Department of Obstetrics and Gynecology, "Giovanni Paolo II" Hospital, Ragusa, Italy
| | - V F M Guardalà
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy
| | - M Ferrara
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy
| | - L Mereu
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy
| | - M G D'Agate
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore", Catania, Italy
| |
Collapse
|
20
|
Belvederi Murri M, Ferrara M, Imbesi M, Leuci E, Marchi M, Musella V, Natali A, Neri A, Ragni S, Saponaro A, Tarricone I, Tullini A, Starace F. A public early intervention approach to first-episode psychosis: Treated incidence over 7 years in the Emilia-Romagna region. Early Interv Psychiatry 2023. [PMID: 37221039 DOI: 10.1111/eip.13437] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/28/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
AIM To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. METHODS We computed the raw treated incidence in 2013-2019, based on FEP users aged 18-35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. RESULTS Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39-43.86; Imola: 3.07; 95% CrI: 1.61-4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = -0.09, p < .001), duration of untreated psychosis (R = -0.12, p < .001) and referral type. CONCLUSIONS The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP.
Collapse
Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Massimiliano Imbesi
- Department of Mental Health and Substance Abuse, AUSL Piacenza, Piacenza, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, AUSL Parma, Parma, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Musella
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
| | - Alba Natali
- Department of Mental Health and Pathological Addiction, AUSL Imola, Imola, Italy
| | - Anastasia Neri
- Department of Mental Health and Pathological Addiction, AUSL Ravenna, Ravenna, Italy
| | - Sabrina Ragni
- Department of Mental Health and Pathological Addiction, AUSL Cesena, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Andrea Tullini
- Department of Mental Health and Pathological Addiction, AUSL Rimini, Rimini, Italy
| | - Fabrizio Starace
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
| |
Collapse
|
21
|
Hagler MA, Ferrara M, Yoviene Sykes LA, Li F, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, Powers AR, Allen AR, Srihari VH, Woods SW. Sampling from different populations: Sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high-risk individuals who progressed to psychosis. Schizophr Res 2023; 255:239-245. [PMID: 37028205 PMCID: PMC10207144 DOI: 10.1016/j.schres.2023.03.047] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Over the past two decades, research and clinical resources on clinical high risk (CHR) for psychosis have both expanded, with goals to better understanding risk and protective factors on the course of illness and inform early intervention efforts. However, some studies have highlighted potential sampling bias among CHR research studies, raising questions about generalizability of findings and inequitable access to early detection and intervention. The current study sought to explore these questions by comparing 94 participants in a CHR longitudinal monitoring study across North America (NAPLS-2) who converted to syndromal psychosis over the course of the study (CHR-CV) to 171 participants who presented for treatment at a localized first-episode psychosis service (FES) after converting. CHR-CV participants were significantly more likely to be White and have a college-educated parent, while FES participants were more likely to be Black and first- or second-generation immigrants. On average, CHR-CV participants were younger at onset of attenuated positive symptoms, had a longer period of attenuated symptoms prior to conversion, and were more likely to be treated with antipsychotics prior to conversion compared to those in FES programs. After controlling for time since conversion, CHR-CV participants had higher global functioning and were less likely to have experienced recent psychiatric hospitalization. Findings suggest that CHR research and FES clinics may be sampling from different populations, although conclusions are limited by inconsistent sampling frames and methods. Integrated early detection that targets defined geographic catchments may deliver more epidemiologically representative samples to both CHR research and FES.
Collapse
Affiliation(s)
- Matthew A Hagler
- Department of Psychiatry, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry, Yale University, New Haven, CT, United States of America; Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Fangyong Li
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Adrienne R Allen
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| |
Collapse
|
22
|
Orgiani P, Chaluvadi SK, Chalil SP, Mazzola F, Jana A, Dolabella S, Rajak P, Ferrara M, Benedetti D, Fondacaro A, Salvador F, Ciancio R, Fujii J, Panaccione G, Vobornik I, Rossi G. Dual pulsed laser deposition system for the growth of complex materials and heterostructures. Rev Sci Instrum 2023; 94:033903. [PMID: 37012774 DOI: 10.1063/5.0138889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 06/19/2023]
Abstract
Here, we present an integrated ultra-high-vacuum (UHV) apparatus for the growth of complex materials and heterostructures. The specific growth technique is the Pulsed Laser Deposition (PLD) by means of a dual-laser source based on an excimer KrF ultraviolet and solid-state Nd:YAG infra-red lasers. By taking advantage of the two laser sources-both lasers can be independently used within the deposition chambers-a large number of different materials-ranging from oxides to metals, to selenides, and others-can be successfully grown in the form of thin films and heterostructures. All of the samples can be in situ transferred between the deposition chambers and the analysis chambers by using vessels and holders' manipulators. The apparatus also offers the possibility to transfer samples to remote instrumentation under UHV conditions by means of commercially available UHV-suitcases. The dual-PLD operates for in-house research as well as user facility in combination with the Advanced Photo-electric Effect beamline at the Elettra synchrotron radiation facility in Trieste and allows synchrotron-based photo-emission as well as x-ray absorption experiments on pristine films and heterostructures.
Collapse
Affiliation(s)
- P Orgiani
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - S K Chaluvadi
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - S Punathum Chalil
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - F Mazzola
- Department of Molecular Sciences and Nanosystems, Ca' Foscari University of Venice, 30172 Venice, Italy
| | - A Jana
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - S Dolabella
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - P Rajak
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - M Ferrara
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - D Benedetti
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - A Fondacaro
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - F Salvador
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - R Ciancio
- AREA Science Park, Padriciano 99, I-34149 Trieste, Italy
| | - J Fujii
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - G Panaccione
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - I Vobornik
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| | - G Rossi
- CNR-IOM Istituto Officina dei Materiali, TASC Laboratory, Area Science Park, S.S. 14, km 163.5, I-34149 Trieste, Italy
| |
Collapse
|
23
|
Gigliotti F, Di Santo F, Cesario S, Esposito D, Manti F, Galosi S, Ferrara M, Leuzzi V, Baglioni V. Psychogenic non-epileptic seizures and functional motor disorders in developmental age: A comparison of clinical and psychopathological features. Epilepsy Behav 2023; 140:109117. [PMID: 36804846 DOI: 10.1016/j.yebeh.2023.109117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Psychogenic Non-Epileptic Seizures (PNES) and Functional Motor Disorders (FMDs) commonly represent the main clinical manifestations of Functional Neurological Disorders (FNDs). Despite their high prevalence in pediatric neurological services, literature on this topic is still spare for this population. The present study aimed to deepen the clinical knowledge of a pediatric FNDs sample through a demographic and clinical characterization of the most recurrent clinical patterns during the pediatric age. Moreover, a comparison of neuropsychological and psychopathological profiles of PNES and FMD patients was carried out to identify specific vulnerabilities and therapeutic targets linked with these different clinical manifestations. MATERIALS AND METHODS A total of 43 FNDs patients (age range 7-17 years old) were retrospectively included in our study, enrolled in two subgroups: 20 with FMDs and 23 with PNES diagnosis. They were inpatients and outpatients referred over a period of 5 years and a standardized neurological, neuropsychological (WISC-IV/WAIS-IV), and psychiatric (CDI-2, MASC-2, ADES, DIS-Q, PID-5) evaluation was assessed. RESULTS In PNES patients the most common clinical phenotypes were functional tonic-clonic (52%) and atonic (32%) manifestations while in the FMDs group were gait alterations (60%), functional myoclonus (35%), and tremor (35%). A higher frequency of cognitive impairment was reported in PNES patients with higher anxiety-depressive symptom rates than FMDs patients. CONCLUSIONS Notably, specific neurocognitive and psychopathological profiles were described in PNES and FMDs, highlighting higher cognitive and psychiatric vulnerabilities in PNES, suggesting as well different strategy for therapeutic approaches.
Collapse
Affiliation(s)
- F Gigliotti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Di Santo
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Cesario
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - D Esposito
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Manti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Galosi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - M Ferrara
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Leuzzi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Baglioni
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| |
Collapse
|
24
|
Palagini L, Zerbinati L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Massa L, Milia P, Miniati M, Maria Giulia N, Petrucci A, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L. Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation-Liaison Psychiatry. J Sleep Res 2023; 32:e13617. [PMID: 35460144 DOI: 10.1111/jsr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/03/2023]
Abstract
Distress associated with physical illness is a well-known risk factor for adverse illness course in general hospitals. Understanding the factors contributing to it should be a priority and among them dysfunctional illness perception and poor sleep quality may contribute to it. As poor sleep quality is recognised as a major risk factor for health problems, we aimed to study its association with illness perception and levels of distress during hospitalisation. This cross-sectional study included a consecutive series of 409 individuals who were hospitalised in medical and surgical units of different hospitals located throughout the Italian national territory and required an assessment for psychopathological conditions. Sleep quality was assessed with the Pittsburgh (Sleep Quality Index), emotional and physical distress with the Edmonton Symptom Assessment System (ESAS), and illness perception with the Brief Illness Perception Questionnaire (BIPQ). Differences between groups, correlations and mediations analyses were computed. Patients with poor sleep quality were more frequently females, with psychiatric comorbidity, with higher scores in the ESAS and BIPQ. Poor sleep quality was related to dysfunctional illness perception, and to both emotional and physical distress. In particular, by affecting cognitive components of illness perception, poor sleep quality may, directly and indirectly, predict high levels of distress during hospitalisation. Poor sleep quality may affect >70% of hospitalised patients and may favour dysfunctional illness perception and emotional/physical distress.Assessing and treating sleep problems in hospitalised patients should be included in the routine of hospitalised patients.
Collapse
Affiliation(s)
- Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.,Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Lucia Massa
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Paolo Milia
- Psychiatric Clinic and Medical Clinic, University of Sassari, Sassari, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Nanni Maria Giulia
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| |
Collapse
|
25
|
Lo Presti V, Tudisco R, Di Rosa AR, Musco N, Iommelli P, Infascelli F, Grossi M, Ferrara M, Chiofalo B, Lombardi P, Oteri M. Influence of season on milk fatty acid profile and sensory characteristics of grazing goats in a Mediterranean environment: a sustainable agro-food system. Anim Prod Sci 2023. [DOI: 10.1071/an21538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
26
|
Mathis WS, Ferrara M, Burke S, Hyun E, Li F, Zhou B, Cahill J, Kline ER, Keshavan MS, Srihari VH. Granular analysis of pathways to care and durations of untreated psychosis: A marginal delay model. PLoS One 2022; 17:e0270234. [PMID: 36472968 PMCID: PMC9725156 DOI: 10.1371/journal.pone.0270234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE An extensive international literature demonstrates that understanding pathways to care (PTC) is essential for efforts to reduce community Duration of Untreated Psychosis (DUP). However, knowledge from these studies is difficult to translate to new settings. We present a novel approach to characterize and analyze PTC and demonstrate its value for the design and implementation of early detection efforts. METHODS Type and date of every encounter, or node, along the PTC were encoded for 156 participants enrolled in the clinic for Specialized Treatment Early in Psychosis (STEP), within the context of an early detection campaign. Marginal-delay, or the portion of overall delay attributable to a specific node, was computed as the number of days between the start dates of contiguous nodes on the PTC. Sources of delay within the network of care were quantified and patient characteristic (sex, age, race, income, insurance, living, education, employment, and function) influences on such delays were analyzed via bivariate and mixed model testing. RESULTS The period from psychosis onset to antipsychotic prescription was significantly longer (52 vs. 20.5 days, [p = 0.004]), involved more interactions (3 vs. 1 nodes, [p<0.001]), and was predominated by encounters with non-clinical nodes while the period from antipsychotic to STEP enrollment was shorter and predominated by clinical nodes. Outpatient programs were the greatest contributor of marginal delays on both before antipsychotic prescription (median [IQR] of 36.5 [1.3-132.8] days) and (median [IQR] of 56 [15-210.5] days). Sharper functional declines in the year before enrollment correlated significantly with longer DUP (p<0.001), while those with higher functioning moved significantly faster through nodes (p<0.001). No other associations were found with patient characteristics and PTCs. CONCLUSIONS The conceptual model and analytic approach outlined in this study give first episode services tools to measure, analyze, and inform strategies to reduce untreated psychosis.
Collapse
Affiliation(s)
- Walter S. Mathis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
- * E-mail:
| | - Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Shadie Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Emily Hyun
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Bin Zhou
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Emily R. Kline
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Massachusetts Mental Health Center, Boston, Massachusetts, United States of America
| | - Matcheri S. Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Massachusetts Mental Health Center, Boston, Massachusetts, United States of America
| | - Vinod H. Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| |
Collapse
|
27
|
Alfonsi V, Scarpelli S, Gorgoni M, Di Muzio M, Pazzaglia M, Giannini A, Ferrara M, Lucidi F, De Gennaro L. The cost of fast-rotating backward-shift work among nurses. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.158] [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]
|
28
|
Salfi F, D'Atri A, Arnone B, Amicucci G, Viselli L, Corigliano D, Tempesta D, Ferrara M. Boosting vocabulary learning during sleep via a portable closed-loop targeted memory reactivation system in a home setting: a pilot study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.049] [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: 10/17/2022]
|
29
|
Di Libero T, Langiano E, Carissimo C, Ferrara M, Diotaiuti P, Rodio A. Technological support for people with Parkinson’s disease: a narrative review. JGG 2022. [DOI: 10.36150/2499-6564-n523] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
30
|
Ferrara M, Franchini G, Funaro M, Cutroni M, Valier B, Toffanin T, Palagini L, Zerbinati L, Folesani F, Murri MB, Caruso R, Grassi L. Machine Learning and Non-Affective Psychosis: Identification, Differential Diagnosis, and Treatment. Curr Psychiatry Rep 2022; 24:925-936. [PMID: 36399236 PMCID: PMC9780131 DOI: 10.1007/s11920-022-01399-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW This review will cover the most relevant findings on the use of machine learning (ML) techniques in the field of non-affective psychosis, by summarizing the studies published in the last three years focusing on illness detection and treatment. RECENT FINDINGS Multiple ML tools that include mostly supervised approaches such as support vector machine, gradient boosting, and random forest showed promising results by applying these algorithms to various sources of data: socio-demographic information, EEG, language, digital content, blood biomarkers, neuroimaging, and electronic health records. However, the overall performance, in the binary classification case, varied from 0.49, which is to be considered very low (i.e., noise), to over 0.90. These results are fully justified by different factors, some of which may be attributable to the preprocessing of the data, the wide variety of the data, and the a-priori setting of hyperparameters. One of the main limitations of the field is the lack of stratification of results based on biological sex, given that psychosis presents differently in men and women; hence, the necessity to tailor identification tools and data analytic strategies. Timely identification and appropriate treatment are key factors in reducing the consequences of psychotic disorders. In recent years, the emergence of new analytical tools based on artificial intelligence such as supervised ML approaches showed promises as a potential breakthrough in this field. However, ML applications in everyday practice are still in its infancy.
Collapse
Affiliation(s)
- Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy.
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Giorgia Franchini
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Via Campi 213/B, Modena, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Via Macchiavelli 33, Ferrara, Italy
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St., New Haven, CT, USA
| | - Marcello Cutroni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Beatrice Valier
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| |
Collapse
|
31
|
Ferrara M, Gallagher K, Yoviene Sykes LA, Markovich P, Li F, Pollard JM, Imetovski S, Cahill J, Guloksuz S, Srihari VH. Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative. Psychiatr Serv 2022; 73:1416-1419. [PMID: 35652190 PMCID: PMC9715806 DOI: 10.1176/appi.ps.202100374] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Duration of untreated psychosis (DUP), the period between psychosis onset and entry into care, is a time of great vulnerability. Longer DUP predicts poorer outcomes, and delayed treatment access can limit the effectiveness of coordinated specialty care (CSC) services. This column details one component of a broader early detection campaign, a quality improvement intervention focusing on reducing the delay between confirmation of eligibility and admission to care within a benchmark period of 7 days. Median delay significantly fell (from 13.5 to 3 days), and the proportion of admissions that met the benchmark increased (from 33% to 71%) over 4 years. This intervention provides a sustainable model to reduce wait times at CSC services.
Collapse
Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Keith Gallagher
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Laura A Yoviene Sykes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Philip Markovich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Fangyong Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Jessica M Pollard
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Shannon Imetovski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| |
Collapse
|
32
|
Annarumma L, Gorgoni M, Reda F, Scarpelli S, D'Atri A, Alfonsi V, Ferrara M, De Gennaro L. The ages of sleep onset: spatio-temporal eeg patterns in preadolescents, young and older adults. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.041] [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: 11/29/2022]
|
33
|
Salfi F, Amicucci G, D'Atri A, Viselli L, Corigliano D, Tempesta D, Ferrara M. Lo smart working durante la pandemia di COVID-19 rimuove la vulnerabilità ai problemi di sonno delle persone con cronotipo serotino e ne allevia la predisposizione alla depressione. Sleep Med 2022. [PMCID: PMC9300191 DOI: 10.1016/j.sleep.2022.05.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
Toffanin T, Folesani F, Ferrara M, Belvederi Murri M, Zerbinati L, Caruso R, Nanni MG, Koch G, Fadiga L, Palagini L, Perini G, Benatti B, Dell'Osso B, Grassi L. Cognitive functioning as predictor and marker of response to repetitive transcranial magnetic stimulation in depressive disorders: A systematic review. Gen Hosp Psychiatry 2022; 79:19-32. [PMID: 36240649 DOI: 10.1016/j.genhosppsych.2022.10.001] [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: 05/09/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cognitive performance in Major Depressive Disorder (MDD) is frequently impaired and related to functional outcomes. Repetitive Transcranial Magnetic Stimulation (rTMS) may exert its effects on MDD acting both on depressive symptoms and neurocognition. Furthermore, cognitive status could predict the therapeutic response of depressive symptoms to rTMS. However, cognitive performances as a predictor of rTMS response in MDD has not been thoroughly investigated. This review aims to evaluate the role of pre-treatment cognitive performance as a predictor of clinical response to rTMS, and the effects of rTMS on neurocognition in MDD. METHOD A systematic review of studies evaluating neurocognition in MDD as an outcome and/or predictor of response to rTMS was conducted using PubMed/Medline and Embase. RESULTS Fifty-eight articles were identified: 25 studies included neurocognition as a predictor of response to rTMS; 56 used cognitive evaluation as an outcome of rTMS. Baseline cognitive performance and cognitive improvements after rTMS predicted clinical response to rTMS. Moreover, rTMS improved cognition in MDD. CONCLUSIONS Cognitive assessment could predict improvement of depression in MDD patients undergoing rTMS and help selecting patients that could have beneficial effects from rTMS. A routine cognitive assessment might stratify MDD patients and track rTMS related cognitive improvement.
Collapse
Affiliation(s)
- Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Institute of Physiology, University of Ferrara, Ferrara, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara, Italy
| | - Luciano Fadiga
- Department of Neuroscience and Rehabilitation, Institute of Physiology, University of Ferrara, Ferrara, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giulia Perini
- Padova Neuroscience Center, University of Padova, Padova, Italy; Casa di Cura Parco dei Tigli, Padova, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| |
Collapse
|
35
|
Folesani F, Belvederi Murri M, Biancosino B, Costa S, Zerbinati L, Caruso R, Nanni MG, Toffanin T, Ferrara M, Purdon SE, Grassi L. The screen for cognitive impairment in psychiatry in patients with borderline personality disorder. Personal Ment Health 2022; 16:279-289. [PMID: 35146968 PMCID: PMC9788074 DOI: 10.1002/pmh.1539] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 12/30/2022]
Abstract
Cognitive deficits are common in borderline personality disorder (BPD) and appear to be associated with psychopathology, functioning and outcome. The availability of a cognitive screening instrument could be of use in clinical settings in order to assess neurocognition in BPD patients. The Screen for Cognitive Impairment for Psychiatry (SCIP) proved to be reliable in different psychiatric populations, but it has not yet been validated in personality disorders. The purpose of this study is therefore to evaluate its psychometric properties in a sample of 58 BPD patients. The SCIP was validated against the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test A and B (TMT A and B). The receiver operator curve analysis displayed an acceptable convergent validity (total score AUC: 0.78, 95% CI: 0.70-0.86; Se: 75%, Sp: 72%). A cut-off total score of 80 identified 81% of patients as cognitively impaired. The exploratory factor analysis displayed a one-factor solution explaining 55.8% of the total variance. The SCIP displayed adequate psychometric properties in BPD and could be integrated in the routine clinical assessment to provide a preliminary evaluation of cognitive features for BPD.
Collapse
Affiliation(s)
- Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Bruno Biancosino
- Department of Mental Health and Addictive Disorders, Health Trust Ferrara, Ferrara, Italy
| | - Silvia Costa
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Scot E Purdon
- Alberta Hospital Edmonton, Edmonton, Alberta, Canada.,Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| |
Collapse
|
36
|
Pallier PN, Ferrara M, Romagnolo F, Ferretti MT, Soreq H, Cerase A. Chromosomal and environmental contributions to sex differences in the vulnerability to neurological and neuropsychiatric disorders: Implications for therapeutic interventions. Prog Neurobiol 2022; 219:102353. [PMID: 36100191 DOI: 10.1016/j.pneurobio.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
Neurological and neuropsychiatric disorders affect men and women differently. Multiple sclerosis, Alzheimer's disease, anxiety disorders, depression, meningiomas and late-onset schizophrenia affect women more frequently than men. By contrast, Parkinson's disease, autism spectrum condition, attention-deficit hyperactivity disorder, Tourette's syndrome, amyotrophic lateral sclerosis and early-onset schizophrenia are more prevalent in men. Women have been historically under-recruited or excluded from clinical trials, and most basic research uses male rodent cells or animals as disease models, rarely studying both sexes and factoring sex as a potential source of variation, resulting in a poor understanding of the underlying biological reasons for sex and gender differences in the development of such diseases. Putative pathophysiological contributors include hormones and epigenetics regulators but additional biological and non-biological influences may be at play. We review here the evidence for the underpinning role of the sex chromosome complement, X chromosome inactivation, and environmental and epigenetic regulators in sex differences in the vulnerability to brain disease. We conclude that there is a pressing need for a better understanding of the genetic, epigenetic and environmental mechanisms sustaining sex differences in such diseases, which is critical for developing a precision medicine approach based on sex-tailored prevention and treatment.
Collapse
Affiliation(s)
- Patrick N Pallier
- Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States; Women's Brain Project (WBP), Switzerland
| | - Francesca Romagnolo
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Hermona Soreq
- The Edmond and Lily Safra Center of Brain Science, The Hebrew University of Jerusalem, 9190401, Israel
| | - Andrea Cerase
- EMBL-Rome, Via Ramarini 32, 00015 Monterotondo, RM, Italy; Blizard Institute, Centre for Genomics and Child Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; Department of Biology, University of Pisa, SS12 Abetone e Brennero 4, 56127 Pisa, Italy.
| |
Collapse
|
37
|
Lazzari J, Scatena A, Milone V, Ferrara M. The evolution of the autopsy over the years. Clin Ter 2022; 173:301-303. [PMID: 35857045 DOI: 10.7417/ct.2022.2437] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Autopsy has played an extremely important role in both the forensic and clinical fields for many years. In recent years, clinical autopsy has become less important, but today, thanks to the pandemic, this importance has been rediscovered. Conversely, forensic autopsy has never lost its importance, but it would need to be updated.
Collapse
Affiliation(s)
- J Lazzari
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - A Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - V Milone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - M Ferrara
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
38
|
Maffucci A, Cesario S, Mammarella V, Colafrancesco G, Ferrara M, Raballo A, Monducci E. Correlation between psychotic risk and depressive “cognitive” symptoms in adolescence. Eur Psychiatry 2022. [PMCID: PMC9567960 DOI: 10.1192/j.eurpsy.2022.1753] [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: 11/25/2022] Open
Abstract
Introduction Prevention of disorders has become a central element of psychiatric research and clinic. Currently, Ultra High Risk (UHR) criteria are internationally recognized for psychiatric risk assessment. Self Disorders (SD) aroused particular interest because they were found to be specific to schizophrenic spectrum disorders and a marker of vulnerability for psychotic onset. Objectives To evaluate the correlation between psychotic risk and depressive symptoms in at-risk adolescent population. Methods We collected data from 80 patients, aged 14-18, with sufficient skills in the Italian language and an IQ ≥70, excluding patients with disorders related to direct effects of a general medical condition or substance. Psychodiagnostic evaluation included K-SADS-PL, SIPS/SOPS, EASE (for the assessment of SDs) and the CDSS (for the assessment of Depression). Results 35 subjects have UHR criteria, while 45 do not have a psychotic risk syndrome or psychotic features. Between the two groups there is a significant difference in the total SCORE of EASE, in domains 1, 2 and 5. In addition, a positive correlation between SDs and depressive symptoms emerged, in particular with pathological guilt and with reference ideas of guilt. Conclusions The results confirm the validity of SDs for early detection of psychosis. Depressive features appear to be associated with the presence of abnormalities of experience. This results suggest a close care and monitoring of depressive symptoms in adolescence, because they can mask disorders of different nature, particularly pathological guilt and guilty ideas of reference that are depressive “cognitive” symptoms more correlate with psychotic risk. Disclosure No significant relationships.
Collapse
|
39
|
Ferrara M, Langiano E, Falese L, Diotaiuti P, Cortis C, De Vito E. Changes in Physical Activity Levels and Eating Behaviours during the COVID-19 Pandemic: Sociodemographic Analysis in University Students. Int J Environ Res Public Health 2022; 19:ijerph19095550. [PMID: 35564943 PMCID: PMC9105810 DOI: 10.3390/ijerph19095550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has forced schools and universities to shift their activities online, influencing the adoption of health-related behaviours such as physical activity and healthy dietary habits. The present study investigates the changes in adherence to a healthy diet and regular physical activity in university students in Italy before and during the COVID-19 pandemic and understands the role of sociodemographic variables in creating the changes above. We conducted a repeated cross-sectional survey performing the same sampling strategy at the first data collection (T0) and second data collection (T1) with a combination of convenience and snowball sampling approaches. The sample is composed of a total of 2001 students, 60.2% women and 39.8% men, with an average age of 22.7 (±5.5 SD). At T1, 39.9% of the students reported regular physical activity. During the pandemic, however, many, especially male students, abandoned or reduced physical activity practice (T1 40%), with an increase in social media use (T0 52.1%; T1 90%). A direct association between very low frequency of physical activity and increased sedentary time (r = 0.2, p = 0.001) and between change in dietary style and increased Body Mass Index (BMI) value (r = 0.3, p = 0.002) was found. The multivariate analysis for the total sample showed that some sociodemographic variables such as gender, age, parents’ level of education, area of study, household type, and perception of one’s body influence eating behaviours and physical activity. Our findings suggest that universities should invest in the protection and promotion of the health of their students with specific awareness programmes, and further research should repeat the survey in the post-lockdown period to investigate the long-term effects on health-related behaviours.
Collapse
|
40
|
Kline ER, Ferrara M, Li F, Cyril D’Souza D, Keshavan M, Srihari VH. Timing of cannabis exposure relative to prodrome and psychosis onset in a community-based first episode psychosis sample. J Psychiatr Res 2022; 147:248-253. [PMID: 35066293 PMCID: PMC8882157 DOI: 10.1016/j.jpsychires.2022.01.039] [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: 09/09/2021] [Revised: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Cannabis has been implicated as both a potential cause and adverse prognostic factor in psychotic disorders. Investigating the contributory role of cannabis toward the overall burden of psychotic illnesses may represent an important step toward psychosis prevention and treatment. The current study samples consecutive admissions (N = 246) to two community based first-episode psychosis services to characterize timing of cannabis use relative to psychosis and attenuated symptom onset, differences between those with and without cannabis exposure, and the association of age at first cannabis exposure with clinical and demographic variables. Both cannabis exposure (78%) and cannabis use disorders (47%) were highly prevalent at admission. In 94% of participants, cannabis use preceded the onset of both attenuated and full-threshold psychosis symptoms by several years. Earlier age at first exposure to cannabis was associated with younger age at prodrome and psychosis onset, worse premorbid functioning, and greater severity of cannabis use disorder at admission. The timing of first exposure to cannabis may have individual prognostic as well as public health significance. Documenting the prevalence and impact of cannabis use in early psychosis samples, as well as the overall incidence of psychotic disorders, will be of vital public health significance as the United States enacts cannabis legalization and cannabis products become more widely available.
Collapse
Affiliation(s)
- Emily R. Kline
- Harvard Medical School, Department of Psychiatry,Beth Israel Deaconess Medical Center, Department of Psychiatry,Boston University School of Medicine, Department of Psychiatry,Boston Medical Center
| | - Maria Ferrara
- Yale University School of Medicine, Department of Psychiatry
| | - Fangyong Li
- Yale University School of Medicine, Department of Psychiatry
| | | | - Matcheri Keshavan
- Harvard Medical School, Department of Psychiatry,Beth Israel Deaconess Medical Center, Department of Psychiatry
| | | |
Collapse
|
41
|
Diotaiuti P, Mancone S, Falese L, Ferrara M, Bellizzi F, Valente G, Corrado S, Misiti F. Intention to Screen for Hepatitis C Among University Students: Influence of Different Communicative Scenarios. Front Psychiatry 2022; 13:873566. [PMID: 35633800 PMCID: PMC9130485 DOI: 10.3389/fpsyt.2022.873566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the influence of different narrative scenarios regarding students' intentions to undergo diagnostic screening for hepatitis C, and whether gender identification with the characters of the scenario could influence the students' intentions to undergo a medical test. A sample of 600 participants was administered three narrative scenarios with different frames (positive, negative, and ambivalent), including two gender options (male and female) for the main character of the story. A statistically significant three-way interaction between scenario, gender identification, and time resulted. There were significant simple main effects on the intention to have a diagnostic test for hepatitis C for the scenarios with the protagonist of the same gender as the participant and after the administration of the negative scenario. The use of a negative scenario with the same gender character was always more effective than the use of a positive framed scenario, even though there was a high level of knowledge regarding the disease. Personal diagnostic testing was not directly associated with knowledge regarding the infection. The findings of this study can ultimately help policymakers develop communication campaigns adapted to target populations such as college students, in order to raise awareness of the risk, promote prevention and behavioral change, and encourage medical screening.
Collapse
Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Lavinia Falese
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Maria Ferrara
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Fernando Bellizzi
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Giuseppe Valente
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Francesco Misiti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| |
Collapse
|
42
|
Gallagher K, Ferrara M, Pollard J, Yoviene Sykes L, Li F, Imetovski S, Cahill J, Mathis W, Srihari VH. Taking the next step: Improving care transitions from a first-episode psychosis service. Early Interv Psychiatry 2022; 16:91-96. [PMID: 35029048 DOI: 10.1111/eip.13127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
AIMS First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these time-limited services. METHODS A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months are presented. A planning phase was followed by recurrent Plan-Do-Study-Act cycles (PDSA) that included the introduction of proactive efforts targeting disposition planning (with patients and families) and follow-up to facilitate transfer after discharge. Fisher's exact test was used to compare disposition and transfer outcomes across the QI phases. RESULTS This QI approach was sustained through a three-fold escalation in discharge volume. Transfer status at 3 months was significantly different between the pre- and post PDSA phases (p = .02). A greater proportion were confirmed transfers post-PDSA (54.3 vs. 37%), but of those with known status at 3 months, similar proportions were successfully transferred (76, 73%). Patients discharged post-PDSA were less likely to have unknown treatment status (26 vs. 51%). Disposition outcomes were also significantly improved post-PDSA (p = .03). Patients were more likely to engage with discharge planning (69.7 vs. 48.6%) and less likely to be lost to follow-up (13.8 vs. 25.7%), or to refuse assistance (11.0 vs. 20.0%). CONCLUSION This QI approach offers a feasible way to improve disposition and transfer after FES and can be built upon in efforts to sustain functional gains in onward pathways.
Collapse
Affiliation(s)
- Keith Gallagher
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Maria Ferrara
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Jessica Pollard
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Laura Yoviene Sykes
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), New Haven, Connecticut, USA
| | - Shannon Imetovski
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - John Cahill
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Walter Mathis
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| |
Collapse
|
43
|
Srihari VH, Ferrara M, Li F, Kline E, Gülöksüz S, Pollard JM, Cahill JD, Mathis WS, Yoviene Sykes L, Walsh BC, McDermott G, Seidman LJ, Gueorguieva R, Woods SW, Tek C, Keshavan MS. Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial. Schizophr Bull Open 2022; 3:sgab057. [PMID: 35295656 PMCID: PMC8919192 DOI: 10.1093/schizbullopen/sgab057] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign (“Mindmap”) can reduce DUP in a US community setting. Methods In this nonrandomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach & detailing, and rapid enrollment of referrals. Both FES recruited 16–35 years old with psychosis onset ≤3 years. Outcome measures included DUP-Total (onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication), and DUP-Supply (first antipsychotic medication to FES enrollment). Results 171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number of referrals and in efficiency of engagement at STEP. Pre-campaign DUP (2014–2015) was equivalent, while Mindmap was associated with DUP reductions at STEP but not PREP. DUP-Total fell significantly in both the first and the second quartile (11.5 and 58.5 days reduction per campaign year, respectively). DUP-Demand and DUP-Supply fell in the third quartiles only (46.3 and 70.3 days reduction per campaign year, respectively). No reductions were detectable across all quartiles at PREP, but between site comparisons were not significant. Conclusions This is the first controlled demonstration of community DUP reduction in the US, and can inform future early detection efforts across diverse settings.
Collapse
Affiliation(s)
- Vinod H Srihari
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Maria Ferrara
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA.,Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), Yale School of Public Health, New Haven, CT, USA
| | - Emily Kline
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sinan Gülöksüz
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA.,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jessica M Pollard
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - John D Cahill
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Walter S Mathis
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Laura Yoviene Sykes
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Barbara C Walsh
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | | | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ralitza Gueorguieva
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Scott W Woods
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Cenk Tek
- Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
44
|
Zerbinati L, Palagini L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Milia P, Nanni MG, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L, Bellucci J, Bergamelli E, Attilio Campagna V, Cherubini M, Folesani F, Gancitano M, Giannetti F, Giovanna G, Gullotta B, Massa L, Montardi G. Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study. Front Psychiatry 2022; 13:959399. [PMID: 36311528 PMCID: PMC9614237 DOI: 10.3389/fpsyt.2022.959399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2-2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1-1998). METHODS We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. RESULTS Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). CONCLUSION CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.
Collapse
Affiliation(s)
- Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Silvia Ferrari
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Milia
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Maria Giulia Nanni
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | | | - Jessica Bellucci
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Emilio Bergamelli
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | | | - Melissa Cherubini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Federica Folesani
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marta Gancitano
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesca Giannetti
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Giovanna
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Benedetta Gullotta
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lucia Massa
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Giulia Montardi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| |
Collapse
|
45
|
Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
Collapse
Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
46
|
Santini D, Armento G, Giusti R, Ferrara M, Moro C, Fulfaro F, Bossi P, Arena F, Ripamonti CI. Management of orphan symptoms: ESMO Clinical Practice Guidelines for diagnosis and treatment †. ESMO Open 2021; 5:e000933. [PMID: 33208491 PMCID: PMC7674109 DOI: 10.1136/esmoopen-2020-000933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- D Santini
- Department of Clinical Oncology, University Campus Bio-Medico of Rome, Oncologia Medica, Italy
| | - G Armento
- Department of Clinical Oncology, University Campus Bio-Medico of Rome, Oncologia Medica, Italy
| | - R Giusti
- Department of Oncology, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - M Ferrara
- Oncology- Supportive Care in Cancer Unit, Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Moro
- Department of Clinical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F Fulfaro
- Department of Clinical Oncology, Policlinico Paolo Giaccone, Palermo, Italy
| | - P Bossi
- Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - F Arena
- Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, Italy
| | - C I Ripamonti
- Oncology- Supportive Care in Cancer Unit, Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | |
Collapse
|
47
|
Cammisa L, Pacifici S, Fegatelli DA, Calderoni D, Fantini F, Ferrara M, Terrinoni A. Non-suicidal self-injury and suicide attempt: A continuum or separated identities? Eur Psychiatry 2021. [PMCID: PMC9471579 DOI: 10.1192/j.eurpsy.2021.463] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Non-suicidal self-injury (NSSI) has been proposed as diagnostic entity and was added in the section 3 of the DSM 5. However, little is known about the long-term course of the disorder: NSSI and suicide attempt (SA) often lie on a continuum of self-harm, but it’s still unclear if they represent two different nosografical entities. Both these groups are commonly enclosed in the term of Deliberate self-harm (DSH), also including self-harm with suicidal intent conditions. Objectives This study aims to explore differences between two clinical samples (NSSI and SA) to highlight the possible connection between these two categories, to better understand the risk of progression from NNSI into suicidal intent conditions. Methods 102 inpatients with DSH (62 NNSI; 40 SA; age range: 12 to 18 years) were assessed by self-report questionnaires: the Deliberate Self-Harm Inventory (DSHI) and the Repetitive Non-suicidal Self-Injury Questionnaire (R-NSSI-Q) to explore the severity and repetitiveness of self-injurious behaviors and by the Beck Hopelessness Scale (BHS) and Multi-Attitude Suicide Tendency scale (MAST), as indirect measures of suicidal risk. Results Preliminary results showed that inpatients with NSSI (62) presented high scores of indirect suicide risk, similar to SA sample (40). Conclusions This result highlights the possibility to consider NSSI and SA in a continuum of psychopathology and that repetitive self-harm even in the absence of clear suicidal intentions represent a significant risk factor in the development of suicidality in adolescence. Disclosure No significant relationships.
Collapse
|
48
|
Zhu M, Ferrara M, Tan W, Shang X, Syed S, Zhang L, Qin Q, Hu X, Rohrbaugh R, Srihari VH, Liu Z. Drug-naïve first-episode schizophrenia spectrum disorders: Pharmacological treatment practices in inpatient units in Hunan Province, China. Early Interv Psychiatry 2021; 15:1010-1018. [PMID: 32924286 PMCID: PMC8359180 DOI: 10.1111/eip.13046] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
AIM This study describes antipsychotic prescription patterns for drug-naïve inpatients diagnosed with first-episode schizophrenia-spectrum (FES) disorders and factors associated with practices deviating from China's current guidelines. METHODS All inpatients aged 7 to 45 years experiencing a first episode of schizophrenia-spectrum disorder with a duration of untreated illness of less than 18 months and admitted between 1 August 2016 and 1 August 2017 to one of eight psychiatric hospitals in Hunan were included. Demographics, clinical characteristics and prescriptions at discharge were collected from electronic medical records. Logistic regression and random forest methods were used to model relationships between demographic and clinical factors and deviations from China's guidelines. RESULTS Of the 602 inpatients included in the study, 598 (99.3%) were prescribed antipsychotics, and no patients were discharged on long-acting injectable antipsychotics. Polypharmacy (more than one antipsychotic prescribed) was present in 121 (20.2%) participants. Clozapine was prescribed to 45 (7.5%) patients. Adults receiving polypharmacy were more likely to be prescribed high-dose antipsychotics than those receiving a single antipsychotic. Minors under 13 years of age were more likely to receive polypharmacy and unapproved antipsychotics than those older than 13 years. CONCLUSIONS Our findings suggest that most of the inpatients were prescribed a single antipsychotic at discharge, consistent with China's guidelines. Minors with FES and patients discharged on polypharmacy and clozapine may require more intense monitoring and management. With the current implementation of China's National Mental Health Working Plan, these results will assist decision-makers in allocating resources and conducting reforms to facilitate best practice treatment for FES.
Collapse
Affiliation(s)
- Mengran Zhu
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Maria Ferrara
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Wenjian Tan
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xingbo Shang
- Yale Systems Biology Institute and Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
| | - Sumaiyah Syed
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Li Zhang
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qilin Qin
- Department of Neurosurgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xinran Hu
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Robert Rohrbaugh
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Zhening Liu
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
49
|
Severi S, Bongiovanni A, Ferrara M, Nicolini S, Di Mauro F, Sansovini M, Lolli I, Tardelli E, Cittanti C, Di Iorio V, Mezzenga E, Scarpi E, Ibrahim T, Paganelli G, Zovato S. Peptide receptor radionuclide therapy in patients with metastatic progressive pheochromocytoma and paraganglioma: long-term toxicity, efficacy and prognostic biomarker data of phase II clinical trials. ESMO Open 2021; 6:100171. [PMID: 34139487 PMCID: PMC8219772 DOI: 10.1016/j.esmoop.2021.100171] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pheochromocytoma and paraganglioma (PPGL) have currently only limited treatment options available for patients in the metastatic phase (mPPGL) in either post-surgery or inoperable settings. However, these rare tumors overexpress somatostatin receptors and can thus be treated with peptide receptor radionuclide therapy (PRRT). We present data about our 10-year experience treating 46 consecutive mPPGL patients with 90Y-DOTATOC or 177Lu-DOTATATE. PATIENTS AND METHODS All patients (20 men and 26 women, median age 52 years) showed positive scintigraphic imaging at 111In-octreotide or 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT). 90Y-DOTATOC was administered in 12 patients, with cumulative dosages ranging from 7.4 to 11 GBq, while 34 patients received 18.5 or 27.5GBq of 177Lu-DOTATATE. We used Southwest Oncology Group Response Evaluation Criteria in Solid Tumors criteria to evaluate treatment efficacy and Common Terminology Criteria for Adverse Events criteria to assess toxicity. The prognostic role of primary tumor site, hormone secretion, succinate dehydrogenase (SDHx) mutation, and metastatic involvement was also evaluated. RESULTS Both 90Y-DOTATOC and 177Lu-DOTATATE PRRT were well tolerated by patients without significant renal or bone marrow toxicity. The median follow-up was 73 months (range 5-146 months). The overall disease control rate (DCR) was 80% [95% confidence interval (CI) 68.9% to 91.9%] with a mean five cycles of therapy. However, 177Lu-DOTATATE patients showed a longer median overall survival (mOS) than those receiving 90Y-Dotatoc and a better DCR when higher dosages were administered, even if a direct comparison was not carried out. Syndromic patients had a poorer mOS. SDHx mutations did not interfere with treatment efficacy. CONCLUSIONS PRRT is safe and effective for the treatment of patients with progressive mPPGL, especially at higher dosages. The longer mOS of 177Lu-DOTATATE-treated patients in our protocols indicates the former radiopharmaceutical as the better candidate for further clinical application.
Collapse
Affiliation(s)
- S Severi
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - A Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - M Ferrara
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - S Nicolini
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - F Di Mauro
- Nuclear Medicine, Ospedale 'M. Bufalini', Cesena, Italy
| | - M Sansovini
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - I Lolli
- Medical Oncology, Ospedale IRCCS 'S. De Bellis', Castellana Grotte, Italy
| | - E Tardelli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Ospedale 'San Luca', Lucca, Italy
| | - C Cittanti
- Nuclear Medicine Unit, University of Ferrara, Ferrara, Italy
| | - V Di Iorio
- Oncology Pharmacy, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - E Mezzenga
- Medical Physics Unit, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - E Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - T Ibrahim
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - G Paganelli
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy.
| | - S Zovato
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| |
Collapse
|
50
|
Ferrara M, Guloksuz S, Mathis WS, Li F, Lin IH, Syed S, Gallagher K, Shah J, Kline E, Tek C, Keshavan M, Srihari VH. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1359-1369. [PMID: 33948678 PMCID: PMC8319102 DOI: 10.1007/s00127-021-02090-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. METHODS Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. RESULTS Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. CONCLUSION Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.
Collapse
Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA.
| | - Sinan Guloksuz
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
| | - Walter S Mathis
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Fangyong Li
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - I-Hsin Lin
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - Sumaiyah Syed
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Keith Gallagher
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Jai Shah
- PEPP-Montreal, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Emily Kline
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cenk Tek
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vinod H Srihari
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| |
Collapse
|