[Psychotropic-associated sexual dysfunctions: a survey of clinical pharmacology and medication-associated practice]

Epidemiological and clinical studies show that often persons affected by depression and schizophrenia can suffer of impairment of the sexual function. Most antidepressant and antipsychotic drugs have adverse sexual effects but it is difficult to identify if the impairment of the sexual function can be attributed to clinical picture or to the psychopharmacological treatments. Both antidepressants and novel and conventional antipsychotics are associated with significant sexual side effects and the presence of sexual side effects may affect compliance and adherence to treatment. In some specific clinical populations (e.g. youths), these specific side-effects turn out to be one of the most annoying and promote increased drop-out rates and poor adherence to treatment. Nevertheless, these clinical variables are often underestimated or not investigated in the course of follow-up of persons suffering from psychiatric disorders in treatment with psychotropic medications. Growing awareness of the adverse effects of psychotropic drugs has led to attempts to use adjuvants or substitute treatments to resolve sexual dysfunction. Effects on sexual function should be carefully diagnosed and treated; it should clearly discuss with patients in order to preserve an adequate quality of life, promote greater adherence to treatment and promote a good remission and recovery. The aim of this study is to review the most recent and significant literature data regarding association between sexual dysfunction and psychotropic medications, especially highlighting neurobiological and clinical data in order to improve the clinical pratice.

Colonoscopic findings in coeliac disease on a gluten-free diet

BACKGROUND

to date, there are few data on colonoscopic findings in patients with celiac disease, and most of these obtained in patients with iron deficiency anaemia.

AIMS

we assessed colonoscopic findings in unselected patients with coeliac disease, since there are no studies available also considering morphological aspects, and there is literature suggestion of increased prevalence of colorectal tumours.

MATERIAL AND METHODS

colonoscopies with multiple biopsies were retrospectively analyzed in 42 coeliac disease patients on gluten-free diet above age 40; 16 had clinical or laboratory features of iron deficiency anaemia. Mucosal biopsies were evaluated for the presence of intraepithelial lymphocytes and of mucosal eosinophils, in addition to conventional histologic assessment, and compared with those obtained in 15 controls.

RESULTS

macroscopic abnormalities (polyps, diverticula, inflammatory changes) were found in 26% of patients. Microscopic abnormalities (lymphocytic colitis, melanosis coli, rectal histiocytosis) were found in 36% of patients. None of these findings was found in controls. Coeliac disease patients had significantly higher eosinophil score than controls in the right colon, whereas this was not significantly different between groups in the left colon.

CONCLUSIONS

colonoscopic findings in coeliac disease on gluten-free diet may reveal significant findings, even in patients without iron deficiency anaemia. There is the need of further studies in larger cohorts of patients to establish whether colonoscopy in these patients may be clinically useful.

Post-Traumatic and Psychiatric Symptoms among Young Earthquake Survivors in Primary Care Camp Hospital

Earthquakes have been found to be associated with increased prevalence of psychiatric disorders: Post-traumatic Stress Disorder (PTSD) with a diagnosis range of 1.5%-74%, depression, anxiety and sleep disorders and substance abuse. Risk factors are varied: exposure to the earthquake, closeness to the epicenter, disruption of social network, financial loss, female sex, low educational level, etc. PTSD diagnosis is difficult because people unconsciously neglect traumatic history and ignore consequences. Between April 6th 2009 and September 2009, 323 young survivors aged between 18 and 30 years were screened for PTSD symptoms at the S.M.I.L.E., a psychiatric service for young people at the L'Aquila Camp Hospital. The screening assessment consisted of: a socio-demographic schedule with questions about earthquake experience, the General Health Questionnaire-12 items (GHQ-12), Impact Event Scale-Revised (IES-R) and Semi-structured Clinical Interview Diagnosis II (SCID-II). Regarding psychiatric morbidity, 44.2% and 37.4% had respectively moderate and high stress levels. Female gender and unemployment were significantly correlated (p<.001) with stress level and Obsessive-Compulsive (OC) trait. After screening assessment, the 66.7% (N=215) of total sample showed a positive post-traumatic symptomatology with 13.8% of PTSD diagnosis. Obsessive-Compulsive trait, female gender, destruction of housing and high level of stress (GHQ ≥ 20) were significant predictors for a PTSD diagnosis when compared with subjects positive for PTSD symptomatology but without a PTSD diagnosis according to DSM-IV criteria. Personality features must be considered important risks for post-traumatic consequences: OC trait was significantly associated with a high score on the GHQ-12 (≥20) and is a significant predictor of PTSD symptoms (“re-experiencing” dimension). Houses destroyed, gender and unemployed were also important risk factors. Our study confirms that a natural disaster produces high levels of mental disorders with significant long-term risk of chronic impairment, such as the development of a PTSD diagnosis (13.8%) with enormously costly consequences for the mental health care system and society. This should be a high priority in a public health program.

Effect of the implementation of HACCP on the microbiological quality of meals at a university restaurant

A study was conducted to evaluate the microbiological quality, including total mesophilic counts and markers of bacteriological hygiene, as indicator of food safety of three categories of the most consumed meals in a university restaurant, before and after implementation of the HACCP system and personnel training. Cold gastronomy products, cooked warm-served products, and cooked cold-served products were tested for bacterial contamination. Throughout the experiment, 894 samples were examined for total counts of aerobic bacteria, counts of indicator organisms (coliform organisms and Escherichia coli) and pathogens (Staphylococcus aureus, Bacillus cereus, Salmonella spp., and Listeria monocytogenes). Implementation of the HACCP system, together with training in personnel hygiene, good manufacturing practices, and cleaning and sanitation procedures, resulted in lower aerobic plate counts and a lower incidence of S. aureus, coliform organisms, E. coli, and B. cereus, whereas Salmonella spp. and L. monocytogenes were not found in all samples studied. The microbial results of this study demonstrate that personnel training together with HACCP application contributed to improve the food safety of meals served in the restaurant studied.