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To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD), and healthy comparisons (HCs).
A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.
The United States, France, Japan, and China.
Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.
The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).
We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.
Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent.
Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals.
To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia.
The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures.
Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p < 0.001), and participation in community-living activities (p < 0.001).
These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD.
The rapid insurgence and spread of coronavirus disease 2019 (COVID-19) exceeded the limit of the intensive care unit (ICU) contingency plan of the Maggiore della Carità University Hospital (Novara, Italy) generating a crisis management condition. This brief report describes how a prompt response to the sudden request of invasive mechanical ventilation (IMV) was provided by addressing the key elements of health care system surge capacity from contingency to crisis. In a short time and at a relatively low cost, a structural modification of a hospital aisle allowed to convert the general ICU into a COVID-19 unit, increasing the number of COVID-19 critical care beds by 107%.
Surveillance of new cases of invasive pneumococcal disease (IPD) in Italy was started in 2007 by the Ministry of Health (MoH). In 2012, pneumococcal childhood vaccination was introduced at the national level and, in 2017, for citizens aged 65 years and over. We describe here IPD epidemiology in Italy over the past 10 years investigating the impact of the vaccine programme on disease burden. Reports of IPD cases, data on serotype and vaccination coverage (VC) data were obtained from MoH annual reports, for the period 2007–2017. IPD notification rate and proportion by year, region, age and serotype were calculated. In 2007, 525 cases were reported (rate 0.88/100 000), rising to 1703 cases (rate 2.82/100 000) in 2017. The distribution of IPD cases by age group over time registered the largest share among individuals aged 65 years and over. A decreasing trend in notification rate was observed among those aged 0–4 years. During the same period, the 24-month VC increased, ranging from 80.9% to 96.7% in 2017. Molecular data indicated re-emergence of PPSV23-specific serotypes and non-vaccine serotypes. We observed an increase in IPD notifications during 2007–2017, likely due to an improved surveillance system, at least in some regions, with the relative quota of IPD notifications decreasing among vaccinated children cohorts. Further strengthening of IPD surveillance system, including molecular and vaccine coverage data, would be needed to assess and inform pneumococcal vaccination strategies in Italy.
Italy has been one of the first countries to implement mitigation measures to curb the coronavirus disease 2019 (COVID-19) pandemic. There is currently a debate on when and how such measures should be loosened. To forecast the demand for hospital intensive care unit (ICU) and non-ICU beds for COVID-19 patients from May to September, we developed 2 models, assuming a gradual easing of restrictions or an intermittent lockdown.
We used a compartmental model to evaluate 2 scenarios: (A) an intermittent lockdown; (B) a gradual relaxation of the lockdown. Predicted ICU and non-ICU demand was compared with the peak in hospital bed use observed in April 2020.
Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%; 95% confidence interval [CI]: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95% CI: 71-121) and 237% (95% CI: 191-282) of the April peak.
Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in health-care resources to maintain surge capacity across the country.
Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions.
Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression.
After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms.
In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.
To assess admission rates to seven General Hospital Psychiatric Wards (GHPWs) located in the Lombardy Region in the 40 days after the start of Coronavirus disease 2019 (COVID-19) epidemic, compared to similar periods of 2020 and 2019.
Anonymized data from the regional psychiatric care register have been obtained and analyzed. The seven GHPWs care for approximately 1.4 million inhabitants and have a total of 119 beds.
In the 40-day period (February 21–March 31, 2020) after the start of the COVID-19 epidemic in Italy, compared to a similar 40-day period prior to February 21, and compared to two 40-day periods of 2019, there has been a marked reduction in psychiatric admission rates. The reduction was explained by voluntary admissions, while there was not a noticeable reduction for involuntary admissions. The reduction was visible for all diagnostic groups, except for a group of ‘Other’ diagnoses, which includes anxiety disorders, neurocognitive disorders, etc.
Large-scale pandemics can modify voluntary admission rates to psychiatric facilities in the early phases following pandemic onset. We suggest that the reduction in admission rates may be due to fear of hospitals, seen as possible sites of contagion, as well as to a change in thresholds of behavioral problems acting as a trigger for admission requests from family relatives or referrals from treating clinicians. It is unclear from the study whether the reduction in admissions was contributed to most by the current pandemic or the lockdown imposed due to the pandemic.
Topiramate (up to 300 mg per day) is more efficacious than placebo as an adjunct to standardised medication compliance management in treatment of alcohol dependence. However, adverse events can limit its use in different clinical situation. In this randomised, double-blind, placebo controlled trial we aimed to investigate the efficacy of low-dosage topiramate on alcohol drinking indices. Craving and psychiatric symptoms improvements were the secondary endpoints.
Forty alcohol dependent subjects where detoxified and subsequently randomised into two groups, respectively receiving topiramate (100mg/die) or Placebo. The level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptomatology was evaluated by the Symptom Check List 90 Revised (SCL-90 R).
The improvement of alcohol drinking indices and craving scores was higher in the topiramate group than placebo. The survival function showed that patients treated with topiramate remained abstinent from any alcohol amount for a longer time with respect to placebo (Z= -2.197; P< 0.05). The SCL-90-R general index of “Positive Symptom Total” significantly reduced in the topiramate group (F= 3.41, p< 0.05). The number of patients dropped-out from the study for adverse events was not different between groups.
To our knowledge, this is the first randomised, parallel group trial to evaluate the efficacy of topiramate at low dosage for alcohol dependence. The use of topiramate at low dosage could increase the number of subjects in treatment, given the reduced possibility of adverse events.
Cognitive deficits, in particular that of memory and executive functions, have been linked to functional disability. The treatment with antipsychotic drugs leads to subjective changes in cognitive functioning as well as subjective experience of schizophrenic patients, which both contribute to compliance and treatment outcome. Aim of this study was to evaluate the role of clinical, neurocognitive and pharmacological variables on the subjective perception of cognitive functioning in schizophrenic patients.
The sample was composed of 78 schizophrenic inpatients (M/F=38/35, mean age 41 + 11.6 years) recruited in the Rehabilitative Centres of two Departments of Mental Health in Italy and treated with typical (n= 15) or atypical antipsychotics (n= 63). Patients were diagnosed according to the DSM-IV TR criteria and evaluated with the Frankfurter Beschwerde Fragebogen (FBF) Scale, the SAPS and SANS (Scales fot the Assessment of Positive and of Negative Symptoms). Neuropsychological functioning was assessed by means of the Wechsler Adult Intelligence Scale (WAIS- R).
The results showed that the severity of symptoms was correlated positively with a greater impairment on self perception of mental functioning. Neuropsychological functioning also correlated with self perception of cognitive deficits, with an abnormal subjective experience associated with more neuropsychological disturbances. Atypical antipsychotics were associated with a better insight of cognitive dysfunction.
The results of the study underline the importance to investigate the subjective experience of schizophrenic patients treated with antipsychotic drugs in order to improve treatment adherence and efficacy in schizophrenia.
Cognitive dysfunction has been demonstrated in patients with schizophrenia, and this may affect patients’ functional outcome. The improvement of such dysfunction by means of cognitive remediation interventions has become a relevant target in the care of schizophrenia.
To assess the effectiveness of the cognitive subprograms of Integrated Psychological Therapy (IPT) on symptomatological, neuropsychological and functional outcome variables and to analyze the relationships between cognitive and functional outcome changes in schizophrenia.
Thirty-two patients with schizophrenia were assigned to cognitive remediation (IPT-cog) or usual rehabilitative interventions in a naturalistic setting of care. Clinical, neuropsychological and functional outcome variables were assessed at baseline and after 24 weeks of treatment.
The IPT-cog group improved significantly more than the comparison group with respect to psychopathological and functional outcome variables. Moreover, only the IPT-cog group improved significantly in the neuropsychological domains of verbal and working memory, with specific significant correlations between neurocognitive performance and functional outcome changes.
The results of the study confirm the effectiveness of the cognitive remediation component of IPT in schizophrenia, and indicate that some of the changes in functional outcome may be mediated by improvement in specific cognitive domains.
Aim of this randomised, parallel, placebo-controlled group trial was to compare oxcarbazepina and topiramate with placebo on alcohol drinking indices. Craving and psychiatric simptomatology have also been investigated.
This randomised, parallel, placebo-controlled psychopharmacology trial studied 60 patients, consecutively recruited, meeting clinical criteria for Alcohol Dependence (DSM-IV). After detoxification, subjects were assigned to flexible doses of oxcarbazepine (n=20), or topiramate (n=20) or placebo (n=20). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) and the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90 Revised (SCL-90 R).
Non-benzodiazepine anticonvulsants have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. During the congress the main results of this study will be presented.
To our knowledge, this is the first randomised, parallel, placebo-controlled group study to evaluate the efficacy of oxcarbazepine and topiramate compared in alcohol dependent patients. The data of this pilot clinical study suggest and investigate a possible role for the anticonvulsants agents in the treatment of alcohol dependent patients.
The concept of Deficit Schizophrenia (DS) is considered one of the most promising attempts to reduce heterogeneity within schizophrenia. Few prospective studies tested its longitudinal stability and ability to predict clinical features and outcome at five years follow-up.
In the present study 51 patients with DS and 43 with Nondeficit Schizophrenia (NDS), previously included in an Italian Multicenter Study on Deficit Schizophrenia, were reassessed after 5 years from the initial evaluation. The diagnosis of DS and NDS was made by raters blind to initial categorization using the Schedule for the Deficit Syndrome. Clinical, neurocognitive and social outcome indices were also evaluated.
The follow-up diagnosis confirmed the baseline one in forty-two out of 51 patients with DS (82.4%) and in 35 out of 54 with NDS (79.6%). Clinical, neuropsychological and social functioning characterization of patients with DS also revealed high reproducibility with respect to baseline assessment: anergia and negative dimension, social isolation and neurocognitive impairment (in particular general cognitive abilities and attention impairment) were more severe in patients with DS than in those with NDS. In neither group a significant deterioration of clinical, neurocognitive and social functioning indices was found, in line with previous studies in patients with chronic schizophrenia.
Study findings provide evidence for the long-term stability of Deficit Schizophrenia.
Subjective experience on antipsychotic drugs (APs) in schizophrenic patients has been the object of several recent studies and it has been connected to treatment adherence, quality of life and outcome. The current study was undertaken to investigate the role of clinical and socio-demographic variables on patients' perceptions and attitude towards APs in schizophrenia.
Seventy-eight schizophrenic patients (M/F=38/35) were recruited in a naturalistic setting, from two Rehabilitative Centres of the Departments of Mental Health of Melegnano and Milano (Italy). Subjective experience towards antipsychotic treatment was assessed using the Drug Attitude Inventory-30 (DAI-30) and the Subjective Well-being on Neuroleptics (SWN) scales. The Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Global Assessment of Functioning (GAF) scale were adopted to evaluate clinical and outcome variables.
The analysis of study data showed a relationship between psychopathological variables and patients’ subjective experience on APs treatment. Positive symptoms affected patients’ perception of their treatment leading to a negative attitude towards APs, whereas negative symptoms were associated with a worse perception of patients’ mental functioning. With respect to pharmacotherapy, atypical antipsycotics were associated to a higher awareness of cognitive dysfunction and better treatment adherence.
These findings underline the clinical relevance of taking into account the subjective experience of schizophrenic patients treated with APs in order to improve treatment adherence and outcome.
Cognitive deficits are a core feature of schizophrenia and the need for a simple and reliable method for assessment of cognitive functions in schizophrenia is well recognized. The Schizophrenia Cognition Rating Scale (SCoRS) has proved to be a valid measure of neurocognitive performance and to correlate with the psychosocial functioning of schizophrenic patients. Aim of the present study was to investigate the correlations among global ratings of the Italian version of the SCoRS and measures of cognitive performance, symptoms severity and psychosocial functioning in schizophrenic subjects. We intended also to test the SCoRS sensitiviity to change over time, in relation also to changes of the above mentioned clinical, neurocognitive and outcome parameters. Forty-eight patients with schizophrenia (29 males, 19 female; mean age 39.1 years) were assessed at baseline and after three months of usual outpatient treatment according to the Italian community assertive treatment program, with the following instruments:
2) comprehensive neuropsychological battery;
3) the Positive And Negative Syndrome Scale and the Clinical Global Impression;
4) the Global Assessment of Functioning, the Health of the Nation Outcome Scale, the Camberwell Assessment of Needs scale.
At baseline, SCoRS global ratings significantly correlated with the composite scores of cognitive performance, with positive, negative and total PANSS scores and with all measures of psychosocial functioning. Conversely, SCoRS global ratings did not change significantly over the 3-month follow up and the changes from baseline did not significantly correlate with the changes of neurocognitive, clinical and functional assessments over the same time period.
There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction.
Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects, in comparison with matched non clinical controls. Any relationship with impulsivity and drinking behaviour (binge drinking) was also investigated.
We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning. BIS-11 was also administered to explore impulsivity levels.
Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Intriguingly, impulsivity in alcoholics seems to not inhibit cognitive performance. Data about binge drinking will be also presented.
Our results show that alcohol dependent patients present a weaker performance in all the domains referable to executive functions when compared to controls. Disruptions in inhibitory control are central to many theories of addiction; the inhibitory activities of the Frontal and Prefrontal Cortex, are particularly important when an individual needs to over-ride a reflexive response, such as a craving response to drug-related cues.
There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction. Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects in comparison with matched non clinical controls. Any relationship with impulsivity and anger was also investigated.
Thirty Alcohol Dependent outpatients with diagnosis of Alcohol Dependence (DSM-IV-TR) and thirty matched control subjects participated to the study. We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning (FAS for verbal fluency; Semantic Fluency; Digit span; Spatial span; Similarities; Stroop test; Wisconsin Card Sorting Test; TMT Making Test Parts A & B; Digit Symbol). BIS-11 and STAXI I and II were also administered to explore impulsivity and anger levels.
Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Furthermore, a correlation between the performance at neuropsychological tests and the score at the instruments designed to assess impulsivity and anger have been deducted.
Alcohol dependence is associated with a significant impairment on executive domain. Impulsivity and anger levels, both dimensions linked with the executive capacity, seem to be altered as well.
Non-benzodiazepine anticonvulsant agents have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. Several studies have demonstrated topiramate's efficacy in improving drinking behavior and maintaining abstinence. The objective of the present randomised, parallel, placebo-controlled trial was to compare topiramate at low dosage with placebo on alcohol drinking indices and craving in detoxified alcohol dependent subjects. Psychiatric symptomatology, quality of life and clinical global improvement have also been investigated.
Sixty detoxified Alcohol Dependent (DSM-IV-TR) outpatients were recruited and randomly assigned to receive topiramate low dosage (n = 30) or placebo (n = 30). Patients have been evaluated after 30, 90 and 180 days of treatment.
Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar); craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VASc) and the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90-Revised (SCL-90-R), quality of life with the QL-INDEX; the Clinical Global Impression (CGI) was also administered.
As to our results, topiramate is more efficacy than placebo on both the improvement of withdrawal symptomatology and the reduction of relapses. Furthermore, it has resulted effective in reducing craving, the severity of global psychopathology and the quality of life.
The data of this pilot study investigate and suggest a possible role for the anticonvulsants agents in the treatment of alcohol dependence. Topiramate could be an alternative option beyond the already approved agents for the treatment of alcohol dependence.