The COVID-19 emergency have imposed a great burden on the Italian health and social health system. In this context, healthcare workers (HCWs) have been exposed to high levels of stress. While many studies addressed the consequences of COVID-19 on hospital workers, little interest has been devoted to the employees of nursing homes.

To evaluate levels of depressive, anxious and post-traumatic symptoms in a population of nursing homes workers in Italy one year after the begin of the pandemic.

The research involved 177 nursing homes, to evaluate the Mental Health outcome of the COVID-19 pandemic 12 months after the first lockdown on a large sample of workers. Participants answered a self-assessment tools aimed to assess the level of trauma experienced, the level of anxiety and depression, the quality of professional life and social and work adjustment.

A consistent level of psychological suffering in the HCWs 12 months after the first lock-down and after the third wave of Covid-19 is highlighted, in accordance with what has been observed in similar research. It turns out that about 30% of subjects, more often women, have elements suggestive of symptoms related to PTSD, with moderate levels of anxiety. On the other hand, 15% of the sample presents moderate levels of depressive symptoms and a severe impact on social and occupational functioning. Of these about 40% of staff has significant interference and just over 15% has a severe impact (see figure 1).

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Interventions tailored to support mental health are needed not only for HCWs from hospital units but also for those working in nursing homes and long-term care units.

None Declared

The efficacy of QTP in the treatment of schizophrenia has been well established in randomised, double-blind, placebo-controlled trials, but there is a lack of data concerning its efficacy in the medium- term management of schizoaffective disorder. Aim of the study was to evaluate retrospectively the efficacy and tolerability of QTP in preventing relapses of Schizoaffective Disorder (1,2).

The study involved 18 outpatients (4 males and 14 females), at least 18 years of age, with a diagnosis of Schizoaffective Disorder, based on the DSM-IV-TR criteria.

Patients were evaluated by using BPRS, CDSS and CGI-S. Clinical evaluation was assessed retrospectively through the data obtained by the clinical records. Evaluation started when QTP was prescribed (T0), and was performed after six months (T6). Moreover, a clinical evaluation was assessed six months before the start of QTP treatment by using the same rating scale (T-6). The main outcome measure evaluated was the rate of hospitalization caused by depressive, manic or psychotic relapses.

At the end of the study (T6), a significant reduction in CGI-S, BPRS and CDSS scores was observed. CDSS mean scores showed a 60% amelioration vs T0. No patients dropped out because of side effects. The mean dosage of quetiapine in our study was 544 mg/die.

QTP, alone or in association with benzodiazepines and/or mood stabilizers, seems to be an effective tool in the treatment of Schizoaffective Disorder and in prevention of relapses and consistent with several researches it seems effective in reduction of depressive symptoms.

Duloxetine (DLX) is approved for treatment of Major Depressive Disorder (MDD).

Aims of this study were to assess the clinical outcome of DLX in the treatment of MDD, with efficacy measures based on clinician and patient assessment, and to evaluate the predicitve value of DLX plasma levels on clinical response.

45 out-patients affected by MDD were included in the study and prescribed 30-120 mg/day of DLX for 12 weeks.

Patients were evaluated at T0, after 2 (T1), 4 (T2), and 12 weeks (T3), by using HAMD21, HAMA, CGI-S, and the self-rating scales BDI and VAS. Plasma samples were collected at T2.

Responders (50% reduction in HAMD21) were 60% and remitters (HAMD21 ≤7) were 56%. HAMD21 showed a significant improvement at T1, T2, T3 vs T0. HAMA and CGI-S showed a significant improvement at T2, T3 vs T0.

15 (33%) patients discontinued the treatment.

Blood pressure, heart rate, and body weight did not show relevant changes.

DLX plasma levels ranged from 5 ng/ml to 135 ng/ml (mean 53.56 ± 39.45 SD). The incidence of side effects irritability and anxiety was found to be significantly correlated with the highest DLX level/dose (mean 1.6 ng/ml/mg ± 0.29 SD) (p=0.02).

We observed a curvilinear relationship between HAMD21 percentage of amelioration at T2 and DLX plasma levels/dose (mg/kg) (y=22.74+0.78x-0.0038x2, R2=0.134; p=0.23).

Good medium-term clinical response, but plasma levels showed an increased of adverse events at higher values, reducing the advantages of dose escalation.

This open label study was performed to evaluate the relationship between the plasma concentration of olanzapine and the response in acute schizophrenic inpatients.

A total of 54 inpatients, 38 males and 16 females, age ranging from 18 to 75 years, affected by Schizophrenia (DSM IV criteria) during an exacerbation phase were included in the study. Olanzapine (OLZ) was started at a dose of 5–20 mg/day and was increased to a mean dose of 15.27 mg ±5.53 S.D. Patients were evaluated at baseline, and after 2 weeks, by using BPRS, PANNS, HRS-D, EPSE, and ACS.

BPRS and total PANSS showed a statistically significant improvement at the end of the study. Olanzapine plasma levels (PL) ranged from 5 to 120 ng/ml (mean 33.15 ng/ml ± 28.28 S.D.) and showed a positive correlation with OLZ dosage. A significant curvilinear correlation between OLZ PL and clinical improvement (BPRS, PANSS and HRS-D percent of amelioration) was observed.

Olanzapine plasma level determination seems to be a useful tool in optimizing acute treatment particularly for more problematic cases.