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Stroop test iteration performances and metabolism of tryptophan (TRP) via serotonin (5-HT) and kynurenine (KYN) have both been associated with suicidal behaviors. This study aims to probe their possible interactions.
We explored the association of the performances on the Emotion Inhibition Subtask (EIS) of the Brief Assessment of Cognition for Affective Disorder and the plasmatic levels of 5-hydroxytryptophan (5-HTP), 5-HT, KYN, melatonin (MLT) among subjects with Lifetime Suicidal Ideation (LSI) vs non-LSI, and with Lifetime Suicide Attempts (LSA) vs non-LSA.
Using R studio, we employed: 1) the t-test for parametric data and the Wilcoxon test for non-parametric data; 2) Linear Modeling to probe the associations of EIS performances with MLT, KYN, 5-HTP or 5-HT plasmatic levels.
In a sample comprising 45 individuals affected by Bipolar Disorder, we found a statistically significant difference for the Color Naming (CN, image 1) and the Neutral words (NW) subtasks among LSA vs non-LSA. In LSI vs non-LSI, only the NW retained significance, but not the CN. A significant association emerged between CN and 5-HTP in LSI but not in non-LSI (image 2). Similarly, in LSA, an association was found between CN and 5-HTP, but not in non-LSA (image 3). No statistically significant difference emerged among groups regarding gender composition, age, pharmacological therapy, Body Mass Index, Hamilton Depression Rating Scale, Young Mania Rating Scale, or Clinical Global Impression scale - Severity.
We found that the plasmatic levels of the metabolites of TRP via 5-HT were correlated to some EIS performances. These findings may represent a hypothesis-generating platform for further investigations.
Armed conflicts produce a wide series of distressing consequences, including death, all of which impact negatively on the lives of survivors. This presentatiin focuses specifically on the mental health consequences of war on adults and child/adolescent refugees or those living in war zones basing upon review of all systematic reviews and/or meta-analyses published from 2005 up until the current time, that is Fifteen systematic reviews and/or meta-analyses conducted in adult populations, and seven relating to children and adolescents. Prevalence rates of Anxiety, Depression and Post-traumatic Stress Disorder (PTSD) were two-three-fold higher amongst people exposed to armed conflict compared to those who had not been exposed, with women and children being the most vulnerable sujects. A series of war-related, migratory and post-migratory stressors contribute to short- and long-term mental health issues in the internally displaced, asylum seekers and refugees. Based upon these evidences psychiatrists and psychiatric associations should take also the ethical responsibility for raising awareness of political decision-makers as to the mental health consequences caused by armed conflicts as a further reason for improving peace-keeping initiatives.
Schizophrenia spectrum disorders are among the most debilitating mental disorders and evidence on its pathophysiological underpinnings is scant. The brain-derived neurotrophic factor (BDNF) appears to be involved in the pathophysiology of these complex psychiatric disorders.
The present study investigates the longitudinal variation of serum BDNF levels in a 24-month observational cohort study of Sardinian psychotic patients (LABSP). This study assessed the variation in BDNF serum levels and its relationship with psychopathological and cognitive changes. Further, we also examined if genetic variations within the BDNF gene could moderate these relationships.
Every six months 105 LABSP patients were assessed for their BDNF serum levels, as well as for a series of psychopathological, cognitive, and drug-related measures. Four tag single nucleotide polymorphisms (SNPs) within the BDNF gene were selected and analyzed using Polymerase Chain Reaction (PCR). Longitudinal data were analyzed using mixed-effects linear regression models (MLRM).
Analysis showed significantly lower peripheral BDNF levels in psychotic patients with depressive and negative symptoms. BDNF levels were also decreased in patients scoring lower in cognitive measures such as symbol coding and semantic fluency. In addition, Val66Met polymorphism within the BDNF gene significantly moderated the relationship between the severity of negative symptoms and BDNF levels.
Our findings are consistent with previous literature suggesting that peripheral BDNF levels are associated with some cognitive domains and mood disruption in major psychosis. The results also suggest the lack of association between most BDNF genetic variants, except Val66Met polymorphism, with the severity of negative symptoms.
Involuntary treatments probably are the most critical issue for psychiatric practice all over the world, including Italy, where the public debate about involuntary admissions and related coercive measures has been constantly alive. In Italy involuntary treatments are justified on the basis of three criteria: the presence of a mental illness; the need for urgent hospital-based treatment, the patient refusal of treatment. Although only 10% of all hospitalizations in Italy occur on a involuntary basis, actually the lowest rate in Europe, proposals of modification of the current Law have been repeatedly presented, in terms of further restrictions of the conditions allowing involuntary hospitalization or even in terms of its abolition. The practice of physical restraint in particular, which has been reported as applied in approx. 85% of Psychiatric Wards, has been strongly criticized, although the effective dimension of its use in Italy is unknown due the lack of official data. In 2015 The National Council of Bioethics expressed a series of doubts and criticisms as well as the Special Commission for Human Rights of the Italian Senate in 2016. Moreover, the death of some patients submitted to physical restraint in the last years, gave repeteadly rise to a media hype, leading again very recently to claims for the abolition of any form of physical restraint during a National Conference on Mental Health, a proposal that the Minister of Health welcomed, committing himself to implement it through a agreement between the State and the Regions, officially devoted to health assistance in Italy.
The coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measures, such as “lockdown” and “social distancing”, have had important consequences on people’s mental and physical health.
We aimed to study the effect of social isolation and subsequent re- exposure and eventual changes in general and ED-specific psychopathology in people with Eating Disorders (EDs).
Three-hundred twelve Italian people with EDs (179 Anorexia Nervosa, 83 Bulimia Nervosa, 48 Binge Eating Disorder and 22 Other Specific Feeding Eating Disorder) were asked to fill-in an online survey to explore several dimensions such as: anxiety, depression, panic, insomnia, suicide ideation, stress, post-traumatic stress and obsessive-compulsive symptoms. Differences in ED specific and general symptoms among the 3 investigated time periods (before, during and after the end of lockdown) were assessed with a one-way ANOVA with repeated measures. Subsequently, ED diagnosis was introduced as covariate in the analysis in order to investigate the possible contribution on psychopathological changes.
ED core symptoms increased during the lockdown but most of them returned to pre-COVID19 levels at re-opening. The severity of general psychopathology also increased during the lockdown and persisted high in the following phase, except for depression and suicide ideation. None of this symptoms was affected by ED diagnosis, participants’age and illness duration.
People with EDs showed worsening of both general and specific psychopathology; moreover, changes in general psychopathology persisted in the re-opening period suggesting a higher stress vulnerability in this kind of patients.
Stigma toward mental illness is considered a major public health problem, being a significant obstacle for the access to care by people with psychiatric disorders, not only the severe ones but also those improperly called “minor” disorders, as recent research demonstrates. Moreover, stigma per se causes further sufference, undermining the quality of life of those who suffer from mental disorders due to discrimination, social isolation and lack of opportunities. Thus, combating stigma is one of the main goal of mental health policies worldwide. After the 1978 Reform Act, substantial ideological and practical changes were introduced in Italy, such as, among others, the abandonement of custodial care and of the dangerousness criterion for involuntary treatments, along with the development of a nationwide system in mental health care. Notwithstanding there relevant changes and more than forty years of experience in community treatment of mental disorders and the widespread implementation of interventions oriented to social inclusion, no data about significant changes in public stigma toward mentally ill people could be registered in our country. Moreover, a quite limited number of specific anti-stigma programmes and campaigns at a national or local level were developed with a correspondently paucity of research regarding the evaluation of these interventions with specific reference to their quality and effectiveness
The pandemic has highlighted with particular evidence the vulnerability of people with mental disorders and a series of specific ethical concerns regarding their condition. First of all, the risk of receiving poor medical care due to the double stigma of being affected by a mental disorder and Covid infection, in addition to the many other additional barriers, including poverty, marginal housing, and food insecurity. Moreover, in some countries, in a situation where demands for intensive care exceeded the treatment facilities available, the tragical ethical dilemma regarding the choice of people to be saved was resolved with the option in favor of healthier and/or younger people who have more chances of recovery, thus excluding, among others, aged people with severe mental disorders such as dementias. In other countries, ethical concerns emerged related to the enhanced risk of involuntary hospital admission of individuals with severe mental illness mainly due the high likelihood of these patients violating physical-distancing and other safety rules. Social distancing measures have determined, among others, relevant obstacles for direct access to psychiatric care services, with the consequent adoption of the so called “telepsychiatry” of “tele mental health” by mental health services, a measure which unfortunately has cut off a large amount of patients who have not been able to benefit from these innovative methods of care both because of barriers posed by their own serious mental conditions, and by the impossibility of having the necessary technology.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Évaluer la tolérance, la sécurité d’emploi et la réponse à un traitement par le palmitate de palipéridone (PP) administré en doses mensuelles flexibles dans un sous-groupe de patients adultes atteints de schizophrénie, non-aigus mais symptomatiques, après échec d’un traitement par aripiprazole oral.
Étude internationale multicentrique, ouverte, prospective de 6 mois.
Changement du score total de PANSS, de CGI-S et CGI-C, du fonctionnement personnel et social (Personal and Social Performance Scale [PSP]), des symptômes extrapyramidaux (Extrapyramidal Symptom Rating Scale [ESRS]) et événements indésirables (EIs).
Quarante-six patients (73,9 % d’hommes, âge moyen 34,4 ± 9,4 ans, 78,3 % souffrant de schizophrénie paranoïde) ont été étudiés. La principale raison de la substitution d’aripiprazole oral (dose moyenne de 22,7 ± 10,7 mg/jour) par le PP était « le choix du patient » (39,1 %) ; 67,4 % des patients ont terminé l’étude à 6 mois. Le score total moyen de PANSS a diminué de 74,7 ± 14,9 à l’inclusion à 62,6 ± 16,5 lors de la dernière observation (soit une variation moyenne de −12,2 ± 16,7 points ; IC 95 % [−17,1 ; −7,2] ; p < 0,0001). Chez 52,2 % des patients, l’amélioration du score total de PANSS a été ≥ 20 % ; le pourcentage de patients considérés légèrement malades ou moins selon les critères de la CGI-S est passé de 23,9 % à 56,5 %. Au total, 75,5 % des patients ont été jugés améliorés à la CGI-C par rapport au traitement antérieur par aripiprazole. Le score de l’échelle de fonctionnement PSP s’est amélioré de 58,9 ± 13,4 à 62,9 ± 15,2 (p = 0,041). Les EIs touchant ≥ 5 % des patients étaient : anxiété (n = 6), douleur au site d’injection, bronchite, insomnie, akathisie (n = 4 chacun) et augmentation du poids, dépression et douleur aux extrémités (n = 3 chacun). Les symptômes extrapyramidaux selon ESRS se sont améliorés de façon significative depuis l’inclusion jusqu’à 6 mois chez les patients ayant terminé l’étude (−1,4 ± 2,7 ; p < 0,006).
L’utilisation de doses flexibles de PP a permis une amélioration symptomatologique et fonctionnelle cliniquement significative chez des patients atteints de schizophrénie, non-aigus et en échec de traitement par aripiprazole oral. Le PP a été bien toléré avec une diminution des symptômes extrapyramidaux.
Évaluer la tolérance, la sécurité d’emploi et la réponse à un traitement par palmitate de palipéridone (PP) à doses flexibles chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par un autre antipsychotique injectable à action prolongée : décanoate d’halopéridol (Déc-Hal), décanoate de flupentixol (Déc-Fpt), décanoate de fluphénazine (Déc-Flu), zuclopenthixol (Zuc) ou rispéridone à libération prolongée (RIS-LP).
Étude internationale, prospective, ouverte, de six mois, chez des patients atteints de schizophrénie, non aigus mais insuffisamment contrôlés par d’autres antipsychotiques injectables à action prolongée.
Taux de réponse (amélioration ≥ 20 % du score total à la PANSS [Positive and Negative Syndrome Scale]), score à la PSP (Personal and Social Performance scale), événements indésirables (EIs).
Les analyses ont été réalisées sur la population en intention de traiter de façon stratifiée pour chaque traitement : 53 patients Déc-Hal, 35 Déc-Fpt, 44 Déc-Flu, 42 Zuc, 56 RIS-LP. Les scores totaux moyens à la PANSS initiale variaient de 67,7 ± 20,3 [RIS-LP] à 75,7 ± 13,2 [Déc-Hal]. Entre 71,4 % [RIS-LP] et 85,7 % [Déc-Fpt] des patients ont terminé l’étude. À la fin de l’étude, 53,7 % [Zuc], 54,7 % [Déc-Hal], 59,1 % [Déc-Flu], 61,1 % [RIS-LP] et 61,8 % [Déc- Fpt] des patients ont vu leur score total à la PANSS diminuer d’au moins 20 %. Les scores moyens de PSP de base étaient de 48,7 [Déc-Hal], 59,6 [Déc-Fpt], 53,5 [Déc-Flu], 52,9 [Zuc] et 60,1 [RIS-LP], et le changement en fin d’étude était respectivement de : 5,2 ; 6,1 ; 6,0 ; 6,4 ; et 5,2 (p ≤ 0,0163 pour tous les traitements). Les EIs rapportés au moins une fois dans tous les sous-groupes : douleur au site d’injection, insomnie, trouble psychotique.
Le PP à doses flexibles a été bien toléré et a permis une réponse thérapeutique cliniquement significative chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par d’autres antipsychotiques injectables à action prolongée.
Évaluer la tolérance, la sécurité d’emploi et l’efficacité de doses flexibles de PP chez des patients adultes en période d’exacerbation aiguë d’une schizophrénie, après échec d’un traitement par antipsychotiques oraux.
Étude internationale, prospective, ouverte, de six mois.
Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), événements indésirables (EI), changement de poids.
Deux cent douze patients (population en intention de traiter) : âge moyen 36,4 ± 12,1 ans, 59,0 % d’hommes, 85,4 % souffrant de schizophrénie paranoïde ont été inclus. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (45,8 %). 70,3 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce ont été : le choix du patient (9,4 %), des EI (9,0 %), les perdus de vue (4,7 %), le manque d’efficacité (2,8 %). Le score total moyen à la PANSS initiale (98,5 ± 20,1) a diminué, et ce dès j8, pour atteindre 67,4 ± 24,0 à la fin de l’étude (diminution de −31,0 ± 29,0, p < 0,0001). 66,7 % des patients ont eu une amélioration de plus de 30 % du score PANSS total et le pourcentage de patients jugés manifestement malades ou pire (CGI-S) a diminué de 75,1 % à 20,5 %. Les EIs (≥ 5 % patients) : douleur au site d’injection (13,7 %), insomnie (10,8 %), trouble psychotique (10,4 %), céphalées (6,1 %) et anxiété (6,1 %). Le changement moyen de poids a été de 2,6 ± 5,6 kg (IC 95 % [1,8; 3,4]).
Ces résultats confirment que le PP à doses flexibles est bien toléré et permet une réponse clinique précoce et cliniquement significative chez des patients en période d’exacerbation aiguë de leur trouble schizophrénique, après échec d’un traitement par antipsychotiques oraux.
The pattern of family burden was compared in 32 relatives of schizophrenic patients and 32 relatives of people with mental retardation, using a standardised semistructured interview named “Accertamento della Disabilità e del Carico Familiare” (Assessment of Disability and Family Burden). There were few quantitative differences between the two samples of relatives, although relatives of schizophrenics presented a tendency for a higher degree of both objective and subjective burden in some areas. Problems frequently reported were the presence of emotional distress, poor social relationships and lack of holidays or free time activities. Relatives of schizophrenics specifically claimed the presence of financial difficulties, while those of people with mental retardation were concerned by problems with neighbours.
Évaluer l’amélioration fonctionnelle chez des patients atteints de schizophrénie sous palmitate de paliperidone (PP) à doses flexibles après échec d’un traitement par antipsychotiques oraux.
Analyse menée dans deux sous-groupes de patients atteints de schizophrénie : aigus (n = 202) et non aigus (n = 593) après échec d’un traitement par antipsychotiques oraux, inclus dans une étude internationale, prospective, de six mois.
Changement du score total à la PANSS (Positive and Negative Syndrome Scale), à la PSP (Personal and Psychosocial Performance scale), et à la Mini-ICF-APP (Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses).
Les deux sous-groupes ont présenté une amélioration significative du score total à la PANSS : de 98,5 ± 20,1 à l’inclusion à 67,4 ± 24,0 à la fin de l’étude (diminution moyenne = −31,0 ± 29,0) chez les patients aigus et de 71,5 ± 14,6 à 59,7 ± 18,1 (diminution moyenne = −11,7 ± 15,9) chez les patients non aigus. Cette réponse thérapeutique était associée à une augmentation significative du score total à la PSP de 43,9 ± 15,0 à 62,9 ± 17,1 (amélioration moyenne = 19,0 ± 18,7, p <0,0001) chez les patients aigus, et de 58,1 ± 13,4 à 66,1 ± 15,7 (amélioration moyenne =8,0 ± 14,0, p < 0,0001) chez les patients non aigus. Il existait une amélioration significative du score à la Mini-ICF-APP qui diminuait de 26,8 ± 8,5 à 18,5 ± 9,8 (diminution moyenne = −8,0 ± 10,4, p < 0,0001) chez les patients aigus et de 19,8 ± 7,9 à 15,9 ± 8,8 (diminution moyenne = −4,0 ± 7,5, p < 0,0001) chez les patients non aigus.
L’amélioration symptomatique sous PP à doses flexibles chez des patients aigus ou non-aigus atteints de schizophrénie après échec d’un traitement par antipsychotique oral s’est accompagnée d’une amélioration fonctionnelle cliniquement significative.
Évaluer la tolérance, la sécurité d’emploi et la réponse à un traitement mensuel par palmitate de paliperidone (PP) à doses flexibles chez des patients adultes atteints de schizophrénie, non-aigus mais symptomatiques, après échec d’un traitement par antipsychotiques oraux.
Analyse d’un groupe de patients atteints de schizophrénie, non-aigus mais symptomatiques, inclus dans une étude internationale, ouverte, prospective de six mois, évaluant la symptomatologie clinique : PANSS (Positive and Negative Syndrome Scale) et CGIS-S (Clinical Global Impression-Severity Scale), les événements indésirables (EIs) et le changement de poids.
Cinq cent quatre-vingt-treize patients (population en intention de traiter) : 63,1 % d’hommes, âge moyen 38,4 ± 11,8 ans, 78,6 % souffrant de schizophrénie paranoïde. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (24,3 %). 74,5 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce étaient : le choix du patient (9,3 %), des effets indésirables (EIs) (6,1 %), les perdus de vue (3,0 %) et le manque d’efficacité (2,5 %). Le score total moyen à l’échelle PANSS a diminué de 71,5 ± 14,6 à l’inclusion à 59,7 ± 18,1 à la fin de l’étude (soit une différence de −11,7 ± 15,9 points ; 95 % IC 95 % [−13,0 ; −10,5] ; p <0,0001). 64,0 % des patients ont eu une amélioration supérieure ou égale à 20 % du score total à la PANSS et le pourcentage de patients légèrement malades ou moins (CGI-S) est passé de 31,8 à 63,2 %. Les EIs touchant plus de 5 % des patients sont : douleur au site d’injection (12,3 %), insomnie (8,6 %), anxiété (6,7 %), trouble psychotique (6,1 %) et céphalées (5,6 %). Le changement moyen de poids a été de 1,2 ± 5,0 kg (IC 95 % [0,7 ; 1,6]).
Ces résultats confirment la bonne tolérance et l’efficacité thérapeutique du PP à doses flexibles chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par antipsychotiques oraux.
The aim of the study was to evaluate quantitative sleep disorders in forty patients with a psychotic disorder (F 20 or F25 at ICD X International Classification), who are taking antipsychotic medication.
We studied 100 patients, affected by schizophrenic or schizoaffective disorder, aged from 20 to 65 years old. These patients were divided in four groups each containing 25 people who were taking neuroleptics or atypical antipsychotic (olanzapine, risperidone or aripiprazole).
The variability of quantitative sleep disorder was measured using questions 4-5-6 of Hamilton Depression Scale to evaluate early, intermediate or late insomnia, and the Epworth Sleepiness Scale to assess EDS (excessive daytime sleepiness)
We all know the sedative effects of neuroleptics, furtherless it is not unexpected that most of the atypical antipsychotics are sedating, and thus have the potential to impair judgement, thinking or motor skills giving the patients the sensation of being different from the other people. Many times we forget that the other side of insomnia is the excessive daytime sleepiness….
In the future, we have to manage these disorders, if we want to avoid lack of compliance and further drop out of therapy.
As many studies suggest, schizophrenic spectrum disorders outcome is linked with the duration of untreated first-episode psychosis; the longer is the gap between the onset of the disease and the first medical treatement the worst is the outcome. Cognitive impairment is one of the major predictor of poor outcome.
We study if there is a correlation between a long duration of untreated first-episode psychosis and cognitive impairment in the long term outcome.
Our sample consisted of 41 subjects (27M and 14 F) with a mean age of 48.6 years (SD = 11.91) with a mean age of onset of 23.4 years (SD = 7.68) and a mean duration of illness of 22.1 years (SD = 14.8) who has been diagnosed schizophrenic according to DSM-IV TR through the SCID-I and evaluated with the Wechsler Adult Intelligence Scale (WAIS) to study neuro-cognitive profile.
A long duration of untreated psychosis is associated with redution in the performance scale of association symbols to number (p = 0.04) and performance IQ (p = 0.04) regardless of the duration of illness.
This study confirms an association between long duration of untreated psychosis and cognitive deterioration. The reduced performance suggest a deficit in memory, attention and concentration, speed of performance, coordination,skill and non verbal ability in the sample with the longer DUI.
Effective antipsychotic treatment of schizophrenia should, beyond symptom control, translate into meaningful functional improvements. This study explored functional outcomes in patients with schizophrenia switched from previous unsuccessful treatment with oral antipsychotics to flexible doses of paliperidone palmitate (PP).
Two groups of acute (N=212) and non-acute (N=593) patients from an international prospective open-label 6-month study. Outcomes were change in Positive and Negative Syndrome Scale (PANSS) total score, Personal and Psychosocial Performance scale (PSP) and Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses (Mini-ICF-APP).
Both groups significantly improved from baseline to endpoint in mean PANSS total score from 98.5±20.1 to 67.4±24.0 (mean change -31.0±29.0) in acute and from 71.5±14.6 to 59.7±18.1 (mean change -11.7±15.9) in non-acute patients (all p<0.0001). Patient functioning in PSP total score increased from 43.9±15.0 at baseline to 62.9±17.1 at endpoint (mean change 19.0±18.7; 95% confidence interval [CI] 16.4;21.6) in the acute and from 58.1±13.4 at baseline to 66.1±15.7 at endpoint (mean change 8.0±14.0; 95%CI 6.8;9.1) in the non-acute group (both groups p<0.0001). Illness-related disabilities of activity and participation within groups improved significantly in Mini-ICF-APP global score decreasing from 26.8±8.5 to 18.5±9.8 (mean change -8.0±10.4; 95%CI -9.5;-6.5) in acute and from 19.8±7.9 to 15.9±8.8 (mean change: -4.0±7.5; 95%CI - 4.6;-3.3) from baseline to endpoint in non-acute patients (both groups p<0.0001).
Symptom reduction in acute and non-acute patients with schizophrenia treated with PP after previous unsuccessful treatment with oral antipsychotics was associated with clinically meaningful functional improvements.
This study explores tolerability, safety and treatment response of flexible doses of the atypical long-acting antipsychotic paliperidone palmitate (PP) in adult patients with an acute exacerbation of schizophrenia previously unsuccessfully treated with oral antipsychotics.
International prospective open-label 6-month study. Outcome parameters were change in Positive and Negative Syndrome Scale (PANSS) total score, Clinical Global Impression-Severity Scale (CGI-S), treatment-emergent adverse events (TEAEs) and weight change.
212 acute patients, 59.0% male, mean age 36.4 ±12.1 years, 85.4% paranoid schizophrenia were enrolled. 70.3% of patients completed the study. Most frequent reasons for early discontinuation were subject choice (9.4%), or an adverse event (9.0%). Recommended initiation regimen of PP (150 mg eq on day 1 and 100 mg eq on day 8) was administered in 92.9% of subjects. Mean baseline PANSS total score decreased from 98.5±20.1 as of day 8 of treatment to 67.4±24.0 at endpoint (mean change -31.0±28.97; 95% confidence interval [CI]-35.0;-27.1; p<0.0001). 66.7% of patients improved ≥30% in PANSS total score and percentage of patients rated markedly ill or worse in CGI-S decreased from 75.1% at baseline to 20.5% at endpoint. TEAEs reported in ≥5% were injection site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache (6.1%) and anxiety (6.1%). Mean weight change at endpoint was 2.6±5.6 kg (95%CI 1.8; 3.4).
These data support results from previous randomized controlled studies that flexibly dosed paliperidone palmitate is well tolerated and associated with an early and clinically relevant treatment response in acute schizophrenia patients previously unsuccessfully treated with oral antipsychotics.
The psychological benefits of regular physical activity is well known, neverthless only recently the impact on physical and mental health in patients with severe mental disorders has begun to be analyzed. the low incidence rates of depression and some anxiety disorders in subjects performing physical activity raises the question about the use of exercise in the prevention of some mental disorders.
Our study aims to assess preferences, degree of physical effort, level of motivation and perceived barriers that prevent the development of more regular physical activity in patients with psychiatric illness.
We collect data and clinical records of 131 randomized patients. We therefore designed a 15 questions questionnaire associated with a useful section with personal and clinical data of patients.
The 52.7% of the sample (n = 69) has a body mass index above 25, thus confirming the trend of overweight and obesity that are secondary both to psychiatric therapies practiced and to a general lack of physical effort, which is due to poor level of motivation, although most of the patients agree that exercise is crucial for their physical and mental health.
Any psychoeducational interventions aiming to implement healthy lifestyles including physical care activities are therefore appropriate. the very nature of the disorder and treatment practiced explains the main barriers perceived by patients to perform physical activity; thus in the therapeutic area is important to ensure euthymic condition and limit the use of drugs that give fatigue and sedation.
Becoming aware of being HCV positive has a very negative impact on quality of life and IFN therapy is also responsible for the development of neuropsychiatric side effects (Pariante 2002).
This prospective study aims to determine the role of IFN in psychopathological symptoms experienced by patients in treatment, in particular it deals with its impact on quality of life and determines which patients can be safely treated with Peg-interferon α, because the therapy is expensive, has significant side effects and prolonged psychiatric that unfortunately cannot be predicted with absolute certainty.
The sample includes 32 patients, including 18 males and 14 females of mean age of 48.19 years (DS. = 9.660) hepatitis C affected, evaluated before the start of peg-interferon antiviral therapy using the interview semi-structured SCID-I and II and self-administered tests Scl90, BDI, SF36 and followed up at first and third months by HAM-a, HAM-D, CGI, YMRS, and sixth months of therapy through Scl90, BDI, SF36, HAM-A, HAM-D, CGI, YMRS.
Although psychiatric disorders worsened or manifested during the peg-interferon α + ribavirin therapy, only 2 out of 32 patients did not come to the end point of our study because of a psychopathological disease. Despite the predominantly psychopathological depressive symptoms and the marked quality of life reduction, with adequate support, even patients predisposed to mood disorders or anxiety, can take the peg-interferon α, and the presence of a life-time psychiatric diagnosis is not an a priori therapy exclusion criterion.