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Stroke represents the third most frequent cause of mortality in developed countries, following only coronary heart diseases and cancer. Post-Stroke Depression (PSD) is extremely common among stroke survivors, and it may have great burden on the likelihood of functional recovery and long-term outcomes. We hypothesized that PSD is related to a higher rate of mortality among people suffering from a stroke.
To estimate the risk of mortality among subjects suffering from PSD as compared with stroke survivors who did not suffer from PSD.
We performed a systematic review of papers indexed in Pubmed. Both fixed and random-effects methods for estimating association and time-to-event pooled effects were used. The presence and the level of heterogeneity were assessed using Q test and I2 statistic.
Seven papers had data suitable for meta-analysis. The pooled association effect for mortality at follow-up in people with PSD were statistically significant (p< 0.05). The time-to-event estimation showed a statistically significant correlation exclusively under the fixed effect analysis.
These findings pointed out the potential burden of PSD on post stroke mortality. Further investigation is required to clarify the nature of PSD/mortality association.
Schizophrenia (SKZ) is a disease characterized by positive and negative symptoms, thoughts and behaviour disorganization with a progressive socio-cognitive impairment1; deficits in facial emotion recognition (FER) represent one of the most serious problems linked to interpersonal problems2. In addition, these patients have often comorbid condition of alcohol and substances abuse3.
to compare the ability of FER in patients with SKZ using alcohol and/or substances (SKZ+SUD) compared to schizophrenics without SUD (SUD-SKZ).
we enrolled 53 subjects (M=40, F=13) with a DSM-IV diagnosis of SKZ (SCID I). The sample was divided according to alcohol and/or substance abuse (AUS and DUS) into two groups, compared for socio-demographic and clinic characteristics (PANSS and Bell model4). We analyzed the association between abuse condition and Ekman test performance.
SKZ+SUD (n=20; M=16, F=4) and SKZ-SUD (n=33; M=24, F=9) show a statistically significant age difference with a mean (SD) of 38.4 years (10.5) and 46.0 years (8.7) respectively (p=0.006). SKZ+SUD Ekman test score (mean=43.1, SD=6.9) was statistically higher (p=0.006) than SKZ-SUD (mean=34.6, SD=12.0). The different performance was more evident in comparison with poly-abusers (44.94±7.05 vs 12.04±34.6; p=0.002). We further noticed the role of disorganization as a mediator of the relationship between abuse and FER score (p=0.017): the proportion of the effect of abuse on Ekman test score was 48%.
In subjects with SKZ, FER seems to be less impaired in abusers than non-abusers. We also showed an important role of thoughts and behavioral disorganization as a mediator between SKZ+SUD and FER.
People suffering from Severe Mental Illness (SMI) have a shorter life expectancy than general population. The excess of mortality may be primarily due to premature cardiovascular diseases. Subjects with a diagnosis of SMI may have an high prevalence of Metabolic Syndrome (MetS).
To estimate the risk of MetS among subjects with SMI compared to their counterpart without SMI.
A systematic review and meta-analysis of English and non-English articles using PubMed, Embase and PsycINFO was performed. ORs with related confidence intervals were used as association measures. All pooled analyses were based on random-effects models.
The pooled analysis showed a statistically significant association for MetS in people suffering from SMI. However, we found a consistent level of heterogeneity between the included studies. Subanalyses showed that both SCZ and BD had higher risk than general population without SMI. No statistical differences were found comparing SCZ and BD subjects.
People with SMI have significantly higher risk to having MetS than general population. Despite some limitations, the results of present meta-analysis emphasize the relevance of a continuous cardio-metabolic assessment in the SMI population. Longitudinal researches are needed in order to assess the impact of a regular cardiovascular screening, prevention and treatment on the improvement of health status and life expectancy among people suffering from SMI.
QTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.
The objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.
The Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.
A sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.
A total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.
The present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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