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Venlafaxine (V) is a SNRI metabolized primarily by the highly polymorphic cytochrome P4502D6 enzyme (CYP2D6) in O-desmethylvenlafaxine (ODV), the main active metabolite. Four CYP2D6 metabolizer phenotypes have been identified: poor (PM), intermediate (IM), extensive (EM) and ultrarapid (UM). Approximately 5-10% Caucasians are PMs; in these individuals metabolism of substrate is decreased and adverse clinical effects may be expected. The effectiveness of pharmacogenetic tests is controversial because the association between plasma levels of V/ODV and side effects is not attested.
We discuss the association between CYP2D6-genotype and Venlafaxine clinical effects.
We will recruit Caucasian patients aged 18 to 65, eligible for Venlafaxine treatment, satisfying DSM-IV criteria for major depressive episode, dysthymia or depressive adjustment disorder. Exclusion criteria will be: pregnancy, acute suicidality, alcohol/substance abuse, concomitant/prior antidepressive treatment in the previous 3 months. We will assess patients’ age, gender, DSM-IV diagnosis, Venlafaxine dose, concomitant pharmacological treatment, BMI, BP, tobacco use, liver and kidney functionality. Clinical response and side effects will be monitored using CGI, HAM-D and SIDE at T0 (onset), T1 (1 week later) and T2 (6 weeks later).
The patients will be analyzed for the presence of 16 CYP2D6-genotype variants by INFINITITTM CYP2D6 assay which utilizes AutoGenomics proprietary film-based microarray technology.
We expect to find out a correlation between CYP2D6-genotype, Venlafaxine dose and clinical response to treatment.
We will investigate whether a pharmacogenetic test prior to treatment can be useful in clinical practice to detect a proper Venlafaxine dosage or to switch to a different drug.
The immigrant population in Italy is currently increasing, particularly, foreigners in East Piedmont raised by 16,8 % last year. We aim to compare immigrant and Italian patients’ Emergency Room (ER) admissions due to psychiatric symptoms.
Of the 658 admissions we observed, 13.1 % of ER contacts concerned immigrants mostly coming from Russia, Albania, Morocco and Romania, consistently with migration streams in East Piedmont. Compared to the Italians, immigrant patients were younger (35.70; SD = 10.56 versus 44.78; SD = 16.57) and more frequently admitted for alcohol and substance abuse/withdrawal. Italians had a higher probability of having a psychiatric history including previous hospitalizations and contacts with Mental Health Services (OR = 2.60; CI 95 %: 1.64-4.12). The presence of social/relational problems associated with admission was significantly lower among the Italians (OR = 0.55; CI 95 %: 0.35-0.88).
Preliminary data suggest that ER utilisation by immigrants may represent their main way to primary health care. Monitoring ER contacts may provide relevant information for the development of culturally sensitive Mental Health Services.
We considered Italian and immigrant patients with psychiatric symptoms who were admitted to the ER Department of Novara during a period of 13 months. We compared sociodemographic (gender, age, education, occupational history, marital status, living circumstances) clinical-anamnestic (history of psychiatric illness, presentation symptoms, previous contacts with Substance Abuse/Mental Health Services, social/relational problems) and admission (type of admission, intervention and discharge) characteristics of the two groups (Italians versus immigrants).
Venlafaxine is a serotonin-norepinephrine inhibitor, mainly metabolized by CYP2D6 to its active metabolite ODV. Depending on CYP2D6 activity, patients may be identified as Poor, Intermediate, Extensive or Ultrarapid Metabolizers. There is some evidence that a PM phenotype is associated with poor tolerance more often than an EM; while a UM patient would only respond to a greater dose of Venlafaxine1.
To evaluate the impact of CYP2D6 phenotype on the efficacy of Venlafaxine XR in depressed patients.
This observational study evaluated 27 Caucasian adult patients (F = 18, M = 9), satisfying DSM-IV criteria for Major Depressive, Bipolar Disorder or Personality Disorder receiving treatment with Venlafaxine 75–300 mg/die.
CYP2D6 alleles were evaluated with INFINITI CYP2D6 assay, which employs AutoGenomics proprietary film-based microarray technology.
Most patients were identified as EMs, 4 as PMs, while only one was identified as UM. The only statistically significant difference between Extensive and Poor Metabolizers was, in contrast with current literature, the need of a greater mean dose of Venlafaxine in the second group (225 mg/die vs 159.38 mg/die, t student: p = 0.01).
Likewise, in contrast with literature, the UM patient was responsive to average doses of Venlafaxine.
On the contrary, we found no statistically significant differences as far as efficacy, adverse events or duration of treatment are concerned.
In our sample, CYP2D6 metabolizer status does not seem to affect treatment response nor adverse events related to Venlafaxine.
The annual global suicide mortality rate is 16 per 100,000 and suicide attempts are 20 times more frequent. We aimed at comparing patients referring to the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, in order to assess possible predictors of self-injury.
Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2011 at the ‘Maggiore’ Hospital in Novara. A multivariate analysis was performed using a logistic regression in order to assess the potential predictors of self-injury behaviors. Results are expressed as Odds Ratio (OR) with 95% Confidence Intervals (95%CI). Statistical significance was set at p≤0.05.
In a sample of 1888 psychiatric consultations, 280 (14.8%) were due to self-inflicted injuries. Female gender (OR: 1.51; p=0.005) was found to positively correlate with attempted suicides, whereas unemployment (OR: 0.68; p=0.013) and being in the colder months of the year (OR: 0.75; p=0.043) were found to be negative correlated. A positive trend without statistical significance was observed for foreign nationality, being not married and living with parents/own family vs a negative trend was found for history of psychiatric disorders.
In accordance with other studies, we observed the female gender positively correlates with attempted suicides and sunlight may act as a trigger. In contrast with literature, individuals with a permanent job would be at higher risk of self-injury behaviours, whereas having a history of psychiatric disorders and being under the care of a psychiatrist might be a protective predictor.
Suicidal behaviours are major public health concerns, associated with many risk factors that vary with sociodemographical features.
To compare the differences between patients visiting the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, as far as their occupational and accommodation status are concerned.
To evaluate the influence of the economic scenery on suicidal behaviours.
Determinants of ER psychiatric consultations were studied prospectively from 2008 to 2011 at the “Maggiore” Hospital in Novara. Comparison of qualitative data was performed by means of the x2 test, or the Fisher’s Exact test in case of expected frequencies less than 5. All tests were two-sided and a P value less than 0.05 was considered as statistically significant.
In a sample of 1888 psychiatric consultations, 281 (14.9%) were due to self-inflicted injuries. The preliminary analysis of socio-demographical features showed that self-harm behaviours are significantly more frequent among employed vs unemployed or disabled subjects (20.1% vs 13.2%; p=0.0005) and among those living in their immediate or own family vs those living alone or in therapeutic facilities (17.0% vs 13.0% vs 8.4%; p=0.012).
In contrast to current literature, our study shows that individuals living in more favourable conditions are at greater risk of attempting suicide. These results might be associated to the current Italian economic scenery, and to emerging difficulties as far as keeping an income to adequately maintain a family are concerned.
Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions.
To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age.
To describe a specific pattern of emotional dysregulation in ED patients.
ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP).
All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20).
The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples.
Clinical implications will be discussed.
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