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As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients.
Materials and methods
During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n = 33) or type-I bipolar disorder (n = 33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication.
At intake, patients with schizophrenia vs bipolar disorder were receiving 3–7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m2), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorder patients, polytherapy and serum lipid concentrations declined more than among schizophrenia patients (e.g., total cholesterol + triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001).
Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophrenia patients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.
This study tested the associations between Language-proficiency (LP) and clinical, therapeutic characteristics among hospitalized immigrants to study how LP may influence the presentation and the outcome of mental disorders.
According to our previous evidences, lack of cultural adaptation may risk or worsen mental illness among immigrants, and interfere with assessment and treatment. Also, LP seems essential for access to foreign environments. In this study further considerations were made regarding LP on a larger sample of immigrant patients and longer period of observation.
We reviewed clinical records of immigrant psychiatric patients hospitalized at the University of Foggia in 2004–2012 (N=153), and compared characteristics of patients with adequate versus inadequate language proficiency (LP).
Subjects were 80 men and 73 women, aged 35.2±10.3 years, 50.3% emigrated from other European countries. Many were diagnosed with a DSM-IV adjustment disorder (31.3%) or depressive disorder (28.1%), and 69.9% were in first-lifetime episodes. Average comprehension and spoken language-proficiency (LP) was considered adequate in 62.7% and inadequate in 37.3%. Adequate-LP was more prevalent among women (p<0.0001), in first-lifetime episode cases (p=0.0005), among patients had entered Italy legally (p=0.0009), and emigrated from another European country (p=0.01).
Findings support an expected importance of LP among immigrant psychiatric inpatients, and encourage language-assessment and training as part of comprehensive support of such patients, especially men.
As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psychoeducation and medical monitoring on metabolic changes among severely mentally ill patients.
Materials and Methods
During repeated, systematized psychoeducation about physical health among 66 consecutive patients diagnosed with DSM-IV schizophrenia (SZ; n=33) or type-I bipolar disorder (BD; n=33), we evaluated (at intake, 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, rated drugs- attitude of patients, and recorded physiological parameters.
At intake, BD vs. SZ patients were receiving 3–7-times more psychotropic medication, with correspondingly higher initial body-mass index (BMI: 29.1 vs. 25.6 kg/m2), 12-times more obesity, and significantly higher serum lipid concentrations. During 6-month follow-up, ratings of drugs- attitude of patients improved, polytherapy decreased in BD, and BMI decreased slightly, as serum lipid concentrations declined continuously (e.g., total cholesterol+triglycerides: BD by 3.21 > SZ by 1.75%/month). Declining lipid levels were associated with: [a] older age, [b] BD diagnosis, [c] being unemployed, [d] higher antipsychotic dose, [e] lower initial BPRS scores (all p≤0.001).
Given the poor compliance of schizofrenic patients to antipsychotic therapies, are been developed drugs in long-acting formulation that for their pharmacokinetic ensures prolonged therapeutic activities. Currently, we consider that their efficacy depends on hereditary tracts, influencing both pharmacodynamic and pharmacokinetic parameters.
Investigate relationships between clinical efficacy and genetic polymorphims of long-acting drugs’ pharmacodynamic targets.
Seventy-eight psychotic patients, treated with atypical long-acting antipsychotics (olanzapine pamoate, paliperidone palmitate, risperidon and aripiprazole), were examined. We carried out a blood sampling to evaluate dopaminergic DRD2 and glutamatergic GRM3 genetic receptors polymorphisms. PANSS and BPRS scales were used to assess clinical condition.
Regarding the GRM3 genes, the study of rs2228595 and rs6465084 polymorphisms showed a prevalence of wild type genotypic frequency of 81.2% and 56.2%, respectively. The prevalence of the patients with mutated heterozygote genotype (rs6465084 polymorphisms) resulted high (40.6%). Considering rs1989796 e rs274622 polymorphisms, the sample showed a prevalence of mutated heterozygote genotype in the 53.1% e 45.3%, respectively, with a percentage of 43.7% of patients with a mutation in homozygosis. Considering the rs146812 polymorphism, the 53.1% of patients resulted with a wild type genotype. Finally, findings showed a prevalence of 56.2% for the mutated heterozygote genotype in the DRD2 rs6277 polymorphism. The genotypic categorization analysis demonstrated a significative association between the GRM3 rs274622 polymorphism and higher BPRS scores.
The relationship between rs274622 polymorphism and worse clinical conditions could indicate a major resistance to long-acting antipsychotics in patients with genotypic frequency CT (mutated heterozygosis) for this polymorphism.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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