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Vaccination remains the best strategy to reduce invasive meningococcal disease. This study evaluated an investigational tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MenACYW-TT) vs. a licensed tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MCV4-TT) (NCT02955797). Healthy toddlers aged 12–23 months were included if they were either meningococcal vaccine-naïve or MenC conjugate (MCC) vaccine-primed (≥1 dose of MCC prior to 12 months of age). Vaccine-naïve participants were randomised 1:1 to either MenACYW-TT (n = 306) or MCV4-TT (n = 306). MCC-primed participants were randomised 2:1 to MenACYW-TT (n = 203) or MCV4-TT (n = 103). Antibody titres against each of the four meningococcal serogroups were measured by serum bactericidal antibody assay using the human complement. The co-primary objectives of this study were to demonstrate the non-inferiority of MenACYW-TT to MCV4-TT in terms of seroprotection (titres ≥1:8) at Day 30 in both vaccine-naïve and all participants (vaccine-naïve and MCC-primed groups pooled). The immune response for all four serogroups to MenACYW-TT was non-inferior to MCV4-TT in vaccine-naïve participants (seroprotection: range 83.6–99.3% and 81.4–91.6%, respectively) and all participants (seroprotection: range 83.6–99.3% and 81.4–98.0%, respectively). The safety profiles of both vaccines were comparable. MenACYW-TT was well-tolerated and demonstrated non-inferior immunogenicity when administered to MCC vaccine-primed and vaccine-naïve toddlers.
The brown hairy dwarf porcupine Coendou vestitus is a poorly studied Andean species endemic to Colombia. Its current Red List category is contradictory: globally it is categorized as Data Deficient but in Colombia it is categorized as Vulnerable. This contradiction has limited the implementation of conservation programmes. We evaluate the level of rarity of the species and provide consolidated information for a new assessment of its Red List status. We reviewed literature, photographs, and voucher specimens in natural history collections. Using the confirmed records, we estimated the extent of occurrence (EOO) based on the minimum convex polygon and the area of occupancy (AOO) summing the area of grid squares occupied by the species. We found that C. vestitus is very rare, with a small range, low estimated population density, occurrence in only one habitat type and small body size. The species has an EOO of 3,323 km2 and an AOO of 24 km2, based on six confirmed localities, all on the western slopes of the Eastern Cordillera, in the central Andean region of Colombia. Based on the species' rarity, restricted distribution, and threats to its natural habitat, we recommend its categorization as Endangered on the IUCN Red List. This will help delineate research and conservation efforts for this porcupine, which has a highly restricted range and inhabits the threatened Andean forest.
Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD.
A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature.
The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model.
Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.
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).
Prostate and breast cancer share many similarities: high lifetime prevalence, increasing frequency, role of environmental factors, long survival also in metastatic disease and possibility of screening. The aim of this work is to evaluate the characteristics related to the patients, disease and treatment which can affect HRQoL at the beginning and after radiotherapy.
since June 2009, we have recruited patients, providing informed consent, before radiotherapy (T0). We assess demographic characteristic (age, qualification, work, marital status…); neoplastic staging and grading; radiation dose and other antineoplastic treatment (hormonal/chemio-therapy or surgery); concomitant medical disease and pharmacological therapy. We evaluate HRQoL by EORTC-QLQ-C30 and EORTC-QLQ-PR25 (prostate-specific) or EORTC-QLQ-BR23 (breast-specific). The protocol also includes HADS, Paykel Life Events Scale and EPQ-R. The work is ongoing and implies a follow-up at 6 and 12 months (T1/T2).
The majority of men have a localized disease with Gleason score between 6 and 8 and the median pretreatment PSA is 10.52 ng/mL; 70% will undergo adjuvant-RT; median age is 69.30 years. Women have a median age of 58.46 years, all underwent surgery and all have a localized disease and positive receptorial status. Global QoL is lightly higher in the man sample; both groups report a major deficit at Emotional Function and high levels of Fatigue. The personological characteristic more represented is “Extravertion”.
The results show an association between worse QoL, “Nevroticism” and high Anxiety levels only in the men sample at T0. At the moment, there is no significant relation in the women sample.
To describe and compare the demographic and clinical characteristics of adult patients with depression in the UK treated with duloxetine and venlafaxine XR.
Depressed adults treated with duloxetine or venlafaxine XR between 1/1/2006 and 9/30/2007 were identified using the General Practice Research Database (GPRD), which represents all primary care practices in the UK. Demographic (age and sex) and clinical characteristics (psychiatric and physical comorbid conditions and concomitant medication use) were examined and the characteristics of the two treatment groups were compared using chi-square or t tests, as appropriate.
Of 2,195 patients identified (mean age 47.2 years; 65.8% female), 41% were prescribed duloxetine and 59% were prescribed venlafaxine XR. On average, patients treated with duloxetine were older than patients treated with venlafaxine XR (49.6 years versus 45.5 years; p< 0.001). Compared to patients treated with venlafaxine XR, patients treated with duloxetine had higher prevalence of a variety of comorbid physical health conditions, including diseases of the circulatory, digestive, respiratory systems, as well as a higher prevalence of diabetes (p< 0.01 for all). Additionally, patients treated with duloxetine had higher prevalence of unexplained pain (p< 0.001). Greater proportions of patients treated with duloxetine had prescription utilization of medications in a variety of classes, including anticonvulsants, analgesics, migraine medications, as well as medications used to treat cardiovascular and gastrointestinal disorders (p< 0.01 for all).
Depressed patients treated with duloxetine in the UK are slightly older and appear to be in poorer health overall than patients treated with venlafaxine XR.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
To evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness.
Patients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness.
From June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale.
Literature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.
Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.
DD represents a common issue in clinical practice, with relevant effects on symptoms, course and treatment of disease. It's often associated with negative outcome as a greater severity of symptoms and resistance to drug treatment.
To assess how the characteristics (sociodemographic, clinical and related to substance abuse) of patients discharged with DD have changed taking into account the FA occurred in three different five-year periods (1990–1994, 2000–2004, 2005–2009). We also compared the characteristics of patients discharged with only psychiatric diagnosis with those of patients with DD to look for possible risk factors for abuse among people with psychiatric illness.
We conducted a retrospective study of medical records of patients at FA to our Institute in three different periods. We divided the patients discharged with DD from those discharged with only psychiatric diagnosis.
Among the FA occurred in the periods examined we noticed an increase of DD cases (12% from 1990 to 1994, 21% 2000–2004, 28% 2005–2009). The incidence of each diagnosis was changed in several years, but each time the diseases more represented remain schizophrenic or affective psychosis and personality disorders. Alcohol is the most widely used psychotropic drug in each period. There is also a progressive increase in the abuse of cannabis, cocaine and in the incidence of multi-drug abusers. Compared with patients discharged with only a psychiatric diagnosis, patients with DD were more frequently:male, younger, unmarried, unemployed, with legal issues, grown up in a family with serious problems, and history of etero-aggressive episodes.
Due to continued increase in cases of DD, we want to highlight the importance of early identification of cases of comorbidity in order to provide adequate treatment and support.
Theory of mind represents the ability to attribute mental states to oneself and others and to use these mental representations to decide one's own and predict others’ behavior. In our study, ToM is investigated in a non-psychiatric setting: a university students sample.
The aim of this study is to evaluate the presence of subthreshold alterations in our sample and, on the other hand, if altered cognitive functioning can worsen study performance. Moreover it investigates a possible correlation between the faculty chosen and cognitive functioning. We considered 228 students attending the Faculty of: Economy (n = 26), Dental hygienists(n = 7), Law(n = 16), Medicine (n = 54), Pharmaceutics(n = 27), Physiotherapy(n = 15), Mathematics, Physics and Biology (n = 12), Midwifery (n = 14), Chemistry and Pharmaceutical techniques (n = 17), Liberal Arts (n = 3), Nursing (n = 37).
We administered the following tests to 228 university students: EYSENCK PERSONALITY QUESTIONNAIRE (EPQ-R): evaluating some personality dimensions including psychoticism, neuroticism, introversion, extroversion;SCL-90-R: self-evaluation scale of some symptom dimensions as somatization, obsessive-compulsiveness, depression, anxiety, anger, hostility, sensitivity, phobic anxiety, paranoid ideation and psychoticism; TEST OF EMOTION ATTRIBUTION: composed of 58 short scenes concerning seven emotions (sadness, fear, shame, disgust, happiness, anger, envy) that the student must identify.
TEST OF ToM: consists of 13 short stories describing social and family situations; the student must identify why the protagonist behaved in a certain manner.
The statistical analysis is still in progress. Preliminary data suggest that people with subthreshold symptoms belonging to the depression, obsessive-compulsiveness, anxiety and phobic-anxiety clusters show deficits of theory of mind. Data concerning the correlation between cognitive functioning and faculty chosen and between cognitive functioning and poor study performance will be examined in a further work.
Our results together with data from literature suggest the chance to apply this set of tests to screen deficit of Theory of Mind in a non mentally ill population.
To study the changes in plasma concentration of homovanillic acid (pHVA) and its relation with clinical outcome during treatment of Bipolar I patients with olanzapine plus lithium.
Patients and Methods:
Fifty six (33 women and 23 men) Bipoar I patients, age 35.1±9.4 (SD) years, diagnosed according to DSM-IV, were treated initially with 10mg/day of olanzapine for 4 days and subsequently with 20 mg/day. On the 8th day lithium was added until a concentration of 0.6 to 1.2 mEq/L was reached in plasma. Patients were, at least, a week without neuroleptic or mood stabilizer medication.
Their clinical state was evaluated before and during 28 days of treatment with the Young scale and with the Clinical Global Impression.
Morning fasting levels of pHVA were analyzed the same days that scales were passed.
Plasma HVA after 28 days of treatment does not decline as habitually happens with neuroleptic treatment alone. Moreover, there was a trend toward significance of a Positive Correlation between pHVA and clinical improvement.
The addition of Lithium to Olanzapine altered the pattern of pHVA response from the first days of treatment up to day 28, suppressing the habitual decline in pHVA concentration. These results are similar to those observed by Bowers et al. (1992) when lithium was combined with perphenazine. The correlation between changes in pHVA concentration during 28 days of treatment and clinical outcome was the opposite to that found in schizophrenic patients treated with neuroleptics alone.
To assess the use of SWN in the acute phase of psychiatric disease as a predictor of clinical outcome.
This study started in June 2009 and at the moment we have recruited 150 patients. The patients were divided into 4 groups according to their psychiatric diagnosis (schizophrenic psychosis, mood disorders, personality disorders, acute stress reaction) and each diagnostic group into three subgroups according to length of stay (T1< 7 days, T2 = 7–14 days, T3> 14 days). The subjective well-being indicators (subscales SWN: emotional regulation; self-control; mental functioning; social integration and physical functioning) and the severity of illness (CGI-S) were evaluated at admission and discharge.
At discharge there is a statistically significant difference in the SWN subgroups among the four diagnostic groups except for social integration and total score with equal CGI-S scores. Schizophrenic patients and personality disorders show a subjective improvement at T2; mood disorders at T3; acute stress reactions T1 = T2. CGI shows a statistically improvement regardless of the length of stay.
Preliminary data suggest that SWN represents a predictor of clinical outcome and remission and together with the clinical evaluation it can help clinician to settle therapeutic programs.
Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with mental illness. Atypical antipsychotics are more associated with obesity, metabolic syndrome, abnormal glucose and lipid metabolism than first generation antipsychotics.
To identify risk factors related to glucose metabolism in short, medium and long time treatment and find out which are related to neuroleptic therapy and which depends on genetic background and lifestyle. To follow up clinical and self-rated variations of the psychiatric symptoms.
We included psychotic or bipolar patients in treatment with only one typical (haloperidol) or atypical (clozapine, olanzapine, risperidon, aripiprazole, paliperidon) neuroleptic, drug-naïve or after a wash-out from previous therapy. Patients will be evaluated five times (at baseline and after 1, 3, 6, 12 months) with a blood sample (haemocrome, glucose, insulin, Hb A1C, thyroid hormones, liver and pancreatic function), BMI, Basal Metabolic Rate (BMR), OGTT, HOMA index, familiar and pharmacological history, SIDE and CGI.
From blood exams and OGTT we will obtain data regarding variations of glucose metabolism and the possible relationship with neuroleptic medications. From SIDE questionnaire we will assess the impact of side-effects by the patient's perspective and with CGI the variations of symptom severity.
Our study will allow us to identify risk factors concerning glucose metabolism alterations related to antipsychotic medications.
A deficit in the theory of mind has been identified, although without univocal results, in various pathologies, such as schizophrenia, bipolar disorder and some personality disorders. Aim of the study was to evaluate, in a non- psychiatric population, the correlation of personological characteristics and symptoms with theory of mind and emotion recognition tasks.
The following protocol was administrated to 130 voluntary students from Novara (Italy) School of Medicine: EPQ-R test for personality analysis; an intention-inferencing task for theory of mind (adapted from Happè's version); the emotion recognition test (adapted from Blair's version); and SCL-90 for symptoms evaluation. Spearman correlation coefficient (SC) was calculated; p< 0.05 was considered statistically significant.
No statistically significant correlations were found between the EPQ-R (psychoticism, estroversion and nevroticism) and theory of mind test scores. Better performances in the theory of mind test corresponded to lower scores in SCL-90 subscales: obsessive-compulsive disorder (SC:-0.248; p=0.004); depression (SC:-0.280; p=0.001); anxiety (SC:-0.276; p=0.001); hostility (SC:-0.178; p=0.042); phobic anxiety (SC:-0.197;p=0.025); paranoid ideation (SC:-0.191;p=0.03); and psychoticism (SC:-0.189; p=0.032). A lower capacity in the recognition of the happiness emotion corresponded to higher scores in the hostility (CS:-0.194; p=0.027) and phobic anxiety (CS:-0.211; p=0.016) SCL-90 subscales, while higher scores in the EPQ-R subscale psychoticism and somatisation SCL-90 subscales were respectively related to lower skills in the recognition of fear (CS:-0.226; p=0.01) and envy (CS:-0.193; p=0.028) emotions.
Theory of mind skills seem independent from personological traits, but are inversely correlated to various symptomatological subscale scores. The recognition of specific emotions correlates selectively with various personological traits and symptomatological subscales.
To examine the perceived needs by patients and radiotherapists using a modified by us version of the Camberwell Assessment of Need (CAN).
We eliminated 4/22 areas of the CAN scale -ideated for psychotic patients- in order to adapt it to oncological subjects (naming it CANo). Each of the scale areas values: the existence of a specific need; the help received from care-givers; the help coming from social services; the completeness of the help received. CANo was administrated to 30 solid cancer subjects consecutively admitted in 2007 to the Radiotherapy Department of Novara Hospital (Italy), and to their respective treating radiotherapists. Patients with cognitive impairment were excluded. Patients were also administrated the following protocol: HADS (Hospital anxiety and depression scale); Paykel's list of stressful events; MBTI (Mayer-Briggs Type Indicator); EORTC QLQ-C30.
Anxiety and depression occurred at any level in 15/30 of cases. There was a significant correlation (Spearman coefficient: SC) between the numbers of needs on CANo scale and anxiety (SC:0.4; p=0.002) or depression (SC:0.48; p=0.006) levels. Higher scores in all functional EORTC scales corresponded to lower needs detected by CANo. Patient needs were perceived less important by patients themselves than their physicians (mean satisfied need scores: 1.87 vs. 3; unsatisfied need scores: 0.63 vs. 1.03). The staff overestimated patient physical health needs (7/30 vs 3/30), psychological distress (20/30 vs 5/30), relationship difficulties (9/30 vs 2/30), received information correctness (7/30 vs 2/30).
The CANo scale may be useful to detect oncological patient needs and to improve the quality of care.
Eating disorders (ED) like anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) have complex psychopathological manifestation most presumably with a multifactor etiology. Abnormal feeding had long been linked to disruptions in brain dopaminergic activity. in humans, dopamine (DA) release in the dorsal striatum regulates feeding behavior and correlates with the degree of pleasure experienced while eating. Lower availability of DA could contribute to appetite dysregulation, binge eating behavior and lack of pleasure connected with meals. DA is metabolized, amongst others, by catechol-O-methyltransferase (COMT). Previous studies found an association between eating disorders and functional polymorphisms of COMT gene.
To evaluate soluble COMT activity in erythrocytes from patients with anorexia, bulimia and binge eating disorders. Diagnostic was made by a senior psychiatry using the Structured Clinical Interview for DSM-IV Axis I disorders and Eating Disorder Examination Questionnaire.
Erythrocyte COMT activity (in pmol/mg prot/h) is significantly increased in AN and BN patients (35.9±6.8 and 39.8±8.2, respectively) compared to the control group (21.2±3.6). in BED patients, COMT activity was also found higher, but due to a high variation between individual results are not significant (35.2±15.4). An interest result was also found in a group of patients with AN and BN that were being treated with a selective serotonin reuptake inhibitor (SSRI). Unexpectedly these patients presented a COMT activity level similar to the control levels.
Patients with AN and BN present higher soluble COMT activity in erythrocytes. This increase is reversed by treatment and SSRI.
Our Psychiatry Ward (SC Psichiatria, Maggiore della Carità Hospital, Novara) has a longstanding tradition in the training of clinicians (psychiatrists, but also non-psychiatrists) about the importance of the approach in helping relationships. This tradition reflects itself in the organization of the assistance to the acute psychiatric inpatients admitted to the Ward. In addition to treatment as usual, patients have the opportunity of being involved in several group activities. The activities are proposed to them, with an approach that varies according to the patient's lifetime diagnosis, current conditions, relational difficulties, etc. In other words, different activities may be proposed to different patients, in different ways.
To describe the integrated treatment approach we use in our Psychiatry Ward.
Group activities are guided by a group leader who is supported by one or two assistants whose role is to facilitate discussion. Activities include: Newspaper Reading (everyday in the morning, 1 hour); Music Listening Group (once a week; 1 hour); Cinema Group (once a week; 2 hours and a half); Fairytale Group (on alternating days in the evening, 1 hour).
More details will be supplied regarding the theoretical background for the group, the group features/implementation, and its specific objectives.
All the group activities integrate themselves in an early rehabilitation project tailored to each patients' characteristics and needs. Briefly, their main objectives include: 1) to help patients endorse their cognitive, emotional and relational skills; 2) to offer support to the crisis they are experiencing, which led them to admission to the Ward.
Lithium has been used in the treatment of pregnant women with bipolar disorder for many decades but information on the effects of its exposure on perinatal variables is scarce.
To determine the effects of in-utero exposure to lithium on neonatal outcomes among infants born to women with treatment with lithium during pregnancy.
Prospective and observational study including all consecutive cases of pregnant women with bipolar disorder type I or II (N = 22) and maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=9), attended at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA between 2005 and 2012. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, obstetric and neonatal variables.
No statistically significant differences were found regarding sociodemographic data between both groups. Rates for umbilical cord:maternal plasma lithium levels were higher in women treated with polytherapy than in women who received lithium alone (1.08 vs. 1.05). Neonates exposed to polytherapy had a higher weight percentile at birth (p70 vs p50) and greater gestational age (39.72 vs. 38.28 weeks), than those exposed to lithium alone. Acute neonatal complications were more frequently observed in infants that were exposed to lithium monotherapy (33.3% vs. 38.50), being all complications transitory and not severe.
The infants exposed to lithium polytherapy presented a higher weight at birth compared to those who received lithium monotherapy. However, no statistically significant differences were found between treatment groups. Further research is needed to better clarify safety of lithium and its effect on neonatal outcomes.