1
|
De Prisco M, Tapoi C, Oliva V, Possidente C, Strumila R, Takami Lageborn C, Bracco L, Girone N, Macellaro M, Vieta E, Fico G. Clinical features in co-occuring obsessive-compulsive disorder and bipolar disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80:14-24. [PMID: 38128332 DOI: 10.1016/j.euroneuro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Obsessive-compulsive disorder (OCD) frequently co-occurs with various psychiatric conditions and may impact as many as one-fifth of individuals diagnosed with bipolar disorder (BD). Despite the expanding body of literature on the coexistence of OCD and BD, there is a notable lack of comprehensive data pertaining to the distinct features of obsessive-compulsive symptoms that define this comorbidity. To bridge this knowledge gap, we conducted a systematic search of PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO until August 7th, 2023. We performed random-effects meta-analyses to compare individuals with both OCD and BD to those with OCD in terms of OCD symptomatology as well as the specific categories of obsessions and compulsions. Out of the 10,393 records initially screened, 17 studies were ultimately incorporated into the qualitative assessment, with 15 of them being included in the quantitative analysis. Individuals with OCD and BD experienced fewer lifetime contamination obsessions (OR=0.71; 95 %CI=0.53, 0.95; p = 0.021) and more sexual obsessions (OR=1.77; 95 %CI=1.03, 3.04; p = 0.04) compared to individuals with OCD without BD. No significant difference was observed for other types of obsessions or compulsions or for the severity of OCD symptoms, although BD type may play a role according to meta-regression analyses. The detection of the presence of sexual or contamination obsessions through a detailed interview may be the focus of clinical attention when assessing OCD in the context of comorbid BD. Sub-phenotyping complex clinical presentation of comorbid psychiatric disorders can aid in making more informed decisions when choosing an appropriate treatment approach.
Collapse
Affiliation(s)
- Michele De Prisco
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristiana Tapoi
- Department of Psychiatry, Professor Dr. Dimitrie Gerota Emergency Hospital, Bucharest, Romania
| | - Vincenzo Oliva
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Possidente
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier 34000, France; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France; Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | | | - Lorenzo Bracco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Nicolaja Girone
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Milan, Italy
| | - Eduard Vieta
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Giovanna Fico
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain
| |
Collapse
|
2
|
Cirnigliaro G, Battini V, Cafaro R, Mosini G, Vanzetto S, Prodi T, Macellaro M, Leuzzi R, Conti D, Carnovale C, Dell'Osso B. Barriers to the use of three-month Paliperidone Palmitate formulation: a study from an Italian real-world setting. Expert Rev Neurother 2023; 23:1031-1039. [PMID: 37750003 DOI: 10.1080/14737175.2023.2263650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Long-acting injectable paliperidone can improve adherence in psychotic patients and reduce relapses and healthcare resource utilization (HRU). This study compares the effectiveness of the three-monthly paliperidone palmitate (PP3M) with the one-monthly formulation (PP1M) and investigates reasons that hinder the use of PP3M in real-world settings. METHODS The authors conducted a three-phase observational study. For subjects recruited from six psychiatric services in Milan, HRU outcomes of PP3M prescription were evaluated through a 12-month mirror-image design (phase 1) and a comparison of HRU of PP1M-only subjects and PP3M subjects during the year prior to PP3M initiation (phase 2). Lastly, they conducted a survey among physicians concerning reasons for not switching to PP3M (phase 3). RESULTS A total of 119 subjects (61 on PP3M and 58 on PP1M) were included. One year after PP3M initiation, outpatients' visits decreased significantly. Comparing PP3M with PP1M subjects, no significant difference was found in HRU. Perception of patient's unstable clinical condition was the main reason for maintaining PP1M (32.8%), followed by the need for monthly monitoring (19.7%). CONCLUSION PP3M initiation was associated with an overall HRU reduction. Subjects switched to PP3M had similar HRU when compared to those who did not, suggesting similar clinical conditions in both groups.
Collapse
Affiliation(s)
- Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vera Battini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giulia Mosini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Simone Vanzetto
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Tiziano Prodi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rodolfo Leuzzi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dario Conti
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Carla Carnovale
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
- CRC "Aldo Ravelli" for Neurotechnology & Experimental Brain Therapeutics, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Benatti B, Girone N, Conti D, Celebre L, Macellaro M, Molteni L, Vismara M, Bosi M, Colombo A, Dell’Osso B. Intensive Neurofeedback Protocol: An Alpha Training to Improve Sleep Quality and Stress Modulation in Health Care Professionals During the Covid-19 Pandemic. A Pilot Study. Clin Neuropsychiatry 2023; 20:61-66. [PMID: 36936622 PMCID: PMC10016100 DOI: 10.36131/cnfioritieditore20230108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective health care workers (HCWs) represent a vulnerable group in the COVID-19 pandemic, given the exposure to greater risk and higher levels of work-related stress. Neurofeedback (NF) has shown to be effective in the treatment of stress-related symptoms. We aimed to assess the effectiveness of an alpha-increase NF protocol for the treatment of acute stress symptoms in HCWs exposed to the COVID-19 pandemic. Method eighteen medical doctors on duty during the COVID-19 health emergency underwent an intensive NF alpha-increase protocol. The mean alpha wave values were recorded at the beginning (T0) and at the last day of stimulation (T1). Rapid Stress Assessment: Italian version; Copenhagen Burnout Inventory (CBI); Pittsburgh Sleep Quality Index (PSQI), and Brief-COPE were administered as psychometric assessment. Results a significant increase in alpha wave values and a significant reduction of the PSQI scores from T0 to T1 were found. Conclusions NF alpha-increase protocol showed promising results in terms of stress modulation, sleep quality improvement, and safety in a pilot sample of HCWs.
Collapse
Affiliation(s)
- Beatrice Benatti
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
| | - Nicolaja Girone
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
- Corresponding author Nicolaja Girone Luigi Sacco University Hospital, University of Milan Via GB Grassi 74, 20154 Milan, Italy E-mail:
| | - Dario Conti
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
| | - Laura Celebre
- Department of Mental Health and Addictions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Macellaro
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
| | - Laura Molteni
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
- Southern Health National Health Service Foundation Trust, Southampton, UK" and "University Department of Psychiatry, Academic Centre, Southampton, UK
| | - Matteo Vismara
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
| | - Monica Bosi
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
| | - Anna Colombo
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
| | - Bernardo Dell’Osso
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- “Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psicogeriatriche”, University of Milan, Milan, Italy
| |
Collapse
|
4
|
Macellaro M, Girone N, Cremaschi L, Bosi M, Cesana B, Ambrogi F, Dell’Osso B. Applying existing clinical staging models in a sample of Italian bipolar patients over a 10-years follow-up. Eur Psychiatry 2022. [PMCID: PMC9565865 DOI: 10.1192/j.eurpsy.2022.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bipolar Disorder (BD) is a life-course illness with evidence of a progressive nature. Although different staging models have been proposed from a theoretical perspective,longitudinal studies are scarce. Objectives The aim of the present study was to apply four staging models in a sample of BD patients and to observe their progression in 10 years of retrospective evaluation. Methods In a naturalistic sample of 100 BD patients, a retrospective assessment of clinical stages across 10 years of observation at six time points (T0: 2010; T1: 2013; T2: 2015; T3: 2018; T4: 2019; T5:2020) was performed according to the BD staging models (Berk et al., 2007; Kapczinski et al., 2009; Kupka et al., 2012 and Duffy et al., 2014). Socio-demographic and clinical variables were collected and the staging progression across time was analyzed. Results A significant progressive staging worsening emerged over 10 years of BD observation for each examined model (p<0.001). Moreover, for all considered staging approaches, stage values were lower over the time points for BD II, lower number of lifetime episodes and hospitalizations (p<0.05). Finally, the stage increase was associated with a lower age at first elevated episode (p<0.05). Conclusions Present preliminary results confirm the relevance of illness onset and early intervention in BD, given their role in patients classified into worse clinical staging. There is an emerging need of a standardized universal staging model in order to better characterize BD patients, their treatment and their clinical course. Disclosure No significant relationships.
Collapse
|
5
|
D'Addario C, Macellaro M, Bellia F, Benatti B, Annunzi E, Palumbo R, Conti D, Fasciana F, Vismara M, Varinelli A, Ferrara L, Celebre L, Viganò C, Dell'Osso B. In Search for Biomarkers in Obsessive-Compulsive Disorder: New Evidence on Saliva as a Practical Source of DNA to Assess Epigenetic Regulation. Curr Med Chem 2021; 29:5782-5791. [PMID: 34879796 DOI: 10.2174/0929867328666211208115536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Brain-Derived Neurotrophic Factor (BDNF) is a promising candidate biomarker in both the development and aetiology of different neuropsychiatric conditions, including obsessive-compulsive disorder (OCD). Most of the studies in the field have been carried out in blood cells, including peripheral blood mononucleated cells (PBMCs), although DNA of high quality can be easily isolated from saliva. OBJECTIVE The objective of this study was to evaluate the epigenetic regulation of the BDNF gene in the saliva of a clinical sample of OCD patients in order to assess this source as an alternative to blood. METHODS We first analyzed DNA methylation levels at BDNF in the saliva of subjects suffering from OCD (n= 50) and healthy controls (n=50). Then, we compared these data with the results previously obtained for the same genomic region in blood samples from the same patients and controls (CTRL). RESULTS Our preliminary data showed a significant reduction of 5mC levels at BDNF gene (OCD: 1.23 ± 0.45; CTRL: 1.85 ± 0.64; p < 0.0001) and a significant correlation between DNA methylation in PBMCs and saliva (Spearman r = 0.2788). CONCLUSION We support the perspective that saliva could be a possible, reliable source, and a substitute for blood, in search of epigenetic biomarkers in OCD.
Collapse
Affiliation(s)
| | - Monica Macellaro
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | | | - Beatrice Benatti
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | | | - Riccardo Palumbo
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele D'Annunzio University, Chieti. Italy
| | - Dario Conti
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. 0
| | - Federica Fasciana
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. 0
| | - Matteo Vismara
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. 0
| | - Alberto Varinelli
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | - Luca Ferrara
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | - Laura Celebre
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | - Caterina Viganò
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| | - Bernardo Dell'Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano. Italy
| |
Collapse
|
6
|
Dell'Osso B, Arici C, Cafaro R, Vismara M, Cremaschi L, Benatti B, Macellaro M, Viganò C, Ketter TA. Antidepressants in bipolar disorder: Analysis of correlates overall, and in BD-I and BD-II subsamples. J Affect Disord 2021; 292:352-358. [PMID: 34139408 DOI: 10.1016/j.jad.2021.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical therapeutic approaches to Bipolar Disorders (BDs) include diverse pharmacotherapies, targeting different symptomatic BD presentations. To date, guidelines about pharmacological treatment of BDs have focused on short-term treatment of mood episodes, at the expense of longer-term treatment, especially for (the most common) predominantly depressive polarity patients. METHODS A database of BD-I and BD-II patients was collected between 2013 and 2019 at the University Psychiatric Clinic of Ospedale Policlinico and Ospedale Luigi Sacco of Milan. Only patients in euthymic phases (no current mood episode) were included in the study. We then analyzed socio-demographic and clinical characteristic overall and in the subgroup BD-I and BD-II, comparing patients taking vs. not taking ADs. RESULTS Our results showed that approximately 1/3 of BD patients between acute episodes took ADs, also among patients from the subgroup with BD-I, especially those first presenting with a depressive episodes, and those with a most recent depressive (as opposed to elevated, irritable, or mixed) polarity episode. LIMITATIONS Although patients included in our study were primarily in follow up for Bipolar Disorder, use of ADs could be explained by other comorbidities, such as Anxiety or Eating Disorders. CONCLUSIONS These data shed light on how managing depressive symptoms is a very important aspect of treating BDs, highlighting the need for wider and more specific studies on the use of ADs in BDs.
Collapse
Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy; CRC Aldo Ravelli, University of Milan, Milano, Italy; Department of Psychiatry and Behavioural Sciences, Stanford University, CA, United States
| | - Chiara Arici
- Department of Mental Health and Addiction, ASST Vimercate, Vimercate, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy.
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy; CRC Aldo Ravelli, University of Milan, Milano, Italy
| | - Laura Cremaschi
- Department of Mental Health and Addiction, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy; CRC Aldo Ravelli, University of Milan, Milano, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy
| | - Terence A Ketter
- Department of Psychiatry and Behavioural Sciences, Stanford University, CA, United States
| |
Collapse
|
7
|
Oldani L, Benatti B, Macellaro M, Porta M, Servello D, Zekaj E, Dell'Osso B. A case of treatment-resistant bipolar depression and comorbid OCD treated with deep brain stimulation of the medial forebrain bundle: 5 years follow-up results. J Clin Neurosci 2021; 89:103-105. [PMID: 34119251 DOI: 10.1016/j.jocn.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Limited though promising evidence exists on the efficacy of Deep Brain Stimulation (DBS) of the Medial Forebrain Bundle (MFB) in otherwise intractable patients with Major Depression and Obsessive-Compulsive Disorder (OCD). Herein, we present acute and follow-up results (up to 5 years) of a 42 year old man with a diagnosis of treatment-resistant Bipolar Depression (BD) and comorbid OCD, successfully treated with DBS of the MFB. Regular follow-up visits with psychometric evaluations highlighted a considerable improvement of patient's depressive and OC symptoms at 5 years from implant. According to the limited, reported experience, we support the efficacy and tolerability of DBS of the MFB as a promising intervention in patients with treatment-resistant BD and comorbid OCD, with specific emphasis on the long-term outcome.
Collapse
Affiliation(s)
- Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Beatrice Benatti
- Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy; CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, Milan, Italy.
| | - Monica Macellaro
- Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Porta
- IRCCS Orthopedic Institute Galeazzi, Department of Functional Neurosurgery, Tourette Center, Milan, Italy
| | - Domenico Servello
- IRCCS Orthopedic Institute Galeazzi, Department of Functional Neurosurgery, Tourette Center, Milan, Italy
| | - Edvin Zekaj
- IRCCS Orthopedic Institute Galeazzi, Department of Functional Neurosurgery, Tourette Center, Milan, Italy
| | - Bernardo Dell'Osso
- Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy; Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA; CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Esposito CM, D'Agostino A, Dell Osso B, Fiorentini A, Prunas C, Callari A, Oldani L, Fontana E, Gargano G, Viscardi B, Giordano B, D'Angelo S, Wiedenmann F, Macellaro M, Giorgetti F, Turtulici N, Gambini O, Brambilla P. Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy. Psychiatry Res 2021; 298:113802. [PMID: 33592401 PMCID: PMC7874958 DOI: 10.1016/j.psychres.2021.113802] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.
Collapse
Affiliation(s)
- C M Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A D'Agostino
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - B Dell Osso
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Fontana
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gargano
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Viscardi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Giordano
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - S D'Angelo
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Wiedenmann
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - M Macellaro
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Giorgetti
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - Ne Turtulici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - O Gambini
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Vanzetto S, Alberto V, Conti D, Macellaro M, Benatti B, Daddario C, Bellia F, Dell’Osso B. Epigenetic modulation in obsessive-compulsive disorder: Methylation and hydroxymethylation of the bdnf gene exon I promoter. Eur Psychiatry 2021. [PMCID: PMC9470468 DOI: 10.1192/j.eurpsy.2021.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Several evidence recognizes Brain Derived Neurotrophic Factor (BDNF) as a promising biomarker in the pathophysiology of psychiatric disorders, including Obsessive-Compulsive Disorder (OCD), considering the involvement of epigenetic regulation in BDNF altered expression. Objectives This study aims to investigate, in a sample of OCD patients, the epigenetic modulation in terms of levels of methylation and hydroxymethylation on the BDNF gene exon I promoter. Methods Fifty OCD patients, recruited from Psychiatry Unit 2, Sacco University Hospital in Milan and fifty healthy controls, comparable by age and gender. Saliva samples were collected by oral swab and epigenetic analysis were performed at the University of Teramo. Statistical analyses were performed with t test with Bonferroni correction. Results Data analysis showed a significant decrease in 5-methyl cytosine levels (5mC) (mean OCD: 1.221%; mean CTRL: 1.784%; p < 0.001) and a significant increase in 5-Hydroxy-methyl cytosine levels (5hmC) (mean OCD: 1.018%; mean CTRL: 0.527% p< 0.0001) in BDNF gene exon I promoter of OCD patients compared to controls. Regarding 5mC of site 3 and 5hmC of site 1 and 2 of the exon I promoter CpG islands, no statistical significance was found. Conclusions Present results showed significant differences in epigenetic modulation of BDNF gene, which might not be univocally interpreted. They could represent an intrinsic OCD characteristic or the effect of antidepressant drugs, assumed by all recruited patients. Further studies, comparing OCD subjects in treatment vs drug-free, are necessary to define BDNF epigenetic modulation role and its possible use as biomarker in the characterization of OCD. Disclosure No significant relationships.
Collapse
|