Efficacy and Tolerability of Two Different Kinds of Titration of Paroxetine Hydrocloride Solution: an Observational Study

BACKGROUND

Depressive disorders are expected to be the second highest cause of morbidity in the world until few years. Moreover, patients with depression frequently show many side effects and low compliance to therapy. To find a more tolerated and more efficacy therapy is a growing need.

OBJECTIVE

This observational study investigates the efficacy, safety and tolerability of paroxetine hydrochloride comparing slow versus standard titration in a population affected by Depressive Disoders (according to DSM 5).

METHODS

186 outpatients were assessed throught the following scales: Hamilton Depression Rating Scale (HDRS) for depression and World Health Organization Quality of Life Scale Bref for the perceived quality of life (WHOQOL BREF). Treatment-emerged Adverse Events (TEAEs) were recorded throught self-reports. Statystical analysys was performed by GraphPad Prism Version 5.1.

RESULTS

The efficacy of paroxetine was confirmed in both titrations by the number of clinical remitters (HDRS ≤ 7 at 12 weeks for 53% of the standard titration group and 58% of the slow titration group), without differences. About safety and tolerability there were more frequent TEAEs among the standard titration group (p < 0.01). Comparing WHOQOL BREF between the two groups at the recruitment and at the twelth week emerged a statistically significant difference (p = 0.003), with highest scores reached in slow titration group.

CONCLUSIONS

Although the short observation period is an evident limit, this study is consistent to the literature about the efficacy of both titrations of paroxetine to improve depression and shows promising results about the increased tolerability of paroxetine slow titration.

Antiepileptic drug use in a nursing home setting: a retrospective study in older adults

The authors set out to examine qualitatively the use of antiepileptic drugs (AEDs) in a population of older adults in a nursing home setting, evaluating aspects such as specialist prescriptions and changes in dosage. This retrospective prevalence study was carried out in a state-funded nursing home that provides care and rehabilitation for elderly people. The first objective of the study was to determine the prevalence of AED use in this population. The second objective was to monitor AED dosage modifications during the fifteen-month study period, focusing on the safety and the tolerability of AEDs. In the period of time considered, 129 of 402 monitored patients received at least one anti-epileptic therapy. The prevalence of AED use was therefore 32%. Gabapentin was found to be the most commonly prescribed drug, with a frequency of 29%, and it was used mainly for anxiety disorders, psychosis, neuropathic pain and mood disorders.

Reliability and validity of the Italian version of the 14-item Resilience Scale

Background

In recent years resilience has gained clinical relevance in sociological, psychological, and medical disciplines, and a lot of scales measuring resilience have been developed and have been utilized in the western countries. The aim of the study was to assess the psychometric properties of the Italian version of the 14-item Resilience Scale (RS-14), by describing its validity and reliability. As agreed with the authors of the original English version of the RS-14, it was translated into Italian. Then the standard procedure for back-translation was followed.

Methods

In total, 150 participants among the nursing and professional education students of the University of Insubria of Varese and health workers of the “ASST dei Sette Laghi-Ospedale di Circolo” of Varese were enrolled. The responses to the questionnaires were collected only from the students and the health workers between the ages of 18 and 65 years who gave their consent to participate in the study from April to September 2015. A subsample of 26 students and health workers was retested on the RS-14, 5 weeks after the first assessment. The questionnaires were handed out to 214 people, and 150 sets of questionnaires (70%) were returned, of which eight were subsequently removed because >60% of the answers were missing. In order to ensure anonymity, every completed questionnaire was identified only via a code.

Results

No significant differences were found between the mean values of the resilience scores between women (76.1) and men (76.3), with unpaired t-test = −0.08 and P=0.93. Similarly, no difference between resilience scores were found between mean age group of 18–25 years (75.3) and 26–65 years (78.7), with t-test = 1.6. The overall Cronbach’s alpha of the RS-14 is 0.88, P=0.10. The RS-14 is negatively correlated with the Beck Depression Inventory-Primary Care Version and the 12-item General Health Questionnaire and positively correlated with the World Health Organization Quality of Life-Brief Version. The test-retest reliability, assessed on the 26 subjects 5 weeks after the first evaluation, highlighted an intraclass correlation coefficient value equal to 0.65. Factor analysis retains three factors, and it considers the factor loadings >0.40: RS-14-06 (‘I am determined’) is loaded on all the factors and RS-14-12 (‘In an emergency, I am someone people can generally rely on’) is not loaded on any factor.

Conclusion

This study demonstrates that the Italian RS-14 has psychometric properties with a good level of internal consistency (Cronbach’s alpha = 0.88), an adequate concurrent validity, verified by relationships with the other scales and as it was expected from literature, and an acceptable test-retest reliability.

Evaluation of the burden management in a psychiatric day center: distress and recovery style

AIM

In psychiatric rehabilitation the individual treatment plan can be formulated from tools that provide a multidimensional assessment of the patient. This study aims to analyze the relationship between distress and recovery style (integration and sealing over) from the psychosis. Assuming that this relationship affects the burden management, the study has the additional target of gaining more elements to direct the formulation of more effective therapeutic / rehabilitation programs.

METHODS

The study was carried out in a psychiatric day center, semi-residential structure of mental health services of the National Health System in Italy. 45 patients enrolled have been evaluated by the Neuropsychiatric Inventory (NPI - Italian version) and Integration / Sealing Over Scale (ISOS - Italian version), within three months (March-June 2014).

RESULTS

In the sample, the symptoms which cause a greater distress in the health workers, in an absolute sense, are uninhibition, irritability and apathy. Moreover, the results indicate that depression and anxiety cause a greater degree of distress in sealer patients.

DISCUSSION AND CONCLUSIONS

Uninhibition, irritability and apathy were more burdensome for mental health workers, because they require a greater engagement in the therapeutic relationship. Anxious and depressive symptoms cause a greater degree of distress in the sealers patients, reporting lower endurance of the denial of psychosis. The data seem to prove that knowing, differentiating and deepening the different aspects of the recovery style of each patient enable us to estimate the burden management, starting from the taking in charge, and to reduce the distress and the risk of burn out of the mental health workers.

Cannabis use and genital self-mutilation: an update of case reports

We reported and compared two case reports of genital self-mutilation with concurrent increasing psychotic symptoms resulting from substance abuse such as cannabis and alcohol.

[Recovery style, symptoms and psychosocial functioning in psychotic patients: a preliminary study]

BACKGROUND

Both integration and sealing over have been identified as global, clinically distinct recovery styles from the psychotic illness. The aim of this study was to investigate the correlation between recovery style, symptoms and global functioning in psychotic patients.

METHODS

106 psychiatric patients in different phases of recovery were studied (no patient at the first episode in our sample). The Integration/Sealing Over Scale, the Recovery Style Questionnaire, the Positive and Negative Syndrome Scale and the Life Skills Profile were completed for all patients; moreover, socio-demographic and clinical data were collected.

RESULTS

A relationship was found between the integrative recovery style and age >45 years (p<0.05), integration and affective disorders (p<0.05), delusions and sealing over (p<0.05).

CONCLUSIONS

Although the limited study sample, our findings suggest some predictors of integration which should be taken into consideration to "drive" patients toward an integrative recovery style after an acute psychotic episode.

Association between CYP1A2 polymorphisms and clozapine-induced adverse reactions in patients with schizophrenia

We investigated the relationships between common polymorphisms in CYP1A2 (CYP1A2(⁎)1C and (⁎)1F), CYP1A2-mRNA levels in circulating lymphocytes and clozapine(CLZ)-induced adverse drug reactions (ADRs) in 34 patients. Patients with ADRs had a higher frequency of CYP1A2 low activity allele combinations (8/12; 67%) and lower CYP1A2-mRNA levels than patients without ADRs (6/22; 27%, P=0.019).

Migrant pathways to community mental health centres in Italy

BACKGROUND

Many studies indicate that migrants in western countries have limited access to and low utilization of community mental health centres (CMHCs) despite the high prevalence of mental disorders.

AIMS

We aimed to compare migrant pathways to care across four CMHCs located in different Italian provinces and to identify pathway to care predictors.

METHODS

Migrants attending the four CMHCs between 1 July 1999 and 31 December 2007 were included in the study. Data were gathered retrospectively from clinical data sets and chart review.

RESULTS

Five hundred and eleven (511) migrants attended the four CMHCs, 61% were referred by GPs or other health services and 39% followed non-medical pathways to care (self-referral or through social and voluntary organizations), with important site variations. Younger age and being married were predictors of medical pathways to care; lacking a residence permit and having a diagnosis of substance abuse were related to non-medical pathways.

CONCLUSIONS

Pathways to CMHCs are complex and influenced by many factors. Non-medical pathways to care seem to be frequent among migrants in Italy. More attention should be paid to developing psychiatric consultation liaison models that also encompass the social services and voluntary organizations.

Gluten encephalopathy with psychiatric onset: case report

Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.

A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.

[Metabolic side effects of second generation antipsychotics in drug-naïve patients: a preliminary study]

AIM

Aim of this study was to investigate metabolic effects of second generation antipsychotics (SGA) in drug naïve patients.

METHODS

we included patients with psychotic disorders who were treated for the first time with a SGA. We evaluate anthropometric and metabolic data at baseline, after three months and after a year.

RESULTS

it was found a statistical significant increase in body weight, waist circumference, heart rate and glucose from the third month of treatment.

CONCLUSIONS

although the limited sample this study confirmed the importance of monitoring patients treated for the first time with SGA.

[Physical and psychic elements in chronic pain]

Chronic pain is a widespread problem in general medicine and in psychiatry. It consists in physical and psychic elements. The pain has a specific role, a different frequency and a different intensity in each mental illness. Medical treatments can get benefit from psychiatric drugs.

[Is the insight a favourable prognostic factor in the treatment of mental disorders?]

In the history of psychology, psychoanalysis and psychiatry, the concept of insight has had alternate fortunes and has been variously interpreted according to the observation apex from which it has been studied. In psychiatry, particularly, the insight has been considered close to the concept of disease consciouness and, consequently, the presence and the degree of intensity of insight have been put in relation with the adhesion to the treatments (the compliance) and the prognostic development of the mental disorders. With regard to the insight, through the analysis of several interpretative models, the authors emphasize how to draw the history of a possible passage of this concept from the side of individual psychopathology to the bi-personal side of therapeutic relationship, where the insight of the patient meets regarding its desease and that of the therapeutist regarding the objects of the treatment.

A single case report of recurrent surgery for chronic back pain and its implications concerning a diagnosis of Münchausen syndrome

While undergoing treatment in the psychiatric department, A.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrollable anxiety attack and in a state of fluctuating consciousness, was found to be suffering from a psychopathological condition characterized by pathological lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple invasive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slow-discharge morphine pump and the patient being granted a full disability pension. The continual increases in the doses of morphine suggested a tendency towards drug addiction. After providing a brief overview of the historical background and current concepts relating to the relationship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of Münchausen syndrome (the hypothesis best supported by the clinical evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not frequently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact.

[Borderline personality disorders in somatic illness]

The borderline personality disorders are very frequent in modern society because of cultural and social reasons. The authors analyze the disturbed mental processes (impulsiveness and memory) because they represent risk factors for the treatment of diseases. On the base of experience of consultation-liaison psychiatry, the authors show some guidelines in the medical practice (primary care and general hospital) in order to overcome the troubles of the treatment.

[Suicidal behavior in the North Varese province: a epidemiological analysis]

OBJECTIVE

Analysis of figures and characteristics of suicide behaviour in the area of Varese and the neighbouring northern towns (Valceresio, the valleys around Luino and northern Verbano), with the purpose of finding out preventing measures.

DESIGN

Epidemiological-descriptive survey. The 1995-1997 ISTAT death cards, included in the death files of the former USSL of Varese have been taken into consideration. Only those people who were resident at the suicide moment have been included in the survey. Afterwards the psychiatric service archives were consulted, to find any possible contact between the subjects in the ISTAT files and the psychiatric services themselves. With regard to these patients, some information such as suicide attempts, psychiatric pathology and first contact with the psychiatric services have been pointed out.

SETTING

Arcisate, Cittiglio, Luino and Varese districts, where the Community Mental Health Services 1 and 2 of "Azienda Ospedaliera Universitaria Macchi" of Varese operate.

MAIN OUTCOME MEASURES

The suicide rates in the studied area have been reckoned and, through direct standardization, the rates of the single districts have been compared.

RESULTS

There were 78 suicides (24 females and 54 males): rate of 8.2 per 100,000. In accordance with the national trend, there is evidence of a general reduction of the suicide phenomenon, except among the youngest. Districts of Luino and Arcisate are geographic areas to examine in the time, because a wider sample could reveal a higher risk. Young and elderly people are the most affected among the males and, 55/64-year-old people, both males and females, are at higher risk. Suicide methods vary with the age. A high percentage of subjects are not married and with low education. Less than one third of the subjects had come into contact with the psychiatric service.

CONCLUSIONS

These data allow a comparison with the national survey and an analysis of the suicide features in the study area. The purpose is to elaborate preventing strategies with multi-dimensional approach whose efficacy may be proved in the future by setting up a provincial observatory.

Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study

The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.

[Primary care and psychoactive drugs. Some reflections]

This paper aims at defining some problems that are present in the prescribing of psychotropic drugs in general practice. An important proportion of the patients in the primary care have psychological and/or clear psychiatric disorders; therefore it is necessary for the general practitioners to understand their needs, but also overuse or misuse of psychoactive drugs. The rational use is discussed and some considerations and instructions are stated.