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De Carlo V, Grancini B, Cassina N, Casati L, Piccoli E, Vismara M, Gobbo D, Zanaschi R, Lupo S, Olivieri S, Dell'Osso B. Cardiovascular risk factors and metabolic syndrome in patients treated with long-acting injectables antipsychotics: a retrospective study. Int Clin Psychopharmacol 2023; 38:160-168. [PMID: 36729532 DOI: 10.1097/yic.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present cross-sectional, retrospective study aimed to assess the prevalence of cardiovascular disease (CVD) risk factors and metabolic syndrome in a sample of psychiatric patients treated with long-acting injectable antipsychotics (LAIs). The clinical charts of 120 patients, mainly diagnosed with schizophrenia (30.0%), schizoaffective disorder (15.0%), and bipolar disorder (13.3%) on LAIs therapy - initiated in the period from 2013 to 2019 and lasting at least one year - were retrospectively reviewed and related socio-demographic, clinical and laboratory variables were collected. The 70.8% of patients were treated with first-generation LAIs, and the remaining 29.2% with second-generation LAIs. The overall sample showed low compliance in performing the required exams and evaluations related to CVD risk factors. The prevalence of metabolic syndrome was 30.8%, and, considering specific CVD risk factors, 55% of the total sample reported abdominal obesity, 43.3% arterial hypertension, 41.7% low HDL-cholesterol, 25.8% hypertriglyceridemia, and 20.8% fasting hyperglycemia. Lastly, 6.7% showed prolonged corrected QT (QTc) interval at the ECG. Patients treated with LAIs should be regularly monitored for metabolic changes and CVD risk factors. Metabolic changes rapidly develop after initiating an antipsychotic therapy and these often involve parameters, that can be easily recorded in an outpatient setting (e.g. abdominal obesity and hypertension).
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Affiliation(s)
- Vera De Carlo
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Niccolò Cassina
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Lorenzo Casati
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- 'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Dario Gobbo
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Raffaella Zanaschi
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Susanna Lupo
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Silvia Olivieri
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Psychiatric Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- 'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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Mauri MC, Cirnigliaro G, Piccoli E, Vismara M, De Carlo V, Girone N, Dell’Osso B. Substance Abuse Associated with Aggressive/Violent Behaviors in Psychiatric Outpatients and Related Psychotropic Prescription. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00842-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractPsychiatric
disorders with substance abuse are considered the leading causes of most violent and aggressive behaviors in the general population. This study was aimed to assess the impact of substance abuse and the therapeutic approaches adopted by psychiatrists in aggressive vs non-aggressive outpatients (n = 400) attending community-based psychiatric services and recruited over a 3-year period. Clinical and therapeutic variables were collected from medical records and the Modified Overt Aggression Scale (MOAS) was used to assess any aggressive/violent behavior. Violent behaviors were significantly higher in alcohol and substance abusers compared to non-abusers (p < 0.01), except for heroin abusers. Mean weighted MOAS score was significantly higher in patients taking antipsychotics (p < 0.005). The administration of Haloperidol, Zuclopenthixol, and Clozapine was more frequent in aggressive than in non-aggressive patients. The most frequently administered drug in these patients was Haloperidol (23.91%), with a higher mean daily dosage in violent vs non-violent patients. Our results confirm the well-established relationship between substance abuse and violent behaviors in psychiatric inpatients also within outpatient community services. Observed rates of most frequently prescribed antipsychotics to aggressive patients did not show any preference for newer generation compounds, with clinicians operating in the community setting likely being in need for further evidence and specific training to support their treatment choice.
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De Carlo V, Vismara M, Grancini B, Benatti B, Bosi MF, Colombo A, Viganò CA, Dell'Osso B. Effectiveness, tolerability, and dropout rates of vortioxetine in comorbid depression: A naturalistic study. Hum Psychopharmacol 2020; 35:e2750. [PMID: 32662933 DOI: 10.1002/hup.2750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/02/2020] [Revised: 04/16/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Vortioxetine is a novel antidepressant whose safety, tolerability, and therapeutic action have been supported by several studies. The present naturalistic study aimed to characterize its effectiveness, tolerability, and dropout rate in the real world. METHODS Total sample consisted of 66 outpatients with major depressive episode, treated with vortioxetine, whose clinical variables were evaluated over three time points. RESULTS Most common primary diagnoses were major depressive disorder (45.5%) and bipolar disorder (33.4%), with an overall comorbidity rate of 48.5% and concomitant medications in the 89.4%. The mean vortioxetine daily dosage was 12.90 ± 5.65 mg. Effectiveness of vortioxetine through a significant improvement on specific psychometric scales emerged, while only a nonsignificant trend of association between higher dosage and effectiveness was found. In the total sample, 51.5% were classified as responders and 36.4% as remitters. Two-thirds of subjects did not report side effects, while in the remaining patients, gastrointestinal ones were the most frequent (72.7%). Almost two-thirds of the sample could complete the follow-up, while 36.4% dropped out; the main reasons for dropout were side effects (37.5%) and lack of efficacy (29.2%). CONCLUSIONS Larger sample studies are warranted to better characterize vortioxetine effectiveness and tolerability in the real world.
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Affiliation(s)
- Vera De Carlo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Monica Francesca Bosi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Caterina Adele Viganò
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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4
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Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell’Osso BM, Albert U, Geller DA, Brakoulias V, Janardhan Reddy Y, Arumugham SS, Shavitt RG, Drummond L, Grancini B, De Carlo V, Cinosi E, Chamberlain SR, Ioannidis K, Rodriguez CI, Garg K, Castle D, Van Ameringen M, Stein DJ, Carmi L, Zohar J, Menchon JM. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol 2020; 35:173-193. [PMID: 32433254 PMCID: PMC7255490 DOI: 10.1097/yic.0000000000000314] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
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Affiliation(s)
- Naomi A. Fineberg
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Stefano Pallanti
- Istituto di Neuroscienze, University of Florence, Firenze, Italy
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Bernardo Maria Dell’Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- CRC ‘Aldo Ravelli’ for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales
- Translational Research Health Institute (THRI), Clinical and Health Psychology Research Initiative (CaHPRI) and School of Medicine, Western Sydney University, Sydney, Australia
| | - Y.C. Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Roseli G. Shavitt
- OCD Spectrum Disorders Program, Institute and Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo-SP, Brazil
| | - Lynne Drummond
- Consultant Psychiatrist, SW London and St George’s NHS Trust and St George’s, University of London, London
| | - Benedetta Grancini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vera De Carlo
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eduardo Cinosi
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - David Castle
- St. Vincent’s Hospital Melbourne and The University of Melbourne, Melbourne, Australia
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lior Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- The Data Science Institution, The Interdisciplinary Center, Herzliya
| | - Joseph Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
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Dell'Osso B, Benatti B, Grancini B, Vismara M, De Carlo V, Cirnigliaro G, Albert U, Viganò C. Investigating duration of illness and duration of untreated illness in obsessive compulsive disorder reveals patients remain at length pharmacologically untreated. Int J Psychiatry Clin Pract 2019; 23:311-313. [PMID: 31144538 DOI: 10.1080/13651501.2019.1621348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 10/26/2022]
Abstract
Aim: Obsessive compulsive disorder (OCD) is a disabling condition, often associated with early onset and chronic course. Early onset combined to the secretiveness that frequently characterises the condition, as well as patient's beliefs that OC symptoms do not represent a medical condition and that OCD can remit spontaneously, are all factors contributing to delayed diagnosis and first treatment, particularly of pharmacological nature.Methods: In this short report, authors performed a review of the most recent literature in the field.Conclusions: The current literature clearly delineates a duration of untreated illness of several years (around 7 years in the majority of the reports), which represented, on average, a portion ranging between the 40 and 70% of the overall duration of untreated illness.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,CRC 'Aldo Ravelli' for Neuro-technology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Benatti
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Benedetta Grancini
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matteo Vismara
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Vera De Carlo
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Giovanna Cirnigliaro
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Caterina Viganò
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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6
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D'Addario C, Bellia F, Benatti B, Grancini B, Vismara M, Pucci M, De Carlo V, Viganò C, Galimberti D, Fenoglio C, Scarpini E, Maccarrone M, Dell'Osso B. Exploring the role of BDNF DNA methylation and hydroxymethylation in patients with obsessive compulsive disorder. J Psychiatr Res 2019; 114:17-23. [PMID: 31004918 DOI: 10.1016/j.jpsychires.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/03/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 01/12/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a clinically heterogeneous neuropsychiatric condition associated with profound disability, whose susceptibility, stemming from genetic and environmental factors that intersect with each other, is still under investigation. In this perspective, we sought to explore the transcriptional regulation of Brain Derived Neurotrophic Factor (BDNF), a promising candidate biomarker in both development and etiology of different neuropsychiatric conditions, in peripheral blood mononuclear cells from OCD patients and healthy controls. In particular, we focused on BDNF gene expression and interrogated in depth DNA methylation and hydroxymethylation at gene promoters (exons I, IV and IX) in a sample of OCD patients attending a tertiary OCD Clinic to receive guidelines-recommended treatment, and matched controls. Our preliminary data showed a significant increase in BDNF gene expression and a significant correlation with changes in the two epigenetic modifications selectively at promoter exon I, with no changes in the other promoters under study. We can conclude that transcriptional regulation of BDNF in OCD engages epigenetic mechanisms, and can suggest that this is likely evoked by the long-term pharmacotherapy. It is important to underline that many different factors need to be taken into account (i.e. age, sex, duration of illness, treatment), and thus further studies are mandatory to investigate their role in the epigenetic regulation of BDNF gene. Of note, we provide unprecedented evidence for the importance of analyzing 5-hydroxymethylcytosine levels to correctly evaluate 5-methylcytosine changes.
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Affiliation(s)
- Claudio D'Addario
- University of Teramo, Bioscience, Teramo, Italy; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
| | | | - Beatrice Benatti
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Benedetta Grancini
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Matteo Vismara
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | | | - Vera De Carlo
- 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
| | - Daniela Galimberti
- University of Milan, Dino Ferrari Center, Milan, Italy; Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit, Milan, Italy
| | - Chiara Fenoglio
- University of Milan, Dino Ferrari Center, Milan, Italy; Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit, Milan, Italy
| | - Elio Scarpini
- University of Milan, Dino Ferrari Center, Milan, Italy; Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit, Milan, Italy
| | - Mauro Maccarrone
- Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy; Fondazione IRCCS Santa Lucia, Unit of Lipid Neurochemistry, Rome, Italy
| | - Bernardo Dell'Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy; CRC "Aldo Ravelli", University of Milan, Milano, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA.
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7
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De Carlo V, Grancini B, Vismara M, Benatti B, Arici C, Cremaschi L, Cirnigliaro G, Degoni L, Oldani L, Palazzo C, Glick ID, Viganò C, Dell'Osso B. Exploring characteristics associated with first benzodiazepine prescription in patients with affective disorders and related diagnoses. Hum Psychopharmacol 2019; 34:e2695. [PMID: 31044486 DOI: 10.1002/hup.2695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/22/2018] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In patients with affective disorders, benzodiazepines (BZDs) are frequently administered at the onset, sometimes inappropriately. We sought to identify clinical variables associated with first BZD prescription in a large sample of patients with affective disorders. METHODS Four hundred sixty patients with mood or anxiety disorders attending different psychiatric services were assessed comparing those who received BZD as first treatment (BZD w/) and those who did not (BZD w/o). RESULTS More than one third (35.7%) of the total sample had received BZDs as first prescription. In relation to mood disorders, BZD w/ subjects more frequently (a) had not a psychiatrist as first therapist, (b) had anxious symptoms at onset, (c) had adjustment disorder as first diagnosis, (d) were treated as outpatients. In relation to specific diagnoses, (a) personal decision of treatment for major depressive disorder, (b) outpatient status for bipolar disorder and (c) longer duration of untreated illness for adjustment disorder were more frequently associated with first BZD prescription. For anxiety disorders, the presence of stressful life events and the diagnoses of panic disorder or specific phobias were more frequently observed in BZD w/ patients. CONCLUSION Patients with affective disorders frequently received BZDs as first prescription with significant differences between and within mood and anxiety disorders.
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Affiliation(s)
- Vera De Carlo
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Chiara Arici
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Laura Cremaschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Luca Degoni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Lucio Oldani
- Department of Mental Health, Fondazione IRCCS Cà Granda Policlinico, Milan, Italy
| | - Carlotta Palazzo
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Ira D Glick
- Department of Psychiatry and Behavioural Sciences, Stanford Medical School, Stanford University, Stanford, California
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioural Sciences, Stanford Medical School, Stanford University, Stanford, California.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
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8
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Cremaschi L, Grancini B, De Carlo V, Pozzoli S, Altamura AC, Dell'Osso B. Benzodiazepine ingestion as a way to die by suicide and related safety: the case of an elderly patient. Aging Clin Exp Res 2019; 31:287-289. [PMID: 29730844 DOI: 10.1007/s40520-018-0966-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/15/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022]
Abstract
Benzodiazepines (BDZs) are widespread psychotropic compounds, often prescribed as first-line symptomatic option by general practitioners in patients with different psychiatric disorders. Sometimes, however, they contribute to delay the administration of the first appropriate psychopharmacological treatment, thus leading to a longer duration of untreated illness in patients with depressive and anxiety disorders. The well-established pros of BDZs use in clinical practice include efficacy, rapidity of action, versatility, and safety. Among the cons, BDZs can provoke cognitive side-effects, asthenia, and misuse/abuse. Although their overall safety has been traditionally viewed as one of their greatest strengths, BDZs massive ingestion for suicidal purposes may pose, in some cases, serious life-threatening conditions, as described in the present case report. Hence, particular attention needs to be paid in prescribing these compounds to special populations, such as elderly patients. Among these, their prescription should be limited to the short-term and particularly monitored in case of risk factors, as they may be unsafe in case of overdose.
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Affiliation(s)
- Laura Cremaschi
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Vera De Carlo
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sara Pozzoli
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Carlo Altamura
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.
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Oldani L, Benatti B, De Carlo V, Cortinovis I, Altamura AC, Dell'Osso B. A new tool to assess duration of untreated illness: Psychopathological Onset and Latency to Treatment Questionnaire (POLT-Q). Riv Psichiatr 2019; 53:290-298. [PMID: 30667395 DOI: 10.1708/3084.30762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Duration of untreated illness (DUI) has been increasingly investigated as a predictor of clinical outcome and course in different psychiatric disorders. To date, however, there are no tools for measuring this variable. Our group developed the Psychopathological Onset and Latency to Treatment Questionnaire (POLT-Q), focused on the onset of psychiatric disorders. Aim of this study was to assess the reproducibility and manageability of POLT-Q. METHODS Fifty consecutive in- and out-patients aged 16-65 with different DSM-5 psychiatric disorders were recruited. Two raters were present during the interview: one of them administered the POLT-Q to the patient and both independently completed the questionnaire. Collected values were compared using Cohen's Kappa test and McNemar test. RESULTS 62.5% of the replies showed a 100% consistency between the two raters. In the 6.25% the agreement was <95%. For all the replies, the K coefficient was >0.8, a high degree of agreement. DISCUSSION AND CONCLUSION The POLT-Q assesses variables related to the psychopathological onset and first pharmacological treatment and, according to present findings, it represents a convenient, reliable and standardised measure for DUI. Further studies on larges sample are needed to confirm our preliminary results.
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Affiliation(s)
- Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Vera De Carlo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ivan Cortinovis
- Laboratory G. A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Italy - CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, Italy - Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
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De Carlo V, Calati R, Serretti A. Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: A systematic review. Psychiatry Res 2016; 240:421-430. [PMID: 27155594 DOI: 10.1016/j.psychres.2016.04.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [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: 04/23/2015] [Revised: 02/15/2016] [Accepted: 04/15/2016] [Indexed: 12/28/2022]
Abstract
Up to one third of patients adequately treated for Major Depressive Disorder (MDD) do not respond to multiple interventions. Many studies investigated predictors in MDD outcome, but no study focused on predictors of non-response or non-remission to antidepressants in subjects with treatment resistant depression (TRD). The present study aimed to evaluate possible socio-demographic and clinical predictors of non-response and non-remission in MDD patients who failed to benefit from at least one antidepressant trial. A total of 51 papers were included. A number of severity indicators, such as longer duration of depressive episode, moderate-high suicidal risk, anxious comorbidity, higher number of hospitalizations and higher dosage of antidepressants, were associated with non-response as well as age. Interestingly, severity of illness, as well as comorbid personality disorders and anxiety symptoms, had also a predictive value in non-remission with the addition of marital status. Considering limitations, selected studies were observational or randomized non controlled/controlled trials and different TRD definitions and outcome measures were used. Overall, predictors of outcome were similar to MDD, but specific socio-demographic and clinical factors should be considered in clinical practice to formulate a more focused treatment in TRD patients.
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Affiliation(s)
- Vera De Carlo
- University of Bologna, Department of Biomedical and NeuroMotor Sciences, Bologna, Italy
| | - Raffaella Calati
- INSERM U1061, La Colombière Hospital, University of Montpellier, UM1, Montpellier, France; FondaMental Foundation, France
| | - Alessandro Serretti
- University of Bologna, Department of Biomedical and NeuroMotor Sciences, Bologna, Italy.
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Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Carlo VD. Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg 1996; 162:105-12. [PMID: 8639722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM To investigate the effect of early postoperative enteral nutrition enriched with arginine, RNA and omega-3 fatty acids on immunological and nutritional variables after elective curative operations for gastric or pancreatic cancer. DESIGN Randomised controlled trial. SETTING University hospital, Italy. SUBJECTS 78 Consecutive patients who were to undergo curative operations for gastric or pancreatic cancer, 60 of whom were suitable for the study. INTERVENTIONS Patients were randomly allocated to three groups (n = 20 each) according to the type of postoperative nutritional support: standard enteral diet, the same diet enriched with arginine, RNA, and omega-3 fatty acids or total parenteral nutrition. The daily nutritional goal was 25 kcal (105 kJ)/kg and 0.25 g nitrogen/kg for all patients. MAIN OUTCOME MEASURES Serum concentrations of immunoglobulins, albumin, transferrin, prealbumin, retinol binding protein (RBP); cholinesterase activity, weight loss, duration of operation, operative blood loss; blood transfusion; delayed hypersensitivity responses, number of lymphocyte subsets, phagocytic ability of monocytes, number of interleukin-2 (IL-2) plasma receptors, interleukin-6 (IL-6) plasma concentrations, postoperative infections and sepsis scores. RESULTS All enterally fed patients but one completed the nutritional programme. There were significant postoperative reductions in both nutritional and immunological variables in all groups. On postoperative days 4 and 8 prealbumin concentration (p < 0.05), RBP concentration (p < 0.05), delayed hypersensitivity responses (p < 0.05), phagocytic ability of monocytes (p < 0.01) and concentration of IL-2 receptors (p < 0.009) had all recovered more in the group receiving the enriched solution. There was no difference in the postoperative infection rates among the three groups, but the infections were less severe in the enriched group (p < 0.005). CONCLUSION Early enteral feeding was well tolerated. Patients who received the enriched solution recovered both their nutritional and immunological status quicker than those in the other two groups.
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Affiliation(s)
- M Braga
- Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy
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