Time and dose dependence of the 'priming' of the expression of dopamine receptor supersensitivity

The D-1 receptor agonist, SKF 38393 (2 mg/kg s.c.), failed to elicit contralateral turning when administered to drug-naive rats 17 days after unilateral 6-hydroxydopamine (6-OHDA) lesioning of the medial forebrain bundle, while it elicited intense contralateral turning 90 days post-lesioning. On the other hand the D-1/D-2 receptor agonist, apomorphine (0.1 mg/kg s.c.), induced contralateral turning in drug-naive rats lesioned 14 days earlier and made the administration of SKF 38393 (2 mg/kg s.c.) 3 days later effective to evoke contralateral turning ('priming'). The effectiveness of apomorphine as a primer of SKF 38393-induced turning depended critically on the interval between the administration of the two agonists. Effectiveness was minimal after 3 h and increased after 6-12 h, peaked at 72 h and was reduced after 10 days. The D-2 receptor agonist, LY 171555 (0.2 mg/kg s.c.), was also effective as a primer of SKF 38393-induced contralateral turning and this effect also was dependent upon the interval between priming and SKF 38393 administration. Moreover, priming was dependent on the dose of drug used as primer and on the dose of SKF 38393 used as a challenge. In contrast to SKF 38393, priming was unable to make effective a dose of LY 171555 that was ineffective in drug-naive rats, suggesting that LY 171555 affects D-1-dependent turning to a greater extent than D-2-dependent turning. The results indicate that the priming phenomenon is rather strictly time- and dose-dependent.

Blockade of acquisition of drug-conditioned place aversion by 5HT3 antagonists

The effect of two 5HT3 antagonists, ICS 205-930 and MDL 72222, on drug-induced place aversion was studied in a two-compartment apparatus with a procedure including a pre-test for spontaneous preference. Naloxone (0.8 mg/kg SC), phencyclidine (2.5 mg/kg SC) and picrotoxin (2.0 mg/kg IP) paired with the preferred compartment elicited a significant place aversion. ICS 205-930 and MDL 72222 failed to modify spontaneous place preference when paired with both compartments. ICS 205-930 (30 micrograms/kg SC) paired with the preferred and, in other experiments, with the non-preferred compartment, also failed to modify spontaneous preference. ICS 205-930 (7.5, 15 and 30 micrograms/kg SC), paired with both compartments, dose-dependently reduced the place aversion induced by naloxone (0.8 mg/kg SC), phencyclidine (2.5 mg/kg SC) and picrotoxin (2.0 mg/kg IP). MDL 72222 (30 micrograms/kg SC) paired with both compartments had a similar effect. The result indicate that 5HT, via 5HT3 receptors, plays a role in the aversive properties of drug stimuli.

Properties of benzodiazepine binding sites in peripheral blood lymphocytes

Benzodiazepine (BDZ) binding sites were studied by using 3H-diazepam and 3H-Ro 5-4864 in intact lymphocytes from peripheral blood (PBL), in comparison to kidney and cerebellum. Experiments with 3H-diazepam performed at equilibrium and measuring kinetics revealed that BDZ binding sites are indeed present in rat PBL. The binding is saturable (Bmax 557 fmoles/10(6) cells), with high affinity (KD = 9.3 nM) and reversible. Specific binding sites are also observed by saturation experiments with 3H-Ro 5-4864 (Bmax 175 fmoles/10(6) cells, KD 2.2 nM). In addition, analysis of saturation isotherms obtained with 3H-diazepam indicates that BDZ binding sites are also present in human PBL. Scatchard plot of binding isotherms revealed an apparent single population of sites in all cases. The pharmacological characterization of BDZ binding sites in PBL, as compared with those of kidney and cerebellum, showed that these sites belong to the so-called "peripheral type."

Familial rates of affective illness in Sardinia with special reference to schizoaffective disorder

Familial rates of psychiatric disorders were studied in southern Sardinia and showed an increase in relatives of probands with the following research diagnostic criteria (RDC) diagnoses: normal, unipolar depression, schizoaffective depressive, schizoaffective bipolar, bipolar with mania and bipolar with hypomania. A significantly higher risk for bipolar schizoaffective disorder was observed in relatives of bipolar schizoaffectives compared with relatives of normal probands.

The importance of respecting accreditation indicators to improve quality of care

Issue

The health and social-care facilities (HSF) of the Lombardy Region provide services specifically conceived for fragile populations, including elderly, disabled, addicts etc. Through its Accreditation Units, the Agency for Health Protection (ATS) in the Metropolitan City of Milan is responsible for overseeing authorization and accreditation indicators of HSFs in all afferent districts. Assessed requirements include the qualitative standard (presence of mandatory professional figures) and the quantitative standard (guaranteed weekly minimum time of care per patient) of operating staff, based on current legislation.

Description of the problem

These standards are evaluated at site-inspection by examining staff qualifications and by matching staff working hours to actual daily presence of patients, randomly selecting a recent past week. The resulting standards may thus not be fully representative of the whole year. In 2019, the Health and Social-care facilities Accreditation Unit of ATS began a retrospective quali-quantitative analysis of health service staffing data for 2017 and 2018. Data were extrapolated from two main databases: “Scheda Struttura”, a data collection tool regarding work hours, qualifications, waiting lists etc. compiled yearly by HSF managers; and economic data detailing reimbursements by the regional health service, based on effective daily presence of patients at the HSF.

Results

Preliminary results relating to 2017 showed that around 4% of HSFs do not guarantee qualitative staffing standards, and almost 30% do not guarantee quantitative staffing standards throughout the year.

Lessons

The proposed tool is useful for emphasizing potentially critical situations and may help define the annual inspection schedule with the aim of continuously improving quality of care among regional HSFs.

Key messages

Data management tools can help local health authorities monitor and identify facilities at risk of falling below the defined standards of care. Qualitative and quantitative analysis of health service staffing is useful for emphasizing potentially critical situations and may help define the annual inspection schedule.

(D-Ala2)deltorphin II: D1-dependent stereotypies and stimulation of dopamine release in the nucleus accumbens

In order to investigate the relative role of central delta- and mu-opioid receptors in behavior, the effects of (D-Ala2)deltorphin II, a natural delta-opioid peptide, and PL017, a beta-casomorphin derivative specific for mu receptors, were compared after local intracerebral and intraventricular administration. Intracerebral infusion of the two peptides was done bilaterally in the limbic nucleus accumbens and in the ventral and dorsal caudate putamen of freely moving rats through chronic intracerebral cannulas. After intra-accumbens infusion, the two peptides elicited marked but opposite behavioral effects: while (D-Ala2)deltorphin II evoked dose-dependent motor stimulation characterized by locomotion, sniffing, and oral stereotypies, PL017 elicited motor inhibition with rigidity and catalepsy. These effects were site specific because they could not be evoked from the ventral or from the dorsal caudate. Low doses of naloxone (0.1 mg/kg, s.c.) blocked the effects of PL017 but not those of (D-Ala2)deltorphin II, which instead were reduced by high doses of naloxone (1.0 mg/kg) and by the putative delta-antagonist naltrindole; this drug failed to affect the catalepsy induced by PL017. Therefore, while (D-Ala2)deltorphin II effects were delta-mediated, PL017 effects were mu-mediated. Blockade of dopamine D1 receptors by SCH 23390 abolished (D-Ala2)deltorphin II effects, while blockade of dopamine D2 receptors by raclopride or by haloperidol was without effect. Local application by reverse dialysis of (D-Ala2)deltorphin II (5 microM) to the accumbens resulted in a naloxone-sensitive increase of extracellular dopamine concentrations; these effects could not be evoked from the caudate, nor by PL017 in the accumbens. Intracerebroventricular administration of (D-Ala2)deltorphin II or of PL017 elicited behavioral effects qualitatively similar to those obtained from the accumbens.

Activation of 574 new Alzheimer’s special care unit beds in the Metropolitan City of Milan

Issue

Dementia is among the main causes of disability and dependency in the elderly. It was defined a public health priority by the WHO. The health and social-care system of the Lombardy region (SSR) plays a key role in implementing assistance and care pathways specifically designed for fragile populations, including those affected by dementia and Alzheimer's disease, its most common form.

Description of the Problem

The SSR provides residential care options especially conceived for dementia patients, known as Alzheimer's special care units (ASCU). However, waiting lists are concerning, and distribution of these facilities is inconsistent throughout the region. In 2018 there were 981 accredited and SSR-covered ASCU beds in the Metropolitan City of Milan (MCM), translating in 1.26 beds/1000 people aged ≥ 65. With regional legislation (DGR 1046/2018), the SSR proposed activation of new ASCU beds in all territories with less than 2 beds/1000 people aged ≥ 65. The MCM Agency for Health Protection (ATS) thus analyzed the distribution of ASCU beds in afferent districts, defining specific needs for each district. The aim was to fund and activate 574 new ASCU beds homogenously among previously accredited and SSR-covered residential care facilities, reaching the targeted 2 ASCU beds/1000 people aged ≥ 65. Applicant facilities had to respond to specific personnel, technological, therapeutic and structural requirements.

Results

Preliminary results indicate 29 residential care facilities applied for evaluation in 2019. The ATS received and evaluated all applications. Following site-inspection, 8 facilities were deemed inappropriate.

Lessons

In 2019, 21 residential care facilities were approved for funding and activation of 558 new ASCU beds. Residual beds will be funded in 2020. Main messages: Activation of new ASCU beds in 2019 and 2020 increased specialized long-term care beds for dementia patients by almost 60%, allowing a more homogenous distribution among MCM districts.

Key messages

The health and social-care system of the Lombardy region proposed activation of new Alzheimer’s special care units beds in all territories with less than 2 beds/1000 people aged ≥ 65. Activation of 574 new Alzheimer’s special care units beds increased by almost 60%, allowing a more homogenous distribution among Metropolitan City of Milan districts.