1,721,205 research outputs found
A proposito della Legge 180 trent’anni dopo : riflessioni su una Psichiatria che cambia (e sul ruolo dello psichiatra)
No full textIn 1978, Law 180 eliminated psychiatric Hospitals for implementing community and rehabilitative care. After 30 years, it is of interest to make the point on limits and unmet needs linked to this Law. Actually, it stemmed from social psychiatry as conceived in 60's and focused on hypothesized social determinants of chronic psychoses, paying less attention to other important variables (e.g. biological) and psychiatric domains like mood and anxiety disorders. In fact, this model was totally devoid of recent epidemiological, diagnostic, psychobiological, therapeutic knowledge, showing the multidimensional etiopathogenesis of mental disorders. In addition, the Law 180 conditioned the formation of clinical psychiatrists with this "dogmatic" reductionism with more emphasis on social aspects and less attention to clinical aspects and to non psychotic disorders. Currently, Italian psychiatrists need to regain their clinical skill, role and identity in an open-minded vision of the etiopathogenetic complexity of psychiatric disorders
Law 180 after 30 years - reflections on unmet needs and risks of loss of identity for Italian psychiatrists
No full textTecniche di brain stimulation in disturbi psichiatrici resistenti : indicazioni e prospettive=Brain stimulation techniques in the treatment of refractory psychiatric disorders : current and future directions
No full textSebbene i progressi dell’ultimo ventennio in campo farmacologico abbiano consentito un miglioramento sostanziale in termini di prognosi e qualità di vita in pazienti affetti da disturbi psichiatrici, una non trascurabile parte di questi rimane refrattaria ai comuni interventi terapeutici. Quella della resistenza al trattamento rappresenta una sfida continua per i clinici e i ricercatori del settore e, nell’ultimo decennio, sono state sperimentate diverse forme di trattamento, tra cui strategie di associazione farmacologica e psicoterapica e interventi di brain stimulation, nell’ottica di ampliare le opzioni terapeutiche in pazienti con disturbi resistenti al trattamento. In particolare, il crescente impiego della brain stimulation ha portato alcuni autori a considerare tale ambito come una sorta di “terza via” di trattamento accanto ai tradizionali interventi di psicofarmacologia
e psicoterapia. Nell’ambito della brain stimulation rientrano la stimolazione del nervo vago (VNS), la stimolazione magnetica transcranica (TMS), la stimolazione cerebrale profonda (DBS) e una recente evoluzione della terapia elettroconvulsivante, la terapia convulsivante magnetica (MST). Tuttavia, è bene ricordare che nessuna delle tecniche menzionate ha ricevuto l’approvazione dalla Food and Drug Administration (FDA) per il trattamento dei disturbi psichiatrici, a eccezione
della VNS, di recente approvata per il trattamento della depressione maggiore resistente. Allo stato attuale, pertanto, tali tecniche sono da considerarsi sperimentali. Nel presente articolo vengono presentate le principali tecniche di brain stimulation discutendone il razionale, i principali studi pubblicati, le attuali indicazioni e le prospettive future.. Although the acquisitions of the last two decades in the pharmacological treatment of psychiatric disorders have improved the prognosis and the quality of life of patients, a consistent part of subjects remain refractory to the standard recommended treatments. Treatment-resistant psychiatric disorders represent an ongoing challenge for clinicians and researchers,
and over the last decade, different forms of treatment, including pharmacological augmentation strategies, psychotherapy augmentation and brain stimulation, have been investigated in order to open new prospects of treatment in this field. Brain stimulation approaches to neuropsychiatric disorders have been increasingly investigated and are currently defining a “third way” of treatment, besides the traditional ones of psychopharmacology and psychotherapy. These include Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), Electroconvulsive Therapy (ECT), and the recent development of a new form of convulsive treatment, Magnetic Seizure Therapy (MST). Nevertheless, none of the mentioned treatments, except VNS for treatment-resistant major depression, has received the Food and Drug Administration (FDA) approval for the treatment of psychiatric disorders, and currently, these techniques should be
considered investigational. The aim of the present review was to present the mentioned techniques describing the rational of their use in psychiatric disorders, the procedure, main results of published trials and future directions
Augmentative transcranial magnetic stimulation (TMS) combined with brain navigation in drug-resistant rapid cycling bipolar depression : a case report of acute and maintenance efficacy
No full textThe efficacy of transcranial magnetic stimulation (TMS) has been poorly investigated in the acute and maintenance treatment of bipolar depression. The present case supports the efficacy of low-frequency repetitive TMS (rTMS) of the right dorsolateral pre-frontal cortex (RDLPFC) combined to brain navigation in a drug-resistant, bipolar depressed subject with rapid cycling. While continuing the pharmacological treatment at stable doses, the patient was stimulated for 3 weeks at 1 Hz, 110% of motor threshold, 300 stimuli/day showing a significant improvement on the Hamilton Depression Rating Scale (HDRS(21)), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression, improvement scale (CGI-I) total scores. On completion of the 3-week rTMS, the patient was treated with periodic maintenance sessions of rTMS at the same parameters of acute phase for an additional 6 months, at the end of which the therapeutic gains were maintained according to rating scales scores. Larger controlled trials assessing the acute and maintenance efficacy of rTMS in bipolar depression are needed
May non-antipsychotic drugs improve cognition of schizophrenia patients?
No full textRationale: Cognitive impairment in schizophrenia patients is associated with poor outcome and it represents one of main challenges of pharmacological treatment. Unfortunately, second-generation antipsychotics have not yielded the expected results in the improvement of these symptoms. Objective: The purpose of the present review paper is to summarize and discuss the available data about the efficacy of non-antipsychotic drugs in the treatment of cognitive symptoms of schizophrenia. Methods: A research in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while studies with schizoaffective patients have been excluded. Results: Several non-antipsychotic compounds have been tested with the purpose to improve cognitive symptoms in schizophrenia patients, but no molecule has a significant pro-cognitive activity. Conclusion: Available data do not support the superiority of non-antipsychotic drugs vs. placebo for cognitive enhancement in schizophrenia. Preliminary results indicate mirtazapine, mianserine, lamotrigine, tandospirone, cyproheptadine, valacyclovir and omega-3 fatty acids as the most promising compounds, however no definitive conclusions can be drawn in the light of small sample size studies
Subjective well-being e insight nei pazienti con disturbi bipolari : modificazioni durante il ricovero e correlazioni con le variabili cliniche e soggettive al follow-up
No full textIntroduzione : diversi studi hanno evidenziato l’importanza delle componenti soggettive quali l’Insight e il Subjective Well-being come predittori dell’outcome clinico nei soggetti affetti da schizofrenia e da disturbi affettivi. Metodi : sono stati reclutati consecutivamente pazienti con diagnosi di disturbo bipolare I e II (DSM-IV-TR) in trattamento con antipsicotici atipici ricoverati presso l’SPDC dell’UOP dell’Ospedale Maggiore Policlinico di Milano. Per la valutazione dell’Insight è stata utilizzata la Scale to Assess Unawareness of Mental Disorder (SUMD, Amador e Strass, 1990); per il Subjective Wellbeing la scala SWN (Naber, 1995) e per la sintomatologia le seguenti scale: Brief Psychiatric Rating Scale, Mania Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impression-Bipolar Version (CGI-BP). Le scale psicometriche sono state somministrate all’ammissione in SPDC (T0) ed alla dimissione (T1). La stabilità dei risultati sarà valutata, successivamente, mediante la somministrazione delle medesima batteria testale ogni 6 settimane per 12 mesi. Risultati : lo studio di associazione tra variabili cliniche e testali al T0 ha evidenziato una correlazione inversa tra numero di ricoveri pregressi e punteggio nella sottoscala controllo emotivo del SWN (r = -0,822; p = 0,012); lo studio di associazione tra variabili sintomatologiche alla dimissione (variabili dipendenti) e le sottoscale SWN e SUMD (variabili indipendenti) attraverso modelli di regressione lineare (metodica Stepwise) ha evidenziato associazioni statisticamente significative tra le sottoscale funzioni fisiche del SWN (B = -0,196; t = -4,303; p = 0,008) e consapevolezza attuale del SUMD (B = 1,060; t = 7,861; p = 0,001) ed il punteggio CGI-BP alla dimissione. Conclusioni : l’associazione inversa tra il controllo emotivo e il numero di ricoveri conferma l’influenza negativa delle recidive sul benessere soggettivo dei pazienti affetti da disturbo bipolare. I risultati della regressione lineare, in accordo con la letteratura internazionale, suggeriscono il valore predittivo della consapevolezza e del benessere soggettivo rispetto alla gravità sintomatologica alla dimissione. Infine, verranno illustrati i risultati della successiva valutazione psicometrica a sei settimane dalla dimission
From ‘classical’ antipsychotics to ‘multidimensional stabilizers’: do we need a new classification for novel drugs used in schizophrenia?
No full textSUMMARY This article revisits the roots of the clinical categorical concept of schizophrenia and its biopathogenetic model (‘dopaminergic model’), based on dopaminergic dysfunctioning in CNS, as conceived in the 1960s and 1970s. These clinical/biopathogenic concepts have been challenged by the dimensional approach and by a more complex neurochemical model of schizophrenia, arising mainly from the use of novel compounds, which involves activity on different neurotransmitters in the CNS. Moreover, new compounds used in the treatment of schizophrenia are effective not only on the psychotic dimension, but also on other dimensions, such as negative, depressive and cognitive ones. Therefore, the term ‘antipsychotic’, which refers to a class of drugs acting mainly on acute psychotic symptoms, seems obsolete, and schizophrenia should not be conceived as an acute disorder, but rather as a chronic multidimensional dysfunction. Consequently, novel compounds acting on different dimensions can better stabilize patients, avoiding the shift from positive to negative symptoms due to the D2 antagonism. Thus, a new denomination is needed considering all of the peculiarities of new compounds compared with neuroleptics for stabilizing not just psychotic symptoms in the acute phase, but also affective, negative and anergic symptoms (which are integral parts of the disorder), even in the medium–long term; more appropriately, they should be considered as ‘multidimensional stabilizers’ instead of antipsychotics. Moreover, this denomination also refers to their efficacy in bipolar disorders, since their use is being increasingly proven to be effective in the treatment of this disorder as well. Finally, a change in the name of this pharmacological class may contribute to reducing the stigma that is now closely linked to antipsychotic drugs, such as chronicity, unfavorable prognosis and ‘craziness’
Designing outcome studies to determine efficacy and safety of antipsychotics for 'real world' treatment of schizophrenia
No full textOver the last 5 years, some studies have questioned the efficacy of second-generation antipsychotics over first-generation neuroleptics in the treatment of schizophrenia. At the same time, these study results have led to re-examination of their design particularly CATIE and CUtLASS - which essentially measured relatively short-/mid-term outcome and did not always take into account real-world clinical practice and outcome measures (e.g. prevalence of positive acute symptoms, exclusion of comorbidity with substance abuse, predominance of chronic patients, lack of quality of life/wellbeing measures, etc.). In fact, one of the greatest challenges to treatment of schizophrenia is its life-long, multifaceted, functional disability associated with progressive cognitive deterioration after each acute episode. As such, the most important goal of the treatment is not just to deal with acute episodes, but rather to improve long-term outcome. Specifically, we aim for modest improvement and then stabilization of the different clinical dimensions involved in the overall symptomatology (i.e. negative/anergic, impulsive, positive, mood and cognitive impairments), and to achieve 'clinical stabilization' after obtaining a partial or full remission of acute symptoms, thus reducing the risk of a progressive cognitive deterioration. All these aspects need to be properly evaluated in a long-run perspective
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