1,721,438 research outputs found
Antipsychotics in pregnancy: balancing between risks of untreated illness and risks of drug-related adverse effects
No full text
Il trattamento del disturbo ossessivo-compulsivo: Farmaci, psicoterapia o trattamento integrato?
No full textno abstrac
Prevalence of non-psychotic disorders in ultra-high risk individuals and transition to psychosis: A systematic review
Full text linkDespite the growing interest in the prodromes of psychosis, the proper identification of those Ultra High Risk (UHR) subjects who will convert to psychosis remains an unresolved issue. It remains to be fully understood whether the risk of transition to psychosis is incremented by the concomitant presence of non-psychotic symptoms. We performed a systematic review in order to estimate: prevalence rates of non-psychotic disorders in UHR individuals and whether any comorbid disorder impacts on the risk of transition to frank psychosis. The review was conducted using the PRISMA guidelines by searching PubMed until August 2017. The inclusion criteria were: studies with appropriate definition of UHR/ ARMS (At Risk Mental States for psychosis); cross-sectional design (for prevalence rates) or longitudinal design (for transition rates to psychosis); adolescents and/or adults; specified instrument/interview for the diagnosis of mental disorder/symptoms. We included 46 English-language articles. We found that non-psychotic symptoms are a prevalent concern in UHR individuals, and this is true for all comorbid disorders examined. None of the mental disorder examined appear to be a marker for transition to psychosis. Our systematic review found that the great majority of UHR individuals actually has a highly prevalent clearly defined, above-the-threshold mental disorder that should constitute the primary focus of intervention
L’inquadramento nosografico dei disturbi dell’umore: dai sintomi alla diagnosi, dalla diagnosi alla terapia.
No full textMood disorders represent a main health concern, due to their high prevalence in the general popula- tion and because they are related to a severe worsening of quality of life and psychosocial functioning of those who are a ected. Because of the importance of such diseases, that, according to WHO, might become the major cause of morbidity by 2020, an e cacious, targeted and precise approach is essential in everyday clinical practice. is article reviews the methods of diagnostic approach, with the aim of describing the di erent phases of nosographic classi cation of mood disorders and their meaning. In particular, the most reliable classi cation distinguishes between unipolar (major depressive disorder) and bipolar (type I and II) disorders: the right di erential diagnosis is important because there are great di erences in the optimal management of these conditions (antidepressants vs. mood stabilizers) and diagnostic errors can potentially worsen the patient’s prognosis. In conclusion, the right noso- graphic classi cation allows the right therapeutic and prognostic approach. is may result in higher rates of remission and response, thus improving patient’s quality of life and overall wellness
Editorial: Early identification of affective and non-affective psychoses: From psychopathology to biomarkers
No full textN/
Clinical correlates of age at onset distribution in bipolar disorder: a comparison between diagnostic subgroups
No full textBackground: Admixture analysis of age at onset (AAO) has helped delineating the clinical pro le of early onset (EO) bipolar disorder (BD). However, there is scarce evidence comparing the distributional properties of AAO as well as the clinical features of EO BD type 1 (BD1) with EO BD type 2 (BD2). To this end, we studied 515 BD patients (224 BD1, 279 BD2, and 12 BD not otherwise speci ed [NOS]) diagnosed according to DSM-IV-TR criteria.
Methods: AAO was de ned as the rst reliably diagnosed hypo/manic or depressive episode according to diagnos- tic criteria. We used normal distribution mixture analysis to identify subgroups of patients according to AAO. Models were chosen according to the Schwarz’s Bayesian information criteria (BIC). Clinical correlates of EO were analysed using univariate tests and multivariate logistic regression models.
Results: A two normal components model best tted the observed distribution of AAO in BD1 (BIC = −1599.3), BD2 (BIC = −2158.4), and in the whole sample (BIC = −3854.9). A higher number of EO BD2 patients had a depression- (hypo)mania-free interval (DMI) course, while a higher rate of (hypo)mania-depression-free interval (MDI) course was found in EO BD1. EO BD2 had also a higher rate of comorbidity with alcohol dependence compared to EO BD1. The latter nding was con rmed by multivariate logistic regression analysis.
Conclusions: In conclusion, both BD1 and BD2 had bimodal AAO distributions, but EO subgroups had a diagnostic- specic clinical delineation
Olanzapine or lamotrigine addition to lithium in remitted bipolar disorder patients with anxiety disorder comorbidity: a randomized, single-blind, pilot study
No full textOBJECTIVE: The aim of the present randomized, single-blind, pilot study was to assess the efficacy of the addition of a second mood stabilizer, either olanzapine or lamotrigine, to lithium in patients with remitted bipolar disorder and comorbid anxiety disorder. METHOD: Adult DSM-IV bipolar disorder patients with a current anxiety disorder and a Hamilton Rating Scale for Anxiety (HAM-A) score of 12 or higher, in remission from an affective episode for at least 2 months while on lithium maintenance treatment, were randomly assigned to receive 12 weeks of single-blind olanzapine 5 to 10 mg/day (N = 24) or lamotrigine 50 to 200 mg/day (N = 23) addition to lithium. The primary outcome measure was the HAM-A; secondary outcome measures were the Clinical Global Impressions-Severity of Illness scale and the Global Assessment of Functioning (GAF) scale. Data were collected from July 2005 to February 2007. RESULTS: Twenty-two patients in the olanzapine and 18 in the lamotrigine group completed the trial. Mean +/- SD final doses of olanzapine and lamotrigine were, respectively, 7.7 +/- 4.2 mg/day and 96.7 +/- 46.7 mg/day in the intent-to-treat sample (N = 47). Both olanzapine and lamotrigine were effective in reducing HAM-A scores from baseline to endpoint (paired t test for completers: t = 11.361, df = 21, p < .001 for olanzapine and t = 6.301, df = 17, p < .001 for lamotrigine). Both drugs were also effective on the secondary outcome measures. Olanzapine was more effective than lamotrigine at weeks 6 and 12 with a last-observation-carried-forward analysis on all 3 outcome measures, while such differences disappeared on the HAM-A and GAF at week 12 with the visit-wise analysis. CONCLUSIONS: The addition of a second mood stabilizer (olanzapine or lamotrigine) to lithium is effective in reducing anxiety symptoms in bipolar disorder patients with a co-occurring anxiety disorder
Family accommodation in adult obsessive-compulsive disorder: Clinical perspectives
Full text linkThe term accommodation has been used to refer to family responses specifically related to obsessive-compulsive (OC) symptoms: it encompasses behaviors such as directly participating in compulsions, assisting a relative with obsessive-compulsive disorder (OCD) when he/she is performing a ritual, or helping him/her to avoid triggers that may precipitate obsessions and compulsions. At the opposite side, family responses to OCD may also include interfering with the rituals or actively opposing them; stopping accommodating OC symptoms or actively interfering with their performance is usually associated with greater distress and sometimes even with aggressive behaviors from the patients. This article summarizes progress of the recent research concerning family accommodation in relatives of patients with OCD. Family accommodation is a prevalent phenomenon both among parents of children/adolescents with OCD and relatives/caregivers of adult patients. It can be measured with a specific instrument, the Family Accommodation Scale, of which there are several versions available for use in clinical practice. The vast majority of both parents of children/adolescents with OCD and family members of adult patients show at least some accommodation; providing reassurances to obsessive doubts, participating in rituals and assisting the patient in avoidance are the most frequent accommodating behaviors displayed by family members. Modification of routine and modification of activities specifically due to OC symptoms have been found to be equally prevalent. Specific characteristics of patients (such as contamination/washing symptoms) and of relatives (the presence of anxiety or depressive symptoms or a family history positive for another anxiety disorder) are associated with a higher degree of family accommodation; these family members may particularly benefit from family-based cognitive-behavioral interventions. In recent years, targeting family accommodation has been suggested as a fundamental component of treatment programs and several interventions have been tested. Clinicians should be aware that family-based cognitive-behavior therapy incorporating modules to target family accommodation is more effective in reducing OC symptoms. Targeting family accommodation may be as well relevant for patients treated pharmacologically
Affective recurrences in bipolar disorder after switching from lithium to valproate or vice versa: A series of 57 cases
Full text linkno abstrac
- …
