1,720,991 research outputs found
Somatic symptom disorders in hospitalized patients: clinical features and health care costs
No full textBackground and objectives. Somatic Symptoms Disorder (SSD), formerly known as somatoform
disorder, is a mental disorder which manifests as physical symptoms that cannot be explained fully
by a general medical condition. In current literature, Medically Unexplained Physical Symptoms
(MUPS) are intended as physical symptoms without a medical explanation. The research provides
for the collection of data from hospitalized patients presenting MUPS, aiming to draw a clinical and
socio-demographic profile of these patients, to estimate economic costs related to hospital
management, and to explore psychopathological correlates of SSD. Materials and methods. The
cross-sectional study consists in the evaluation of data referring to all hospitalized patients admitted
between 2008 and 2018 in the wards of a teaching hospital in Northern Italy. Results. Data referring
to 273 hospitalized patients presenting MUPS have been detected. The sample shows a prevalence of
female, married, and worker patients. The most frequent ward involved are Neurology, Internal
Medicine and Short Unit Stay. The most common symptoms found are headache, pain, syncope and
vertigo. The overall estimated cost of hospitalization for patients with MUPS is 475'409.73 €. No
evidence that a history of medical disease is associated with a diagnosis of SSD. A personality
disorder diagnosis in patients with MUPS is associated with increased probability of having a
diagnosis of SSD. A marginally significant positive association also emerges with anxiety disorders,
but not with depressive disorder. Conclusions. The research provides the investigation of a large
number of patients with MUPS and a financial estimate of related hospitalization costs. Moreover, it
allows to study clinical, socio-demographic and psychopathological correlates involved in SSD
Evaluation of the burden management in a psychiatric day center: distress and recovery style
No full textAim: 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 conclusion. 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
A case of reversible splenial lesion syndrome (Resles) related to neuroleptic malignant syndrome in a schizophrenic patient
Full text linkObjective: Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological condition characterized by a transient lesion in the splenium of the corpus callosum. Method: A systematic search of the literature has highlighted a possible correlation between this rare condition and neuroleptic malignant syndrome (NMS) despite only few cases have been reported. Results: This paper reports a case of RESLES syndrome in a 36-years old male patient with NMS who was undergoing psychiatric treatment for schizophrenia. Conclusions: The reported clinical case highlights the possibility of including NMS as one of the differential diagnosis in RESLES syndrome
Biological Correlates of Dissociative Disorders: A Systematic Review on Biomarkers and Trauma Connections
No full textPathological dissociation is characterized by disruptions in consciousness, memory, identity, perception, and affect, often linked to trauma and observed across various psychiatric conditions. Previous reviews do not fully cover key biological correlates used as biomarkers and do not clearly define the trauma-dissociation link. Therefore, this systematic review gives an overview of the studies on biomarkers research of the most relevant findings in associations between dissociative disorders and biological correlates. Additionally, it seeks to explore potential links between specific trauma types and recurrent biomarkers. A total of 123 studies were included, highlighting the role of increased prefrontal cortex activation and reduced hippocampal volume as potential biomarkers for pathological dissociation. Altered connectivity in the limbic system, frequently tied to childhood trauma, further underscores the neurobiological basis of dissociative symptoms. Biochemical and genetic studies, while promising, present inconsistent results and require further validation. This review underscores the importance of identifying reliable biomarkers to improve diagnostic accuracy, inform personalized treatment strategies, and monitor therapeutic responses. Future research should aim to unify methodologies and explore novel approaches to enhance clinical applications
Pharmacogenetic Tests in Reducing Accesses to Emergency Services and Days of Hospitalization in Bipolar Disorder: A 2-Year Mirror Analysis
Full text linkDespite the enormous costs associated to mood disorders’, few studies evaluate potential cost saving from the use of pharmacogenetic tests (PGT). This study compares 12 months before the execution of the PGT versus 12 months after, in terms of number and days of hospitalization and accesses to emergency services, in a sample of 30 patients affected by bipolar disorder. Secondarily, the study gives an economic value to the data based on the diagnosis-related group (DRG). Patients included in the study were required to be aged ≥18 years, sign an informed consent, have a score of Clinical Global Impression item Severity (CGIs) ≥3, and have a discordant therapy compared to the PGT in the 12 months preceding it and a therapy consistent with it for the following 12 months. Cost saving has been evaluated by paired t-tests in a mirror analysis. Statistically significant differences in all the comparisons (p < 0.0001) emerged. Important cost saving emerged after the use of PGT (€148,920 the first year versus €39,048 the following year). Despite the small sample size and lack of a control group in this study, the potential role of PGT in cost saving for the treatment of bipolar disorder treatment emerged. To confirm this result, larger and clinical trials are needed
Efficacy of short-term psychodynamic psychotherapy (STPP) in depressive disorders: A systematic review and meta-analysis
No full textIntroduction: Depression is a common illness worldwide and can severely interfere with daily and work functioning. Both pharmacological and psychotherapeutics interventions are used for adult depression. The aim of the review is to evaluate the efficacy of short-term psychodynamic psychotherapy (STPP) comparing with different types of intervention. Materials and methods: A systematic review with meta-analysis on the efficacy of STPP in depressive disorders was conducted. Results: Meta-analysis results confirm the superiority of STPP versus no interventions. The average effect size of depressive symptoms severity at the end of the treatment is -0.91 (95 % CI: -1.49 - -0.33) in favor of STPP, while for clinical improvement of depressive symptoms is -0.78 (95 % CI: -1.56 - 0.01). Results confirm a net superiority of STPP to usual treatments unstructured. A mild superiority of efficacy of STPP on support psychotherapy emerged. Comparison of the efficacy of STPP vs cognitive-behavioral psychotherapy (CBT) shows little superior in case of STPP. No substantial differences in efficacy in case of STPP than control interventions emerged. Antidepressant pharmacotherapy is resulted to be slightly more effective to STPP. Discussion: While all the other results confirm current literature, this review shows no superiority of combined treatment than STPP only. Limitations: The review has some limitations such as the lack of moderation analysis and the high heterogenicity of the type of the studies. Conclusions: The results confirm the efficacy of STPP in depressive disorders endorsing the guidelines of National Institute for Health and Clinical Excellence
Compulsory versus voluntary admission in psychiatry: an observational study
Full text linkBackground: in Italy compulsory admission (ca) in psychiatry is governed in accordance with law 833/78 establishing that "all treatments are voluntary" and that "the health authorities may prescribe involuntary treatments in respect of the dignity of a person and of his civil and political rights." this study aims to observe the most frequent diagnosis both in compulsory admitted patients and in those with voluntary admission. the second aim of the study is to evaluate the most recurring clinical features in the two groups of patients and to verify the existence of a correlation between the modality of admission and the length of hospitalization (LOs). Methods: the study evaluates data from two groups of patients: 100 compulsorily admitted and 100 voluntarily admitted patients from January 2014 to March 2017. In order to include the data, patients had to be ≥18 years old; admitted in emergency regime; only data for the first hospitalization of patients who had multiple admissions were included in this analysis. Patients were tested through the Brief Psychiatric rating scale (BPrs) version 4.0, as part of the clinical routine. Results: schizophrenia, schizotypal Personality and Delusional Disorder (F20-29) and other Personality Disorders (F60-69) are the most frequent diagnosis among patients compulsorily admitted (55% vs. 35%, P value <0.01); Mood Disorder is more frequent among volunteer patients (F30-39: 32% vs. 15%, P value <0.01). A significant difference between LOs of the volunteer patients (13.033 days, Ds 8.19) and LOs of compulsory admitted patients (26.33 days, sD 22.4) was observed (P<0.003). Conclusions: schizophrenia and others psychotic disorders are more frequent among patients compulsorily admitted, with a lack of caregivers and poor social support. ca are related to higher LOs. this study has some limits such as the study design
Four clinical cases of recurrent surgery addiction (polyopérés): diagnostic classification in the DSM-IV-TR vs DSM-5
Full text linkThe article presents four clinical cases of patients with the common history of recurrent
surgery. These conditions are interesting first of all for general medicine and surgery, apart
from psychiatry. Indeed, patients with these characteristics are almost invariably subjected to
psychiatric evaluation by internal doctors and surgeons and this is evident in our case reports,
despite the rarity of the phenomenon in latest decades aside from plastic surgery. The first
aim of the study is to compare diagnostic classifications between DSM-IV-TR and DSM-5 in
reference to the case reports of recurrent surgery in order to observe the changes occurring in
the diagnostic criteria and classification and the different attitude of the two manuals towards
these disorders. The second endpoint is to describe the common features and the differences
between the cases that could motivate a different prognostic evolution to raise a hypothesis
that could be a starting point for further research. According to previous classification of
mental disorders in the DSM IV-TR, patients addicted to recurrent surgery are included in the
diagnostic category of “Factitious Disorder with Predominantly Physical Signs and Symptoms”. In
the DSM-5 typical clinical manifestations of recurrent surgery are excluded from diagnostic
criterions of “Factitious Disorder”. The new manual moves away from the classic nosography
tradition and highlights a bigger importance of an objective clinical observation of patients in
comparison with the sole clinical history: the most suitable diagnosis is the “Somatic Symptom
Disorder”
Efficacy and tolerability of therapies set under pharmacogenetic tools suggestions: A systematic review with meta-analysis about mood disorders
No full textBackground: Bipolar Disorder (BD) and Major Depressive Disorder (MDD) have a huge impact on functioning and quality of life; moreover, they are linked to extensive direct and indirect costs. This systematic review with metaanalysis aims to evaluate the utility of pharmacogenetic tests (PGT) in terms of efficacy and tolerability into the routine clinical treatment of mood disorders.
Materials and methods: The first part of the review is a qualitative overview of the PGTs used in the included studies. The second part aims to compare, in terms of efficacy and tolerability, patients affected by BD and MDD treated as usual (TAU), according to the clinicians’ prescribing attitude, versus patients whose psychopharmacological treatments were set up following the PGT suggestions. Results: 6 studies on MDD and 2 studies on BD were included. Regarding MDD, the meta-analysis shows a significantly higher number of patients achieving better outcome in terms of efficacy, through the evaluation of response rate and remission rate at the HDRS (Hamilton Depression Rating Scale) in the group of patients treated under the PGT suggestions; regarding BD the meta-analysis does not show any significant difference in terms of efficacy. In terms of adverse events, the available data suggest promising results about the utility of PGT to set more tolerated therapies.
Conclusions: Although the limited number of studies, results confirm the importance of PGT in setting up psychopharmacological therapies as a support to clinicians’ choices
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