5,333 research outputs found
Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5
No full textIvano Caselli, Nicola Poloni, Marta Ielmini, Marcello Diurni, Camilla Callegari Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy Abstract: A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. FD is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clear. Thus, the aims of this study were to outline a demographic and clinical profile of a large sample of patients with FD and to study the evolution of the position of FD in the Diagnostic and Statistical Manual of Mental Disorders. One thousand six hundred thirty-six records were obtained based on key search terms, after exclusion of duplicate records. Five hundred seventy-seven articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation, and factors leading to the diagnosis of FD. In the sample, 65.4% of patients were females. Mean age at presentation was 33.5 years. A health care profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency, and internal medicine departments. The broad survey of sociodemographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases. Keywords: fabricated illness, factitious disorder, medically unexplained symptoms, Munchausen syndrom
Towards personalized medicine: the role of pharmacogenetics in the treatment of bipolar disorder
No full textAbstract
Background
Bipolar disorder (BD) is a severe psychiatric disease characterized by mood swings between mania and
depression, with a life-time prevalence of approximately 2.4%. Patients suffering from BD frequently present
several problems due to drug-resistance and drug-drug interactions, rapid-cycling, and cognitive decline.
Pharmacogenetic tests (PGTs) have been proposed as a method to determine the most efficacious treatment
with the lowest side effects, recognizing individual variability in genetics as a key component of drug response.
Nevertheless, PGTs have been occasionally used in clinical practice up to now and their clinical utility is an
empirical question that has remained largely untested. This research project aims to evaluate the utility of PGT
in routine clinical practice for the treatment of BD in terms of efficacy and cost saving; evaluate the attitude
of psychiatrists towards the PGT use in clinical practice; review the literature dealing with lithium, the most
common mood stabilizer used, to find any correlation among genes and tolerability/efficacy.
Materials and methods
The first phase of study evaluated 30 patients affected by BD type I or II who underwent the PGT
Neurofarmagen® between March 2016 and March 2017. Second phase 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. Secondarily, it gives an economic value to the data based on the diagnosis-related group
(DRG). The third part of the study evaluates psychiatrists’ attitude towards the use of PGx into clinical practice;
the last phase of study reviews the literature about lithium salts.
Results
In phase I At T0, 4 patients (13%) had an optimal therapy in line with the PGT suggestions. At 3-month followup, 13 patients (40%) had received a change of therapy consistent to the test, showing a significant statistical
improvement in CGI-S score over time compared to those not having changes consistent with the test.
Regarding AEs, at baseline 9 out of 10 (90%) of the patients who received a therapy modification according
to the test presented AEs, and a significant within-group reduction was observed after 3 months (p = 0.031).
At 12 months follow-up (T3) 93% of patients (n=28) received a therapy concordant to the test; the others (7%,
n=2) had a therapy discordant to the test Phase II showed statistically significant differences in all the
comparisons (p < 0.0001). Important cost saving emerged after the use of PGT (€148,920 the first year versus
€39,048 the following year). Phase III showed a positive attitude of the 45 psychiatrists interviewed towards
the use of PGX. All respondents 100% (N = 45) believe that pharmacogenetics can help in making decisions
about psychopharmacological treatment. All respondents 100% (N = 45) believe that pharmacogenetics can
help in setting up therapy, particularly regarding drug interactions. There were no significant differences
between those who already had experience with PGTs and those who did not. Phase IV showed that the
pharmacogenetics of Lithium appears to be a field still in its infancy, even though the advent of genome-wide
association studies holds particular promise for future studies.
Conclusion
Despite the small sample size and lack of a control group this study shows promising data about the usefulness
of PGT to support clinicians in reaching a more effective and tolerated treatment in the routine approach and
the potential role of PGT in cost saving for the treatment of bipolar disorder. Also the attitude of clinicians
seemed to be positive towards the use of PGT as a helpful tool into clinical practice. To confirm this result,
larger and clinical trials are neede
A naturalistic study on the relationship among resilient factors, psychiatric symptoms, and psychosocial functioning in a sample of residential patients with psychosis
No full text Nicola Poloni, Daniele Zizolfi, Marta Ielmini, Roberto Pagani, Ivano Caselli, Marcello Diurni, Anna Milano, Camilla Callegari Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy Objective: Resilience is a multidimensional process of adaptation aimed to overcome stressful or traumatic life experiences; only in the last few years it has been considered as a personal resource in psychosis and schizophrenia. This study aimed to assess the relationship between intrapersonal and interpersonal resilience factors and schizophrenia, particularly whether and how resilience can improve the course of psychotic illness. Patients and methods: In this observational study, all patients recruited had to fulfill the following inclusion criteria: diagnosis of schizophrenia spectrum disorder (Diagnostic and Statistical Manual of Mental Disorders-5); aged between 18 and 65 years; provided written informed consent; to be clinically stable (Clinical Global Impression Scale <3); history of illness ≥5 years; to be compliant with antipsychotic therapy over the last year; and regular submission to periodic monthly psychiatric visits. Patients were evaluated through the following scales: Resilience Scale for Adults (RSA) for resilience; Brief Psychiatric Rating Scale-Anchored version (BPRS-A), Scale for the Assessment of Negative Symptoms (SANS), and Scale for the Assessment of Positive Symptoms (SAPS) for psychotic symptomatology; and Life Skills Profile (LSP) for psychosocial functioning. ­Statistical analysis was performed by SPSS. Partial correlations were evaluated to assess the relationship between RSA total scores and subscores and BPRS-A, SANS, SAPS, and LSP total scores, removing the common variance among variables. Then, a series of hierarchical multiple linear regression models were used to examine the association between resilience, psychopathology, and psychosocial functioning. Results: A statistically significant negative correlation among intrapersonal resilience factors and BPRS-A total score emerged, predicting psychiatric symptoms severity and explaining approximately 31% of the BPRS-A variance; otherwise, only the interpersonal resilience factors associated with social support were statistically and positively correlated with LSP total score, predicting psychosocial functioning and explaining the 11% of LSP variance. Conclusion: The specific contribution that resilience factors may have in predicting the severity of symptoms and the extent of psychosocial functioning emphasizes the importance of personalizing treatment for patients affected by schizophrenia, promoting personal resources, and translating them into better outcomes. Keywords: resilience, personal resources, psychosis, schizophrenia, residential patients, psychosocial functionin
Pharmacogenetic Tests in Reducing Accesses to Emergency Services and Days of Hospitalization in Bipolar Disorder: A 2-Year Mirror Analysis
No full textDespite 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
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
A case of reversible splenial lesion syndrome (Resles) related to neuroleptic malignant syndrome in a schizophrenic patient
No full textObjective: 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
The utility of pharmacogenetic testing to support the treatment of bipolar disorder
No full textBackground: Bipolar disorder (BD) is a frequent cause of disability, health care costs, and risk of suicide. Pharmacogenetic tests (PGTs) could help clinicians to identify those patients predisposed to the occurrence of adverse events (AEs) improving the understanding of the correlation between genetic variants and drug response. Materials and methods: The study evaluated 30 patients affected by BD type I or II (according to Diagnostic and Statistical Manual of Mental Disorders, version 5) who underwent the PGT Neurofarmagen® (AB-BIOTICS SA, Barcelona, Spain) between March 2016 and March 2017. The primary aim of this study was to identify if the treatment prescribed by the psychiatrists was consistent with the treatment suggested by the PGT at T0 (corresponding to the test report communication). As a secondary aim, we wanted to assess if clinicians had changed the treatment (in case of discordance) at T1 (3-month follow-up visit) according to the results of the PGT. Results: At T0, only 4 patients (13%) had an optimal therapy in line with the PGT suggestions. At 3-month follow-up, 13 patients (40%) had received a change of therapy consistent to the test, showing a significant statistical improvement in the Clinical Global Impression item Severity (CGI-S) score over time compared to those not having changes consistent with the test. Regarding AEs, at baseline 9 out of 10 (90%) of the patients who received a therapy modification according to the test presented AEs, and a significant within-group reduction was observed after 3 months (p = 0.031). Conclusion: Despite the small sample size, the study shows promising data about the usefulness of PGT to support clinicians in reaching a more effective and tolerated treatment in the routine approach of BD
Medically unexplained physical symptoms in hospitalized patients: A 9-year retrospective observational study
No full textIntroduction: “Medically Unexplained Physical Symptoms” (MUPS) defines a subgroup of patients presenting physical symptoms of unclear origin. The study aims to profile clinical and socio-demographic characteristics of patients with MUPS. Materials and Methods: This 9-years observational retrospective study assesses all patients admitted between 2008 and 2016 in the divisions of neurology and gastroenterology. Socio-demographic and clinical variables were evaluated: gender, age, diagnosis or diagnostic hypothesis, presence of psychiatric comorbidities, psychiatric evaluation, pharmacological treatment, number of admissions/visits. Results: Among 2,479 neurological patients 10.1% presented MUPS. Patients were more frequently women (63.5%), with a mean age of about 50 years. Reported symptoms were headache (22.6%), seizures (8.7%), vertigo (5.9%), fibromyalgia (5.5%), paresthesia (5.1%), visual disturbances (5.1%), amnesia (3.9%). The diagnosis was somatoform disorder in 6.3% of cases, conversion disorder in 2.7%, and somatic symptom disorder in 1.5% only. 2,560 outpatients were evaluated in gastroenterology division. 9.6% (n = 248) of patients had MUPS; 62.1% of them were women. The most affected age group ranged between 15 and 45 years. The most frequent diagnoses were functional abdominal pain (50%), dysmotility-like dyspepsia (26.6%), irritable bowel syndrome (10.4%), meteorism of unknown cause (2.4%), hiccup (1.6%), burning mouth syndrome (1.2%). No patients received a diagnosis of somatic symptom disorder. Discussion: Patients with MUPS are more often women, of middle age, with self-referred specific symptomatology. While neurological patients received a diagnostic-therapeutic approach in line with the literature, gastroenterological patients mainly received antipsychotics. A more comprehensive assessment and a development of psychoeducational interventions are needed to improve patients' quality and quantity of life
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