1,721,017 research outputs found
Clozapine-related extrapyramidal side effects: a case report
No full textThe present report describes extrapyramidal side effects (EPS) appearing after 32 months of exclusive treatment with clozapine at low dosages.This case evidences that long-term treatment with clozapine may be associated with EPS and suggests that, even if clozapine is considered the medication with the fewest EPS and it is often prescribed as an effective treatment for them, its use does not fully eliminate the risk of neurological side effects
Valutazione del funzionamento cognitivo e sociale in pazienti con disturbo bipolare in fase eutimica: dati preliminari
No full textIl cinema nella pratica psichiatrica. intervento di gruppo, test proiettivo, elemento di psicoeducazione, terapia. l’esperienza del day hospital dell’università Sapienza di Roma - Policlinico Umberto I
No full textNell’ambito della clinica psichiatrica l’uso del cinema ha spesso avuto un ruolo di rilievo. Nel presente articolo verranno presentate alcune delle modalità con cui la cinematografia è stata utilizzata clinicamente presso il Day Hospital dell’Università Sapienza di Roma - Policlinico Umberto I nell’ambito di interventi di gruppo a sfondo riabilitativo, di valutazioni proiettive, di terapia e di percorsi psicoeducativi
The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence
Get PDF: Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise high risk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, large- scale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders
ECT, rTMS, and deepTMS in pharmacoresistant drug-free patients with unipolar depression: a comparative review
Get PDFBackground: Biological treatments are considered as additional options for the treatment of resistant unipolar depression. Controversial data exist about the efficacy and tolerability of three of the most used somatic treatments: electroconvulsive therapy (ECT), transcranial magnetic stimulation (rTMS), and deep transcranial magnetic stimulation (deepTMS). The aim of this review is to investigate and compare the efficacy and tolerability of these three techniques in drug-free patients with pharmacoresistant unipolar depression. Methods: Three independent reviewers extracted data and assessed the quality of methodological reporting of selected studies. The first outcome was the clinical response to the three different techniques defined as a percentage improvement of Hamilton Depression Rating Scale (HDRS). The second outcome was the evaluation of their neuropsychological effects. The third outcome was the evaluation of the number of remitted patients; remission was defined as an absolute HDRS-24 score of <= 11 or as an absolute HDRS-17 score of <= 8. Tolerability was the fourth outcome; it was evaluated by examining the number of dropped-out patients. Results: The comparative evaluation of HDRS percentage variations shows ECT as the most effective method after 4 weeks of therapy; on the other hand, a better efficacy is obtainable by deepTMS after 2 weeks of therapy. DeepTMS is the technique that gives the best improvement of cognitive performances. The percentage of remitted patients obtained with ECT treatment is the same obtained in the deepTMS group. Both techniques have a remitted patients percentage two times larger than the rTMS. DeepTMS shows a tolerability, measured by the number of dropped-out patients, worse than ECT. Conclusion: Our investigation confirms the great therapeutic power of ECT. DeepTMS seems to be the only therapy that provides a substantial improvement of both depressive symptoms and cognitive performances; nevertheless it is characterized by a poor tolerability. rTMS seems to provide a better tolerability for patients, but its therapeutic efficacy is lower. Considering the small therapeutic efficacy of deepTMS in the last 2 weeks of treatment, it could be reasonable to shorten the standard period of deepTMS treatment from 4 to 2 weeks, expecting a reduction of dropped-out patients and thus optimizing the treatment outcome
La versione italiana della Demoralization Scale: uno studio di validazione
No full textObjective. Demoralization and depressive symptoms are very common in chronic organic diseases. The aim of the present study is to evaluate reliability and psychometric properties of the Italian version of the Demoralization Scale (DS) in patients with advanced cancer. Methods. The Italian version of DS was administered to a sample consisting of 100 patients affected by different forms of cancer. The following scales were also administered: Patient Health Questionnaire, Beck Depression Inventory (BDI), Mini-Mental Adjustment to Cancer (MAC) and Karnofsky Performance Status Scale. Results. The total mean score of the DS was 23.9±14.5. The study showed a good degree of stability and internal consistency of DS total score (α=0.90) and the 5 factors represented by loss of meaning and purpose (α=0.69), dysphoria (α=0.72), disheartenment (α=0.84), helplessness (α=0.50) and sense of failure (α=0.74). Significant correlations were found between DS total score and BDI (r=0.74) and between DS factors and BDI (r=0.64 for loss of meaning and purpose; r=0.55 for dysphoria; r=0.71 for disheartenment; r=0.51 for helplessness; r=0.46 for sense of failure). Good correlations were also found between DS total score and Hopelessness scale of MAC (r=0,51). According to different cut-off values, between 28 and 32 patients were seriously demoralized and 40 had moderate levels of demoralization. Between 6 and 20 patients were seriously demoralized but not clinically depressed; between 16 and 31 patients with moderate levels of demoralization had no depression. Conclusion. Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer and confirm the hypothesis of the ontological difference between demoralization and depression
Cerebral perfusional effects of 1-year rivastigmine treatment in Alzheimer disease. A case report
No full textRIASSUNTO. Viene descritto il caso di una donna di 74 anni con probabile malattia di Alzheimer che presenta una buona risposta clinica alla rivastigmina associata a rilevante miglioramento di perfusione cerebrale dopo 1 anno di trattamento. La tomografia a emissione di fotone singolo (SPECT) mostra un significativo miglioramento nella captazione corticale del tracciante delle regioni temporo-parietali e frontali rispetto all'esame eseguito prima del trattamento
Prefronto–cerebellar transcranial direct current stimulation improves visuospatial memory, executive functions, and neurological soft signs in patients with euthymic bipolar disorder
Get PDFObjective: The aim of the study was to improve neuropsychological functioning of euthymic patients with bipolar disorder (BD) using transcranial direct current stimulation (tDCS) applied to cerebellar and prefrontal cortices.
Methods: Twenty-five BD outpatients underwent prefrontal (anodal) and cerebellar (cathodal) tDCS for 3 consecutive weeks. All participants were assessed through the Rey Complex Figure Test delay and copy and the Neurological Examination Scale at baseline and after therapy with tDCS.
Results: After tDCS treatment, patients showed significant improvements in visuospatial memory tasks. Patients with worse baseline cognitive performances also showed a significant improvement in executive functioning tasks. Neurological Examination Scale total score and motor coordination subscale significantly improved.
Conclusion: Prefrontal-excitatory and cerebellar-inhibitory stimulations in euthymic BD patients may lead to better neurocognitive performances. This improvement could result from the modulation of prefronto-thalamic-cerebellar circuit activity pattern, which can be disrupted in BD
P300 component in euthymic patients with bipolar disorder type I, bipolar disorder type II and healthy controls: a preliminary event-related potential study
Get PDFThe aim of the present study was to investigate P300 event-related potential components in euthymic bipolar disorder type I (BDI) and bipolar disorder type II (BDII) patients and matched controls. A total of 10 BDI patients, 10 BDII patients and 10 healthy individuals were enrolled in the study. Event-related potential data were collected according to a standard auditory 'oddball' paradigm. A significant groups effect in both the peak amplitude (P<0.001) and the mean amplitude (P<0.001) was observed; post-hoc comparisons showed that the peak and mean amplitudes of BDI and BDII patients were significantly lower than the peak and mean amplitudes of the healthy controls. The neurophysiological patterns found in the present study might at least partially reflect the presence of a mild selective cognitive impairment in euthymic BDI and BDII patients. From a clinical point of view, these evidences support the potential role of cognitive interventions in the treatment of BD
Investigating the role of the endocannabinoid system and gut-microbiome in psychotic and severe mental illness: a focus on negative symptoms
Get PDFNegative symptoms, such as anhedonia and amotivation, represent unmet therapeutic needs and key
determinants of functional loss in severe mental illness. Albeit traditionally considered a unique
feature of schizophrenia, anhedonia and amotivation manifest outside the psychotic spectrum, where
they are equally debilitating and difficult to treat. A number of clinical trials using newly developed
compounds or re-repurposing existing drugs have tried to treat negative symptoms without success.
There is therefore urgent need of clarifying the mechanisms underlying negative symptoms, before
engaging in further trials. The aim of my DPhil was to investigate the relevance for negative
symptoms of two recently discovered biological systems, the gut-microbiome and the
endocannabinoid systems. The rationale was based on emerging evidence showing an independent
contribution of these two systems to the pathophysiology of severe mental illness and their proven
interplay in other fields of medicine. I initially explored the independent contribution of the
endocannabinoid system and the gut microbiome to schizophrenia and severe mental illness through
two systematic reviews and meta-analyses. The first meta-analysis aimed at investigating disturbance
of the endocannabinoid system in psychotic illness. Pooled results from 18 studies including 442
patients and 590 controls showed that anandamide, the main agonist of the endocannabinoid system,
was increased in blood and cerebrospinal fluid of patients with psychotic illness, at any stage
(including the prodrome) and independent of medication status. Across the included studies the
increase in anandamide was inversely related to the severity of negative symptoms, suggesting
endocannabinoids are protective towards illness mechanisms and severity of clinical features. The
second meta-analysis aimed at investigating blood biomarkers of reduced microbial diversity (gut
dysbiosis) in severe mental illnesses (schizophrenia, depression, and bipolar disorder) and chronic
fatigue. Pooled results from 33 studies including 2,761 patients and 1,847 controls showed that blood
biomarkers of gut dysbiosis were increased and positively associated with severity of negative
symptoms in patients vs controls, independent of medication status and across diagnostic boundaries.
I then brought the gut-microbiome and the endocannabinoid system together and explored the
relevance of their interplay for negative symptoms in a general population cohort (TwinsUK). Data
from 786 individuals showed that the endocannabinoid system mediated the association between gut
dysbiosis and the severity of negative symptoms. In particular, gut dysbiosis was associated with
increased faecal excretion of endocannabinoids (protective for mental health), which in turn was
associated with more severe symptoms. These findings advocate for the existence of a gut microbiome-
endocannabinoid axis, relevant for negative symptoms and a putative novel target for
intervention.
I therefore explored if existing molecules targeting the first node of this axis, the gut-microbiome,
could palliate negative symptoms in severe mental illness using two systematic reviews and meta-analyses.
The first meta-analysis investigated the efficacy of already known gut-microbiome-targeted
therapeutics (antibiotics, antimicrobials, pre and probiotics) for the treatment of negative symptoms in
psychotic illness. Pooled results from 28 eligible randomised controlled trials showed that none of the
already known gut-microbiome based therapeutics were effective for treating negative symptoms of
psychotic illness. Results were mainly led by antibiotics and antimicrobics (25 trials), with paucity of
evidence on pre and probiotics. The second meta-analysis investigated the efficacy of metformin,
which novel evidence showed to have a specific action on the gut-microbiome (i.e., increase in the
relative abundance of butyrate-producing bacteria, beneficial for the host’s mental health). Analyses
on the TwinsUK cohort showed that the relative abundance of these bacteria is associated with fecal
levels of endocannabinoid metabolites. Pooled results from 5 eligible randomised controlled trials
showed that metformin has pro-cognitive effects, with preliminary evidence showing efficacy on
negative symptoms. Altogether these findings suggest that aspecific approaches targeting the gutmicrobiome
are not effective for the treatment of negative symptoms, while more defined approaches
targeting a specific biological axis might translate into clinically meaningful results.
In conclusion, findings from my DPhil advocate for the existence of a gut microbiome-endocannabinoid
axis, which might be relevant for negative symptoms across severe mental illness
and beyond, such as in chronic fatigue and in general population. Future studies should validate
findings in a well-powered clinical sample of patients with severe mental illness and test the efficacy
of compounds targeting this axis
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