1,721,643 research outputs found
Can quetiapine extended release (ER) induce labial edema in a female patient with treatment-resistant major depressive episode?
No full textDissociation and Temporality in Substance Abuse: A Clinical Phenomenological Overview
No full textThe term "dissociation" encompasses a wide array of symptoms and phenomena, all sharing the common characteristic of involving altered states of consciousness where an individual temporarily loses the sense of continuity of their own identity. In the context of addiction pathology, however, the dissociative paradigm remains a topic of ongoing debate. It fluctuates between the description of individual dissociative symptoms and the notion of post-traumatic dissociation as a structural process. This process involves fragmentation that extends beyond the confines of perception and experience within a singular moment, instead ensuring a persistent discontinuity of the self throughout one's existence. Pathological addiction stresses the question of the donation of sense in this deep and dramatic experience; it situates individuals within a compressed and constricted realm of vital space, alongside a frozen perception of time. Within this context, every emotion, sensation, and comprehension becomes impaired. Consequently, we have embarked on a journey starting with a historical analysis: the aim was to construct an elucidative framework for the dissociative paradigm in the context of addiction. This involves an in-depth exploration of the fundamental constructs of trauma and temporality, examined through the lens of phenomenological perspective
The Loss of Spatiality and Temporality in Twilight Consciousness: The Emergence of Exogenous Psychosis Induced by Novel Psychoactive Substances
No full textBackground: The state of twilight consciousness is marked by a focused narrowing of awareness, maintaining vigilance and attention while simultaneously experiencing perceptual shifts in the surrounding environment. It is crucial to recognize that this twilight state represents not just a contraction but also an expansion of conscious experience. Summary: Substances of abuse, particularly new psychoactive substances, play a significant role in inducing this twilight state. They achieve this by deconstructing essential components of consciousness, such as the perception of time and space. Key Message: This paper aimed to explore the phenomenon of the twilight state of consciousness and shed light on how new psychoactive substances can alter the perception of time and space during this twilight phase, potentially triggering exogenous psychosis. This comprehensive inquiry employs a phenomenological approach to the study of consciousness, recognizing it as the primary tool for ascribing significance to this intricate yet often overlooked aspect of psychopathology
Vortioxetine in the treatment of major depression -Vortioxetina nel trattamento della depressione maggiore
No full textNotwithstanding the high prevalence, functional burden, negative consequences and risk of chronicity of major depressive disorder, few innovative medications have been developed in recent years for the treatment of this heterogeneous disease. Vortioxetine is a multi-modal antidepressant that functions both as serotonin transporter (SERT) inhibitor and as 5-HT3, 5-HT7 and 5-HT1D receptors antagonist, 5-HT1A receptor agonist and 5-HT1B receptor partial agonist. A recent meta-analysis of 11 randomized, double-blind, placebo controlled, acute (6-8 weeks) treatment studies has demonstrated the efficacy of vortioxetine 5-20 mg/day in the treatment of depression, with an increasing effect associated with increasing dose. Additionally, vortioxetine 5-20 mg/day has shown efficacy on the whole range of depression symptoms (as demonstrated by the improvement of all single-item MADRS scores). Vortioxetine has also been shown effective in the treatment of severe depression and depression with inadequate response to a previous SSRI or SNRI treatment, as well as in the prevention of relapse. In studies designed to assess cognition in depression, vortioxetine showed evidence of improving cognitive performance in patients with acute major depressive disorder. Vortioxetine appears well-tolerated, with very limited effects on weight gain and sexual functioning. The most commonly occurring adverse event (nausea) was generally transitory
A 10-year evaluation on adolescents with anxiety disorders: are they at risk of bipolarity?
No full textOlanzapine 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
Involuntary admissions in Italy: the impact of seasonality
Full text linkAbstract
Objective: The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months.
Methods: All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected.
Results: Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons.
Conclusions: Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients
Affective recurrences in bipolar disorder after switching from lithium to valproate or vice versa: A series of 57 cases
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Management of treatment resistant obsessive-compulsive disorder. Algorithms for pharmacotherapy
No full textTreatment resistant OCD subjects, defined as those patients who undergo an adequate trial of SRI (clomipramine or SSRI) and do not respond or show unsatisfactory results, account for 40-50% of all patients. Once the appropriateness of the trial has been assessed, several options exist for the clinicians. If clomipramine or citalopram have been used, an appropriate strategy consists in giving the same drug intravenously. Double-blind studies exist on the efficacy of clomipramine IV, while data are missing for citalopram. Another option that should be considered first, although data are scarce, is the addition of a cognitive behavioral therapy, when available, in the forms of exposure and response prevention. When such options are not suitable or available, augmentation of the ongoing SRI with another compound represents the preferable strategy. Double-blind, placebo-controlled studies have shown the efficacy of adding pindolol (7.5 mg/d), risperidone (2 mg/d) and olanzapine (5-10 mg/d). Other agents have been proposed, but data emerging from double-blind studies were negative or contradictory. Another option available is switching from CMI to SSRI, or vice versa, or from SSRI to SSRI. Data regarding such treatment strategy, however, are highly preliminary, based on a couple of open label reports and on studies performed in treatment resistant depression. An unresolved question is whether augmentation should be preferred to switching. No data exist in OCD; a practical approach would suggest augmentation first, considering that response should be obtained faster than by switching compound. When all the available and effective strategies prove uneffective, clinicians should consider switching the patient to other compounds in monotherapy, such as venlafaxine, sumatriptan, inositol, although research is strongly needed before conclusions on the efficacy of such compounds can be drawn
La stabilità temporale dei sintomi ossessivo-compulsivi in un campione di pazienti con DOC
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