1,720,961 research outputs found
Venlafaxine: Successful treatment in impulsive disorders
No full textThis letter describes the clinical history of three patients with impulsive symptoms successfully treated with venlafaxine. Literature reports a potential efficacy of SSRI and very little information is available on new antidepressants. These cases might provide an initial piece of evidence that SNRI antidepressants can be considered in the treatment of some impulsive disorders
Evidenze preliminari sulle modifiche del transporter della dopamina in pazienti depressi con rallentamento psicomotorio
No full textA day treatment programme on mood disorders: One-year activity outcomes
No full textIntroduction: Previous evidence has shown the efficacy of day treatment programmes and partial hospitalisation in moderate to severe mood disorders. Therefore, these treatments are considered as a valid alternative to full hospitalisation. The present study examines retrospectively the experience of our treatment programme in difficult patients with a Major Depressive Episode (MDE).
Methods: The treatment programme focuses on: reducing symptoms, developing new coping skills, improving relational ability and psycho-educational rehabilitation. The programme was carried out over 12 weeks. Multidimensional assessments were made throughout the treatment using clinical interviews and psychometric tests. Outcomes were evaluated considering remission, severity of residual symptoms, social and professional functioning. During 2006, 93 depressed patients who had previously not responded to conventional monotherapy (M/F = 36/57; Mean Age: 46,87± 15,00), have been treated.
Results: At the end of the programme a significant clinical improvement could be observed in most patients: 60,6% achieved full remission, while only 14,8% continued to present consistent residual symptoms. 70% of the patients took at least two drugs and also took part in a psycho-educational programme.
Conclusion: Our day treatment programme is intended to implement a model for a prompt management of difficult patients with moderate to severe MDE. Our findings concur with previous evidence in showing the efficiency of such integrated treatment programmes in patients with mood disorders. In our sample, a partial response has been dependent on social isolation, chronicity of the disorder and relevance of co-morbidities
Plasma magnesium level and psychomotor retardation in major depressed patients
No full textNumerous studies have been performed on magnesium (Mg) metabolism in patients with mood disorders but consistent results have not been obtained. To date, systematic clinical data about Mg levels in major depressed patients according to the psychopathological profile are not available. In the present study we have investigated the relationship between plasma Mg level severity of symptoms and specific psychopathological dimensions (anhedonia and retardation) in 53 mild-to-moderately depressed patients (M/F = 21/32; mean age 46.49 +/- 13.48). The psychopathological status was assessed using standard psychometric evaluation scales: HAM-D for severity of depression, HAM-A for severity of anxiety symptoms, DRRS for psychomotor retardation and SHAPS for anhedonia. We did not find any significant correlation between total plasma Mg levels (0.86 +/- 0.09 mmol/L), severity of depression (HAM-D = 17.13 +/- 6.76) and anxiety (HAM-A = 16.62 +/- 6.60). A statistically significant correlation between Mg levels and psychomotor retardation was observed. Patients with higher psychomotor retardation scores (DRRS = 20.41 +/- 7.72) showed higher plasma Mg levels (0.89 +/- 0.07 mmol/L), even though they remained in the normal range, in comparison to patients with lower retardation scores (DRRS = 7.29 +/- 3.80; Mg = 0.82 +/- 0.10 mmol/L). A relationship between catecholamines and Mg metabolism has been described and our results support the hypothesis that hypermagnesaemia might lead to hypoactivity and psychomotor retardation which is so often observed in depressed patients
Predicting treatment outcome in difficult-to-treat depressed patients
No full textIntroduction: The treatment of depression has a very high rate of non-responding patients. The recurrence of the disorder and a poor response to the treatment configure difficult-to-treat depression. This is a widespread subgroup, which should be detected earlier for a better formulation of the therapeutic project. The efficacy of a day hospital treatment in containing moderate to severe disorders seems to be comparable to full hospitalisation. However the need for a strict definition of the programme itself and of the psychopathological features of participants emerged as crucial issues. If the integration of different therapeutic approaches seems to improve outcome, there are several limitations due to the severity of the disorder. The aims of the study were to measure the efficacy of a day treatment programme on mood disorders and analyse several clinical features as predictors of treatment outcome.
Methods: The present study was conducted in the outpatient service for depressive disorders in Gemelli Hospital on 102 patients (mean age=45.4±15.5; M/F = 43/59). Most of them were affected by difficult to treat depression, that includes patients with history of at least two MDE, risk of chronicization and who did not achieve remission in previous treatments. They underwent a Day Treatment Programme focused on: (1) a prompt reduction of symptoms, based on pharmacological therapy and emotional support; (2) promoting the development of new coping skills; (3) improving relational capacities; (4) psycho-educational rehabilitation. The programme was carried out over 12 weeks. Multidimensional assessments were made at baseline (t0), after 1 month (t1) and after 3 months (t3), using clinical interviews and psychometric tests as: 21-Hamilton Depression and Anxiety Rating Scales; BPRS for the global psychopathological load; Social Adaptation Self-evaluation Scale for social and professional functioning; Connor-Davidson Resilience Scale for resilience. Treatment outcome was measured considering response to the therapy and remission. Involvement of relatives or partners in the treatment programme, social functioning, comorbidities and resilience were taken as predicting clinical features.
Results: Patients recruited were moderately depressed (HDRS = 20.2±5.5). Response and remission rate were comparable to those obtained through inpatient care (60% had HAMD18), higher baseline SASS above the average (34) is correlated to a higher remission rate (56.7% vs. 36.7%).
Conclusions: Patients who had a better response to the treatment, achieving remission by three months from initial assessment, had the following favourable prognostic elements: (1) single diagnosis of Major Depressive Disorder, (2) better relational support, (3) higher scores at SASS and CD-RISC rating scales. Patients who were still affected by a significant psychopathological load by the end of the treatment had at least two of the following unfavourable prognostic elements: (1) diagnosis of Bipolar Depression, (2) comorbidity with Personality Disorders, (3) physical diseases that limited the use of pharmacological therapy, (4) chronic disorder (at least 2 years since the mood disorder started). (5) social isolation, (6) lower scores at SASS and CD-RISC
Plasma cortisol levels and resilience in depressed patients
No full textIntroduction: In recent years a large body of evidence has emerged linking stressful life events with an increased vulnerability for affective and anxiety disorders. Stressful events often precede the onset of depression and stress has also been associated with the severity of the illness. Meantime there has been growing interest in the concept of resilience. A current theory views resilience as a measure of stress coping ability and its clinical significance may lie in its ability to function as an index of overall mental health. Resilience is a complex notion that incorporates such dimensions as coping mechanism and personality. Several critical factors are associated with a successful adaptation to stressful events: some of these include temperament, personality traits, cognitive factors, genetic traits, and other attribute, such a sense of humour and social support. Existing literature highlights a correlation between PTSD and low resilience. Furthermore, resilience can be used as a measure of treatment outcome in patients suffering of post-traumatic stress. Regarding mood disorders there is a lack of information on the correlation between resilience and treatment outcome. An analysis of the biological mechanisms underlying both resilience and depression shows the implication of common features. Several biochemical mediators of response to extreme stress may be related to resilience or vulnerability, and the release of cortisol may tend to undermine resilience. The present study analyses the correlation between resilience and plasma cortisol levels in depressed patients during treatment.
Methods: 38 outpatients (M/F = 13/25; mean age 43.09±15.01) with a Major Depressive Disorder (MDD) during a Major Depressive Episode (MDE) have been recruited at the Institute of Psychiatry of the Catholic University in Rome. Acute symptoms were measured with 21-HDRS (Hamilton Depression Rating Scale) and HARS (Hamilton Anxiety Rating Scale); CD-RISC (Connor-Davidson Resilience Scale) was used to measure resilience. A blood sample for the determination of plasma cortisol levels was collected. Psychopathological status and laboratory testing were assessed before the admission and after 12 weeks.
Results: No significant correlation between plasma cortisol levels and HDRS, HARS or resilience scores at the baseline has been found in depressed patients. A significant inverse correlation between resilience scores and severity of symptoms has been observed (r = -0.428, p = 0.01). A significant decrease of plasma cortisol levels has been observed after antidepressant treatment (173.10±68.43 vs. 126.83±49.90, p = 0.014).
A higher remission rate was observed among the patients having a better resilience.
Conclusions: Recent studies are trying to determine which neurobiological responses are related to resilience, to psychological stress in general and in specific psychopathological forms. More specifically, the hyperactivity of the hypothalamic–pituitary–adrenal axis is a frequent finding in depressed patients. This same alteration has been correlated to a weak stress response and therefore to a low resilience. In our small sample plasma cortisol levels did not provide significant correlation to resilience scores. Nevertheless resilience seems to be inversely related to the severity of depressive episode and could offer a predictive value for treatment outcome
SNRI effective treatment does not restore changes of immune and inflammatory parameters in depressed patients
No full textIntroduction: It has been hypothesized that major depression may be accompanied by alterations in cell-mediated and humoral immunity. Moreover, major depression appears to be associated with increased plasma concentrations of positive `acute-phase' proteins and increased production of cytokines. It has been suggested that an altered production of cytokines may underpin many changes of immune or inflammatory markers which have been observed.
Our aim was to determine plasma concentrations of interleukin 6 (IL-6), soluble interleukin 6 receptor (sIL6R), Tumor Necrosis Factor (TNF-α) and C reactive protein (CRP) in patients with major depression in an acute phase of illness and after 12 weeks of antidepressant treatment with SNRIs.
Methods: 24 outpatients (M/F = 8/16; mean age 46.79±12.97) with a Major Depressive Disorder (MDD) during a Major Depressive Episode (MDE) and 20 healthy controls (M/F = 8/12, mean age = 40.05±11.02) have been recruited at the Institute of Psychiatry of the Catholic University in Rome. The severity of depression was assessed with the 21-item HDRS, anhedonia and retardation scores were evaluated by Snaith-Hamilton Pleasure Scale (SHAPS) and Depression Retardation Rating Scale (DRRS). Blood samples for the determination of C-reactive protein, TNF-alpha, IL-6 and sIL-6R were collected. Cytokines were measured using commercial enzyme linked immunosorbent assays (ELISA). Levels of C-reactive protein were measured using an immunoturbidimetric assay. Following baseline investigation all patients were treated with either venlafaxine (150–225 mg) or duloxetine (60–120 mg). Psychopathological status and laboratory testing were assessed before the admission and at the end of the study, after 12 weeks.
Results: Plasma concentrations of IL-6 (0.59±1.14 vs. 0.06±0.27 pg/ml) and CRP (3.28±3.59 vs. 1.33±1.48 mg/ml) were significantly higher in depressed patients than in healthy controls. sIL-6R and the product of IL-6 and sIL6R were higher but not significantly. There was no difference in plasma concentrations of TNF-α between depressed patients and healthy controls. A significant positive correlation between CRP and IL-6 (r = 0.25, p = 0.047) has been observed.
All patients significantly improved after treatment and most of them (62.5%) achieved a full remission. Finally, antidepressant treatment with SNRIs did not significantly change plasma IL-6, sIL-6R, TNF-α, CRP.
Conclusions: Changes of plasmatic levels of IL-6 and CRP in depressed patients are consistent with previous findings. Despite the clinical efficacy SNRIs did not appear to have a significant effect on immune parameters in major depression. Our finding is in contrast with O'Brien et coll. that observed a significant drop of C-reactive protein after SSRIs and showed an anti-inflammatory response independent of antidepressive action.
The immune alteration in major depression seems to be trait rather than state associated and the inflammation response could not be directly involved in the pathophysiology of depression. The efficacy of antidepressant treatment may reflect indirect immunomodulatory effects rather than a direct down-regulation of inflammatory response activation.
Further researches in larger samples are needed to clarify the involvement of immune variables in major depression and the influence of SNRIs
How do we treat the broad spectrum of patients with serious mental illness who have committed crimes? The Law 81/2014: limits and problems
Full text linkIn Italia è in corso un processo di deistituzionalizzazione che non ha precedenti al mondo. Si stanno progressivamente svuotando gli Ospedali Psichiatrici Giudiziari che non sono mai stati riformati negli ultimi 80 anni. Questo processo sta venendo attuato tramite una stratificazione di norme senza una progettualità diversa dalla rapida chiusura di queste fatiscenti strutture. Ai Dipartimenti di Salute Mentale (DSM) sono richieste una molteplicità di compiti nuovi e fortemente specialistici, e una estensione del loro potere di controllo, senza che queste strutture siano organizzate in tale senso. Alcune delle norme recentemente varate, come la Legge 81 del 2014, per risolvere alcuni problemi derivanti dalle difficoltà di deistituzionalizzazione complicano, a nostro parere, diversi aspetti gestionali di questa popolazione di gravi pazienti psichiatrici, che comunque non è assimilabile alla normale utenza dei DSM.Vi è necessità di un intervento legislativo coordinato e pensato su una prospettiva a lungo termineIn Italy an ongoing process of deinstitutionalization unprecedented in the world is been enacted.The Judicial Psychiatric Hospitals, that were never reformed in the past 80 years, are now on the edge of their closure.This process is being implemented through a layering of rules that had no purpose other than the rapid closure of these structures.The Mental Health Departments have now the responsibility of a multiplicity of new and highly specialized tasks, and an extension of their power to control.There is no previous organization for these tasks in the Mental Health System. Some of the recently enacted laws,such as the Law 81 of 2014, are intented to solve some problems, althought issues of deinstitutionalization are getting worse.In our opinion several management aspects of this population of severe psychiatric patients are unfit with the present organization of the Mental Health Services.There is need for legislative action coordinated and based on a long-term perspective
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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